Lessons Learned From the Integration of Reproductive Health Specialists in the Multidisciplinary Care of Women With Locally Advanced Breast Cancers

INTRODUCTION: The objective of this study was to investigate whether a multidisciplinary approach to breast cancer care with the inclusion of a reproductive health specialist improves referral rates for fertility counseling and/or preservation. METHODS: An IRB-approved retrospective study including women of reproductive age diagnosed with locally advanced breast cancer and treated at a health system before and after the advent of a comprehensive, multidisciplinary tumor board (cMTB) with a reproductive health specialist was conducted. Rates of referral for fertility counseling and utilization of fertility preservation methods were compared between the cMTB and non-cMTB groups using t tests. Secondary analyses comparing baseline group characteristics and rates of referral/fertility preservation by age, insurance type, and race were performed using χ 2 tests. RESULTS: Of 306 study participants, 117 were cared for by a non-cMTB and 189 by a cMTB. The groups did not differ in average age, parity, breast cancer subtype, insurance type (public versus private), or treatment site (urban versus suburban); however, the distribution of race was significantly different ( P =.003). Overall, a greater percentage of women in the cMTB group received referrals for fertility counseling compared to those in the non-cMTB group (23.3% versus 0.9%, P <.001). Of the patients in the cMTB group who were referred for counseling, 20.5% underwent fertility preservation. Within the cMTB group, women younger than 30 were significantly more likely to be referred for fertility counseling (41.7% versus 20.6%, P =.043) and undergo a fertility preservation procedure (16.7% versus 3.0%, P =.016) than those aged 31–40. No significant differences in rates of referral or fertility preservation by race or insurance type were noted within each group. CONCLUSION: The inclusion of a reproductive health specialist in a multidisciplinary breast cancer tumor board increased rates of referral for fertility counseling for women of reproductive age. A similar, comprehensive approach to the care of reproductive-aged women with gynecologic malignancies should be considered.