Ovarian function suppression decision-making and uptake in premenopausal women with breast cancer: a mixed methods...

Ovarian function suppression (OFS) reduces the risk of recurrence of hormone receptor-positive breast cancer but increases the likelihood of toxicity and nonpersistence with endocrine therapy. In addition, rates of OFS utilization are lower than expected. To increase understanding of these issues, we sought to identify patient factors associated with the use of OFS injections, as well as treatment decision-making and education needs.

In this convergent mixed methods designed study, patients receiving OFS, who started then discontinued OFS injections, and who never initiated OFS injections underwent 1:1 semi-structured interviews and completed questionnaires on shared decision-making and medication beliefs.

Of 33 enrolled participants, 30 completed both the questionnaires and the interview. Median age was 43 (range 32-55), 24 were white (80%), and 20 (66.7%) had received chemotherapy. Four key themes emerged. (1) There was concern about need for more education, especially about short- and long-term side effects of OFS. (2) For those receiving OFS injections, the decision to take OFS was mainly due to a desire to reduce cancer recurrence risk. (3) For those who stopped OFS, injections were often used as a stop-gap measure, with a preference for permanence of oophorectomy. (4) For those who never took OFS, there was often perceived lack of strong physician recommendation.

Tailored support for patients is needed to optimize decision-making regarding OFS, related to both potential benefits and risks of OFS in addition to adjuvant endocrine therapy. Educational strategies such as peer mentors or decision aids should be explored in this clinical setting.