Abstract P6-12-01: Attitudes and practice of breast surgeons towards referring young women with breast cancer (YWBC) for fertility preservation (FP)
Bibliographic record
Abstract
Abstract Background: Despite ASCO guidelines (2006, 2013) recommending that young cancer patients be offered referral for FP as soon as possible after diagnosis, the literature consistently shows suboptimal referral rates for YWBC. Surgeons are in a unique position to initiate early FP referral. Surgeon & Patient Oncofertility Knowledge Enhancement (SPOKE) is one of 5 components of the pan-Canadian RUBY research program for YWBC. SPOKE aims to improve breast surgeon FP knowledge and referral rates. The lead surgeon from each of the RUBY sites was previously interviewed about FP. The goal of the current survey was to assess the baseline oncofertility attitudes and practice of the non-lead breast surgeons at those sites. Methods: An online survey taking approximately 10 minutes to complete was developed specifically for this study. In February 2015, an email invitation with a hyperlink to the anonymous survey was sent to all 86 surgeons identified by the 23 lead surgeons. Repeated reminders were sent by the research assistant over 3 months and a final request was sent by the PI. Participants received a $25 gift certificate. Results: A total of 55/86 (64%) surgeons with an average of 15 years' surgical practice completed the survey. 53% were male, 56% were under age 50, and 93% worked at a cancer centre or university-affiliated hospital. Thirty respondents (55%) indicated that more than half of their practice was breast cancer. Twenty (36%) never or rarely initiated a fertility discussion, and 23 (42%) never or rarely discussed FP options with their YWBC. Twenty-two respondents (40%) stated it was the duty of the medical oncology rather than the surgical team to initiate fertility discussions. Only a minority were quite or very familiar with egg freezing (n=10, 19%) and embryo freezing (n=11, 20%), while only 7 (13%) felt comfortable discussing egg or embryo freezing with their patients. Twenty-four (44%) did not know a FP centre in their area to which they could refer. Compared to surgeons who assumed responsibility for fertility discussion, surgeons who did not think FP referral was their clinical responsibility were less familiar with egg freezing (21% vs. 63%, p<.001) and embryo freezing (32% vs. 73%, p<.01), and were less likely to know where to send FP referrals (31% vs. 85%, p<.05). The most common patient factors that surgeons stated would deter them from FP referral were: poor prognosis, need to start chemotherapy urgently, and already having children. A quarter of surgeons said they would be less likely to refer a highly anxious YWBC for FP. Conclusions: Many Canadian breast surgeons are unaware of the importance of early FP referral and nearly half surveyed did not consider FP referral to be their mandate. A majority of these surgeons lack sufficient oncofertility knowledge to feel comfortable mentioning FP options to their patients, and have not created a protocol for FP referral by the surgical team. In the next phases of the SPOKE study, a knowledge translation intervention will be developed and its effectiveness tested. Support: Canadian Breast Cancer Foundation & Canadian Institute of Health Research (OBW139590). Citation Format: Warner E, Yee S, Glass K, Kennedy E, Foong S, Seminsky M. Attitudes and practice of breast surgeons towards referring young women with breast cancer (YWBC) for fertility preservation (FP). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-12-01.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.009 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".