By Myles Starr
The incidence of younger women with breast cancer (YWBC) is steadily increasing, and supportive care programs (SCPs) can empower these women to face the unique challenges of their diagnosis (Ann Palliat Med 2024;13[5]:1246-1257).
“There are certain considerations that are unique to young breast cancer patients because of the timing of their diagnosis. However, sometimes practitioners just focus on the cancer itself. With young patients, it can be especially important and helpful to know a patient’s social history and plans for life in order to offer the best care possible,” explained study co-author Sandy Vuong, CCPA, a physician assistant and navigator at the PYNK Program for YWBC at the Sunnybrook Odette Cancer Centre, in Toronto.
The researchers sought to catalog and raise awareness among treating clinicians about the common challenges faced by YWBC. They advocated for the implementation of SCPs, like PYNK, to meet the patients’ need for financial assistance, treat adverse side effects and aid in making family planning choices.
Preserving fertility is the most unique need of YWBC identified by the researchers. Although pregnancy has historically been contraindicated for this population, two papers (from 2022 and 2023) cited by Ms. Vuong indicate that pregnancy after a breast cancer diagnosis can be safe. This leads to several considerations about which providers must counsel their patients:
- Chemotherapy will greatly reduce a woman’s chances of being able to bear children without fertility intervention.
- If a woman does want the option of bearing children after breast cancer treatment, “in general, it is safe to have a two- or two-and-a-half-week delay, for a patient to get fertility treatments before starting chemotherapy,” according to Ms. Vuong.
Patient navigators are a key part of these support programs, not only to inform patients of their options and to support surrounding family planning but for “managing the expectations of patients pertaining to the decreasing likelihood that fertility treatments will work the older a patient is,” Ms. Vuong explained.
Mitigating Effects of Aggressive Treatment
Breast cancer screening is not recommended for most women who are younger than 40 years of age. This leads to YWBC being diagnosed with later-stage disease than screen-detected cancers in older women. Consequently, YWBC are more likely to require mastectomy, radiation and suppression of estrogen by either chemotherapy or hormonal therapy. These treatments can lead to early menopause, vasomotor symptoms, genitourinary symptoms and mood changes that can negatively affect a patient’s intimate life and self-esteem. Researchers highlighted that these issues often are overlooked during regular oncology appointments. SCPs offer space for safe discussions on sexuality and intimacy changes post-treatment, education and practical resources for addressing symptoms of early menopause, and channels to connect YWBC to a pelvic floor physiotherapist and/or sex therapist that can help improve quality of life.
“Patients just don’t have to sit there and deal with side effects. We ask ourselves, what can we do? With some adjuvant endocrine therapies, we can even switch the drug [potentially reducing side effects]. Maybe we can just reduce it. Women are empowered by having that information,” explained Sandra Cuellar, PharmD, the director of the oncology residency in the Department of Pharmacy Practice at the University of Illinois Chicago (UIC), who advocates for SCPs for YWBC but is not associated with Ms. Vuong’s research.
Financial toxicity is also a concern. YWBC face more financial toxicity than women who are diagnosed with breast cancer at an older age. This is due to younger women needing to take time off from work for treatment, higher rates of unpaid mortgages and a need to pay for child care. Furthermore, these women often have less access to free, or government subsidized, healthcare. Multidisciplinary SCP teams with an experienced pharmacist who can help YWBC access lifesaving drugs at low or no cost are key to reducing financial toxicity. In the PYNK Program, pharmacists connect patients to a drug access navigator who helps patients gain subsidized or free coverage.
At UIC, YWBC are offered similar support. “Sometimes patients don’t understand they have to they have a deductible or are unaware of copay assistance programs. Sometimes the institutions themselves offer free or subsidized care. We refer patients to an appropriate program so that they can afford the medication they need,” Dr. Cuellar explained.
Ms. Voung concluded that “YWBC who have access to SCPs have a better cancer experience,” and a survey of PYNK patients reported that more than 90% of respondents were satisfied or very satisfied with the information, support and care provided. However, further quantitative data indicating that SCPs improve patients’ health has not been gathered and is crucial for securing the large amount of funding that SCPs for YWBC require.
