Fertility preservation does not delay the initiation of chemotherapy in breast cancer patients treated with adjuvant or neo-adjuvant chemotherapy

Purpose

The aim of this study was to verify whether fertility preservation (FP) in adult women diagnosed with breast cancer (BC) has an impact on the time frame between diagnosis and initiation of chemotherapy in an adjuvant or neo-adjuvant setting.

Methods

A retrospective cohort study encompassing patients diagnosed with breast cancer between January 2012 and December 2017, who underwent FP before chemotherapy, and matched control patients, who were not referred to a fertility centre for FP counselling, was performed in two study population groups, more specifically BC patients undergoing neo-adjuvant chemotherapy (NAC) and BC patients undergoing adjuvant chemotherapy. Case patients were selected from the patient database of the Centre for Reproductive Medicine (CRG) at Universitair Ziekenhuis Brussel (UZ Brussel). Fertility preservation consisted of oocyte cryopreservation after ovarian stimulation, ovarian tissue cryopreservation or in vitro maturation of immature oocytes retrieved transvaginally or obtained during an ovarian tissue cryopreservation procedure. The FP procedure was patient-tailored and some patients underwent a combination of procedures. Control patients were selected from the patient database of the Breast Cancer Clinic at UZ Brussel. Cases and controls were matched for tumour characteristics and type of oncological treatment. Time intervals between oncological diagnosis and initiation of chemotherapy were analysed.

Results

Fifty-nine BC patients who underwent FP, of which 29 received NAC and 30 received adjuvant chemotherapy, were selected and matched to control patients. The average time to chemotherapy in BC patients with NAC was 28.5 days (27.3 (range: 14.0-44.0) days in cases and 29.6 (range: 14.0-62.0) days in controls, p = 0.441) and in BC patients with adjuvant chemotherapy 58.9 days (57.2 (range: 36.0-106.0) days in cases and 60.7 (range: 31.0-105.0) days in controls, p = 0.145). The FP procedure took on average 7.1 ± 6.1 days in BC patients with NAC and 11.8 ± 6.9 days in BC patients with adjuvant chemotherapy.

Conclusion

The initiation of chemotherapy is not delayed when adult women diagnosed with breast cancer are referred to an oncofertility team to undergo fertility preservation.