Quality of Life, Fertility Concerns, and Behavioral Health Outcomes in Younger Breast Cancer Survivors: A Systematic Review

David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095-6900, USA.
Journal of the National Cancer Institute (Impact Factor: 12.58). 03/2012; 104(5):386-405. DOI: 10.1093/jnci/djr541
Source: PubMed


Breast cancer is the most common cancer in women younger than age 50 years. Cancer treatments in younger women may cause premature menopause, infertility, and negative psychosocial effects. In this systematic review, we examined three key domains of functioning that are particularly relevant for younger breast cancer survivors: health-related quality of life (QOL), menopausal symptoms and fertility concerns, and behavioral health outcomes.
We conducted a literature review using PubMed and secondary sources and examined 840 articles published between January 1990 and July 2010. Inclusion criteria for articles were 1) published in English after 1989; 2) exclusively analyzed female breast cancer survivors aged 50 years or younger or premenopausal at diagnosis, with baseline characteristics and/or quantitative or descriptive analyses for this age group; 3) investigated QOL (health-related QOL including physical functioning and mental health, depression, and anxiety), menopause- or fertility-related concerns, and weight gain or physical activity-related behavioral health outcomes. Data were extracted using a standardized table collecting the purpose, design, population, and results of each study. Extracted data were reviewed for accuracy by two investigators and presented as descriptive tables.
A total of 28 articles met the inclusion criteria (15 cross-sectional studies, eight longitudinal studies, and five randomized trials). Regarding data review, no discordance between investigators was noted. Standardized measures of QOL and depressive symptoms identified worse outcomes as being more frequent or severe in breast cancer survivors aged 50 years or younger when compared with the general age-matched population of women without cancer and to older women (aged >50 years) with breast cancer. Concerns about premature menopause, menopausal symptoms, and infertility were common in younger women (aged ≤ 50 years) and had a role in the level of distress after treatment. Weight gain and physical inactivity were common health outcomes in younger women.
Younger women with breast cancer were found to experience distinct psychosocial and menopause-related concerns, weight gain, and physical inactivity. A need for more longitudinal research, including efforts at intervention to manage these symptoms and adverse health outcomes, remains.

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    • "As survival rates increase for young cancer patients, growing emphasis is placed on post-treatment quality of life. Fertility preservation is considered a major issue for these patients as the ability to have biological children is often a central element to their quality of life (Anderson et al., 2012). Despite, proven clinical and psychological benefits (Letourneau et al., 2012;Yee et al., 2012), and recommendations that cancer patients should be routinely asked about their interest in fertility preservation before starting cancer treatment, very few female young adult patients undergo fertility preservation counselling and treatment. "
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    ABSTRACT: Background: The trend toward late childbearing has made fertility preservation a major issue for women who face gynecological cancer. New techniques in assisted reproductive medicine enable conception after primary treatment of these cancers. Here, we aimed to review the efficacy and safety of assisted reproductive techniques (ART) after fertility-preserving treatment of gynaecological cancers. Methods: We conducted a systematic literature review of both prospective and retrospective studies in the PubMed, EMBASE, CENTRAL and SciSearch databases. In the retrieved studies, we evaluated live births, clinical pregnancies, overall survival and disease-free survival. Results: We identified many prospective and retrospective studies on this topic, but no relevant randomized clinical trials. Fertility-sparing treatments with safe oncological outcomes are feasible in endometrial, cervical and ovarian cancer cases. After cancer treatment, ART seem safe and show variable obstetrical outcomes. Conclusions: After fertility-preserving treatment for gynaecological cancers, ART can enable pregnancy to be achieved with apparent oncological safety. The success of such procedures should directly impact clinical practice and management of those patients who require fertility-sparing treatment.
    Full-text · Article · Jan 2016 · Human Reproduction Update
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    • "Incidence rates of breast cancer have stabilized in women aged 50 years and older but continue to increase in younger women, with over 25 % of breast cancer cases occurring in premenopausal women (DeSantis et al. 2014). Younger breast cancer survivors (BCS) are at elevated risk for depression (Howard-Anderson et al. 2012); indeed, their levels of depressive symptoms are approximately twice as high as those of older women in the months after diagnosis (Avis et al. 2013). Although depressive symptoms typically improve over time, younger survivors continue to report higher levels of depression in the months and years after diagnosis, with negative consequences for quality of life, medical adherence, and potentially for recurrence and survival (Avis et al. 2013). "
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    ABSTRACT: Depression, sleep disturbance, and vasomotor symptoms are common in breast cancer survivors (BCS), especially in younger women diagnosed before menopause. Risk factors and mechanisms for depression in this population are relatively unexplored. In 163 young BCS, vasomotor symptoms were significantly associated with higher depressive symptoms (β=0.26, p=0.001) and 64 % of the total effect was mediated through sleep disturbance (beta for specific indirect effect=1.296, 95 % CI 0.591–2.212). Treatments reducing vasomotor symptoms might alleviate sleep disturbance and depression in this population.
    Full-text · Article · Jan 2015 · Archives of Women s Mental Health
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    • "Although never welcome, a cancer diagnosis before age 50 years is less common and is more unexpected for many individuals. Younger women with breast cancer have been studied more than other populations of younger survivors, and we know more about the quality of life of these patients over time than we do about other cancer patients diagnosed as younger adults262728. Among premenopausal breast cancer survivors , quality of life can be disrupted by chemotherapyinduced ovarian dysfunction—which can result in vasomotor symptoms, vaginal dryness, impaired sexual functioning, and sleep problems—as well as symptoms associated with treatment, such as peripheral neuropathy, fatigue, cognitive symptoms, and pain. "

    Preview · Article · Jul 2014 · North Carolina medical journal
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