Impact of chemotherapy on the fertility of patients with breast cancer submitted to oncological treatment

• Grant number: 19/21699-9
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: February 01, 2020
• End date: January 31, 2021
• Field of knowledge: Health Sciences - Medicine - Maternal and Child Health
• Principal Investigator: Ana Carolina Japur de Sá Rosa e Silva
• Grantee: Samara Campos Oliveira Reis
• Host Institution: Faculdade de Medicina de Ribeirão Preto (FMRP). Universidade de São Paulo (USP). Ribeirão Preto , SP, Brazil

Abstract

Breast cancer is one of the most prevalent in women, but improvements in prevention and treatment have reduced its overall mortality. With an increase in survival, attention to sequelae secondary to treatment gains relevance. Among them, we highlight the reduction in fertility or early ovarian failure that may occur after chemotherapy and radiotherapy, since some of the patients are still of reproductive age at diagnosis. Evaluation of ovarian reserve and gonadal damage has been done by tracking the return of regular menstrual cycles and the normalization of plasma FSH concentration. However, these methods have little sensibility, and their apparent normality does not necessarily equal to maintaining fertility in these individuals. Parallel to this, the correct orientation of patients regarding the real impact of treatment on their reproductive function is important in order to decide on the preservation of fertility. Information on the impact of chemotherapy on fertility is essential for both the medical team and the patient, so they can choose the best methods for preserving fertility in each specific case, according to the patient's age, prognosis and gonad toxicity of the treatment chosen. This study will evaluate the fertility of women undergoing chemotherapy for breast cancer, identifying prognostic factors for gonadal failure. Objective: To identify prognostic factors for gonadal damage in women with breast cancer undergoing chemotherapy. This is a cross-sectional study that includes surviving cancer patients from the mastology service of the Ribeirão Preto Hospital das Clínicas, followed for the treatment of breast cancer from 2000 to 2010. There are 3 phases of work: data collection from the list of eligible patients; telephone interview with a semi-structured questionnaire; and, finally, identification of risk factors for infertility in this population profile. The patients will be subdivided into a group with offspring and group without offspring, according to the reproductive outcome after chemotherapy. A multiple logistic regression model will be constructed with the following variables: outcome of fertility / pregnancy (yes, no) and predictor variables: age during chemotherapy (years), chemotherapy class (3-level categorical variable), previous menarche (binary ), total chemotherapy time (months), radiotherapy (yes, no), anterior offspring (binary), time between the end of chemotherapy and the beginning of the conception attempt (months), hormone therapy (yes, no). The identification of these prognostic factors will serve as a scientific substrate to better guide decision making about whether or not to submit the patient under procedures available for preserving future fertility. (AU)