title: Does a dedicated program for young breast cancer patients affect the likelihood of fertility preservation discussion and referral?
abstract: OBJECTIVE
  To assess whether a dedicated program for young breast cancer patients, including a nurse navigator, improves the frequency of: a) fertility discussion documentation and b) fertility preservation (FP) referrals.
  
  
  METHODS
  A retrospective chart review and prospective survey were undertaken of breast cancer patients diagnosed at age 40 or younger between 2011 and 2013 who received adjuvant or neo-adjuvant chemotherapy at two academic cancer centers in Toronto, Canada. The Odette Cancer Centre (OCC) has a dedicated program for young breast cancer patients while Princess Margaret Cancer Centre (PM) does not. Patient demographics, tumor pathology, treatment and fertility discussion documentation prior to systemic chemotherapy administration were extracted from patient records. Prospective surveys were administered to the same cohort to corroborate data collected.
  
  
  RESULTS
  Eighty-one patient charts were reviewed at both OCC and PM. Forty-seven and 49 at OCC and PM returned surveys for a response rate of 58% and 60% respectively. Chart reviews demonstrated no difference in the frequency of fertility discussion documentation (78% versus 75% for OCC and PM, p = 0.71); however, surveys demonstrated higher rates of recall of fertility discussion at OCC (96% versus 80%, p = 0.02). A greater proportion of women were offered FP referrals at OCC, as observed in chart reviews (56% versus 41%, p = 0.09), and surveys (73% versus 51%, p = 0.04). Time to initiation of chemotherapy did not differ between women who underwent FP and those who did not.
  
  
  CONCLUSIONS
  A dedicated program for young breast cancer patients is associated with a higher frequency of FP referrals without delaying systemic therapy.
authors.affiliation: Division of Medical Oncology, BC Cancer Agency, Vancouver Centre, 600 West 10th Avenue, Vancouver, British Columbia V5Z 4E6, Canada. Electronic address: amirrtha.srikanthan@bccancer.bc.ca.
authors.forename: Amirrtha
authors.initials: A
authors.lastname: Srikanthan
authors.affiliation: Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M6, Canada.
authors.forename: Eitan
authors.initials: E
authors.lastname: Amir
authors.affiliation: Division of Medical Oncology, Sunnybrook Odette Cancer Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada. Electronic address: ellen.warner@sunnybrook.ca.
authors.forename: Ellen
authors.initials: E
authors.lastname: Warner
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000188:drug therapy / Q000523:psychology*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D005260:Female; D059247:Fertility Preservation / Q000523:psychology*; D006801:Humans; D007246:Infertility / Q000139:chemically induced / Q000523:psychology; D009864:Ontario; D015397:Program Evaluation; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Breast cancer; Delivery of care; Documentation; Fertility preservation; Young adults