Prospective Study of Fertility Preservation in Young Women With Breast Cancer in Mexico.

BACKGROUND: Despite the risk of treatment-related infertility, implementation of fertility-preservation (FP) strategies among young patients with breast cancer is often suboptimal in resource-constrained settings such as Mexico. The "Joven & Fuerte: Program for Young Women With Breast Cancer" strives to enhance patient access to supportive care services, including FP measures through alliances with assisted-reproduction units and procurement of coverage of some of these strategies. This study describes patients from Joven & Fuerte who have preserved fertility, and assesses which characteristics were associated with the likelihood of undergoing FP. METHODS: Women aged ≤40 years with recently diagnosed breast cancer were prospectively accrued. Sociodemographic and clinicopathologic data were collected from patient-reported and provider-recorded information at diagnosis and 1-year follow-up. Descriptive statistics, chi-square test, and simple logistic regression were used to compare patients who preserved fertility with those who did not. RESULTS: In total, 447 patients were included, among which 53 (12%) preserved fertility, representing 38% of the 140 women who desired future biologic children. Oocyte/embryo cryopreservation was the most frequently used method for FP (59%), followed by temporary ovarian suppression with gonadotropin-releasing hormone agonists (GnRHa) during chemotherapy (26%), and use of both GnRHa and oocyte/embryo cryopreservation (15%). Younger age, higher educational level, being employed, having private healthcare insurance, and having one or no children were associated with a significantly higher likelihood of preserving fertility. CONCLUSIONS: By facilitating referral and seeking funds and special discounts for underserved patients, supportive care programs for young women with breast cancer can play a crucial role on enhancing access to oncofertility services that would otherwise be prohibitive because of their high costs, particularly in resource-constrained settings. For these efforts to be successful and widely applied in the long term, sustained and extended governmental coverage of FP options for this young group is warranted.

Factors associated with the desire to undergo post-mastectomy breast reconstruction in a Mexican breast cancer center.

PURPOSE: To assess the proportion of breast cancer patients treated with total mastectomy who are interested in undergoing breast reconstruction, the factors associated with their desire to undergo this procedure, and the motives stated for their decision. METHODS: Women with stage I-III breast cancer, public health insurance, and history of total mastectomy treated at a center in Monterrey, Mexico, were invited to answer a series of questionnaires regarding their clinical and demographic characteristics, information received about breast reconstruction, body image, and relationship satisfaction. RESULTS: A total of 100 patients were interviewed, of which 68% desired to undergo breast reconstruction. Only 35% recalled talking about this procedure with a physician and 85% claimed not to have enough information to make an informed decision. Those who desired breast reconstruction were younger (p < 0.001), more likely to be in a relationship (p = 0.025), and had a higher probability of having talked to a physician about the procedure (p = 0.019). Furthermore, they felt less sexually attractive (p < 0.001), more deformed (p = 0.006), and less feminine (p = 0.005) since the mastectomy. The main motives to undergo this procedure were to have breast symmetry and greater freedom on which clothes to wear, while the main deterrent was the high economical cost. CONCLUSIONS: Insufficient information about the procedure and high economical cost were identified as potential barriers to undergo breast reconstruction. The findings of this study emphasize the pressing need to optimize patient care by providing information in a standardized manner and improving access to breast reconstruction within the Mexican public healthcare system.

Contraste empírico del modelo de cinco fases de duelo de Kübler-Ross en mujeres con cáncer / Empirical Contrast of the Kubler-Ross Model of the Five Stages of Grief among Women with Cancer / Contraste empírico do modelo de cinco fases do luto de Kübler-Ross em mulheres com câncer

Objetivos. (a) Definir cinco escalas unidimensionales que permitan evaluar las cinco fases de duelo del modelo de Kübler-Ross y (b) contrastar el modelo secuencial de cinco fases de duelo de Kübler-Ross. Método. Se aplicó la escala de las fases de duelo a una muestra no probabilística de 120 mujeres mexicanas con cáncer. Se usó análisis factorial y de senderos para analizar los datos. Resultados. Se definieron cinco modelos unidimensionales de medida para cada fase de duelo con consistencia interna alta, ajuste a los datos y validez de contenido. El modelo secuencial de cinco fases de duelo presentó un ajuste pobre a los datos. Las fases de duelo fueron independientes del tiempo transcurrido desde el diagnóstico de cáncer. Un modelo no secuencial tuvo buen ajuste a los datos. En este modelo, la negación predijo ira, negociación con un ser superior y depresión; por su parte, la ira predijo depresión; negociación con un ser superior predijo aceptación; y depresión predijo menor aceptación. Conclusión. En estas mujeres mexicanas con cáncer, más que una secuencia de fases en el proceso de duelo, se observaron seis respuestas psicológicas que se interrelacionan entre sí y con la pérdida de la salud. Los 39 ítems seleccionados pueden emplearse como una escala de seis factores y dos dimensiones correlacionadas, afecto positivo (promesas/pacto, fe/esperanza y aceptación) y afecto negativo (negación, depresión e ira).

Objective. (a) To define five one-factor scales for assessing the five stages of the Kubler-Ross grief model, and (b) to contrast the sequential model of the five stages of grief proposed by Kubler-Ross. Method. The Phases of Grief Scale was applied to a non-probability sample of 120 Mexican women with cancer. Factor analysis and path analysis were used to analyze the data. Results. One-factor models were defined for each phase of grief with high internal consistency, fit to the data, and content validity. The sequential model of five stages of grief showed a poor fit to the data. The stages of grief were independent of time from the moment of diagnosis of cancer. A non-sequential model had a good fit to the data. In this model, denial predicted anger, negotiation with a superior being and depression; for its part, anger predicted depression; negotiation with a superior being predicted acceptance; and depression predicted less acceptance. Conclusion. Six interrelated psychological responses due to loss of health were observed among these Mexican women with cancer, rather than a sequence of stages during the grieving process. From the 39 selected items, a scale of six factors and two correlated dimensions: positive affect (promises/covenant, faith/hope, and acceptance) and negative affect (denial, depression, and anger) can be defined.

Escopo. a) Definir cinco escalas unidimensionais que permitam avaliar as cinco fases de luto de modelo de Kübler-Ross e b) contrastar o modelo sequencial de cinco fases de luto Kübler-Ross. Metodologia. Foi aplicada a escada das Fases de luto a uma amostra não probabilística de 120 mulheres mexicanas com câncer. Foi usada uma análise fatorial e de sendeiros para analisar os dados. Resultados. Foram definidos cinco modelos unidimensionais de medida para cada fase de luto com consistência interna alta, ajuste aos dados e validez de conteúdo. o modelo sequencial de cinco fases de luto apresentou um ajuste pobre aos dados. As fases de luto foram independentes do tempo transcorrido desde o diagnóstico de câncer. Um modelo não sequencial teve um bom ajuste aos dados. Neste modelo, a negação previu ira, negociação com um ser superior e depressão: por sua parte, a ira previu depressão; negociação com um ser superior previu aceitação; e depressão previu menor aceitação. Conclusão. Nestas mulheres mexicanas com câncer, mais que uma sequência de fases no processo de luto, foram observadas seis respostas psicológicas que estão inter-relacionadas e com a perda da saúde. Os 39 itens selecionados podem ser empregados como uma escada de seis fatores e duas dimensões correlacionadas, afeto positivo (promessas/pacto, fé/esperança e aceitação) e afeto negativo (negação, depressão e ira).