Impact of a Reproductive Health Survivorship Care Plan on Fertility, Pregnancy Concerns, and Accessing Reproductive Healthcare Among Young Nulliparous Breast Cancer Survivors.
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BACKGROUND: Young patients with breast cancer frequently receive chemotherapy and/or endocrine therapy that adversely affect ovarian function, leading to fertility, pregnancy, and other reproductive health concerns. Despite available evidence-based management strategies, dissemination to survivors and healthcare providers remains limited, resulting in substantial unmet informational and care needs. Web-based survivorship care plans may offer an effective approach to address these gaps. AIMS: To evaluate the effect of a web-based Reproductive Health Survivorship Care Plan (SCP-R) on reproductive concerns and reproductive healthcare access among nulliparous young breast cancer survivors (YBCS). METHODS AND RESULTS: This is a secondary analysis of a 24-week randomized controlled trial on the effectiveness of a web-based SCP-R addressing unmet informational and clinical management needs for breast cancer survivors aged 18-50 years. The current analysis is restricted to nulliparous participants ages 18-40. The primary outcomes are improvement in fertility and pregnancy health concerns, as measured by the Reproductive Concerns After Cancer (RCAC) scale. The secondary outcome is fertility specialist access measured by referral, consultation, or treatment by a fertility specialist. Among 182 study participants from the parent trial, 47 met the inclusion criteria for the current study (17 in the intervention and 30 in the attention control). Mean age at diagnosis was 30.7 (SD = 3.5) years, and mean age at study participation was 34.0 (SD = 3.8) years. Fertility potential and pregnancy concerns improved in 35.3% of participants randomized to the intervention arm compared to 10.0% in the control arm (RR = 3.5, 95% CI = 1.01-12.34, p = 0.05). Intervention arm participants were significantly more likely to receive a fertility specialist referral, schedule a fertility consult, or undergo fertility treatment (37.5% in the intervention arm vs. 6.7% in the control arm; RR = 5.6, 95% CI = 1.28-24.73, p = 0.02). CONCLUSIONS: The web-based SCP-R intervention led to improvements in fertility potential and pregnancy concerns over time and resulted in more YBCS accessing fertility specialists, highlighting the importance of age- and parity-specific survivorship care interventions to address reproductive health concerns.