title: Family-building After Breast Cancer: Considering the Effect on Adherence to Adjuvant Endocrine Therapy.
abstract: Adherence to endocrine therapy (ET) is a longstanding problem in breast cancer (BC) survivorship care, particularly among younger women. Younger patients have reported lower ET initiation rates and greater rates of early discontinuation and are considered an "at risk" group for nonadherence. For women who hope to have children in the future, concerns about premature menopause and the implications of postponing childbearing for the 5 to 10 years of ET are widespread. Preliminary evidence suggests that prioritizing fertility, along with concerns about side effects, leads to ET noninitiation and early discontinuation. Clinical efforts to improve adherence might need to consider patients' family-building goals during the course of treatment and to appropriately counsel patients according to their priorities and family-building intentions. Educational materials about family building after cancer are still not consistently available or provided. Helping patients to access trusted informational resources and decision support tools, in conjunction with medical counseling, will promote informed decisions regarding ET adherence and pregnancy that are medically appropriate. Such shared patient-provider decision-making about ET adherence and pregnancy could help to maximize patient autonomy by incorporating their values, preferences, and priorities into decisions, using providers' medical expertise.
authors.affiliation: Department of Medicine, Hofstra Northwell School of Medicine, Manhasset, NY. Electronic address: cbenedict@northwell.edu.
authors.forename: Catherine
authors.initials: C
authors.lastname: Benedict
authors.affiliation: Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Bridgette
authors.initials: B
authors.lastname: Thom
authors.affiliation: Hofstra Northwell School of Medicine, Monter Cancer Center, New Hyde Park, NY.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Teplinsky
authors.affiliation: Hofstra Northwell School of Medicine, Monter Cancer Center, New Hyde Park, NY.
authors.forename: Jane
authors.initials: J
authors.lastname: Carleton
authors.affiliation: Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Joanne F
authors.initials: JF
authors.lastname: Kelvin
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000523:psychology*; D017024:Chemotherapy, Adjuvant; D003657:Decision Making; D005260:Female; D059247:Fertility Preservation; D006801:Humans; D010349:Patient Compliance; D011247:Pregnancy; D011379:Prognosis
chemical_list: D018931:Antineoplastic Agents, Hormonal
keywords: Adjuvant therapy; Fertility; Infertility; Tamoxifen; Young adult