Reproductive Concerns and Depression among Younger Survivors

Institution: University of California, San Diego
Investigator(s): Jessica Gorman, M.P.H. -
Award Cycle: 2008 (Cycle 14) Grant #: 14GB-0140 Award: $34,617
Award Type: Dissertation Award
Research Priorities
Community Impact of Breast Cancer>Sociocultural, Behavioral, and Psychological Issues: the human side

Initial Award Abstract (2008)

About a quarter of breast cancer cases in the United States are diagnosed in premenopausal women. The issues and decisions faced by younger women are different than those of older women, including concerns about early menopause, fertility, and long-term survivorship. Breast cancer treatment may increase the risk of early menopause and cause difficulties with fertility. This can be especially challenging for younger women who have not finished growing their families. There is limited research on how fertility problems impact the long-term well-being breast cancer survivors.

The primary questions we will address among younger breast cancer survivors in this project include: (1) how do symptoms of depression change over time?, and (2) are problems with fertility associated with increased symptoms of depression over time?

In addition, we will describe younger breast cancer survivors’ reproductive history, experiences with fertility-related side effects of treatment, and whether they made treatment decisions in order to maintain fertility. We will use data from approximately 200 younger breast cancer survivors who participated in the Women’s Healthy Eating and Living (WHEL) study. WHEL is a nutritional intervention designed to test whether a diet high in fruits and vegetables can lower breast cancer recurrence. The sample for this study includes survivors who were 40 at younger when they were diagnosed and who have agreed to be contacted again. Some data has already been collected, including demographics, cancer characteristics/treatment, and physical and mental well-being. We will conduct a follow-up survey to ask whether survivors wanted to have children or attempted pregnancy, whether they’ve had problems with infertility or fertility-related side effects of their treatment, whether they currently have any symptoms of depression, and about their current feelings toward pregnancy and their ability to have children.

There are few studies that follow a group of younger breast cancer survivors over time. The WHEL study includes a significant number of younger women who have survived for 10 years or longer. The proposed project provides a great opportunity to combine existing long-term data with new questions to explore the association between the reproductive concerns and long-term well being.

Final Report (2009)

Breast cancer diagnosis and treatment can negatively impact fertility in pre-menopausal women and influence reproductive planning. This study evaluated whether concerns about reproduction after breast cancer treatment were associated with long-term depressive symptoms in women diagnosed with early stage breast cancer at age 40 or younger.

The study’s primary aims were to:
a) Describe the baseline demographics, cancer characteristics, reproductive history, lifestyle, physical and psychosocial health of participants;
b) Describe reproductive health during survivorship, including reported difficulties with fertility and number of pregnancies and births;
c) Characterize depressive symptoms over time; and
d) Use multilevel modeling to identify whether greater reproductive concerns are associated with increased depressive symptoms over time.

After overcoming obstacles to enrollment, we have successfully completed all study aims. Our study includes 131 women diagnosed at age 40 or younger who participated in the Women’s Healthy Eating and Living (WHEL) Survivorship Study. Participants were enrolled an average of 2 years post-diagnosis and depressive symptoms were monitored 6 times throughout the average additional 10 year follow-up period. Detailed recall of reproductive concerns after treatment was collected approximately 12 years post-diagnosis. We used multilevel modeling to evaluate whether long-term depressive symptoms differed as a function of reproductive concerns.

Despite the fact that the study included a lower than expected number of young survivors, we were able to detect significant effects. Greater reproductive concerns independently predicted consistent depressive symptoms after controlling for both social support and physical health (B’ 0.02, SE= 0.01, pO.O4). In bivariate analyses, not having a child at the time of diagnosis and reporting treatment-related ovarian damage were both strongly associated with higher reproductive concerns and with depressive symptoms.

Our results suggest that reproductive concerns are associated with consistent depressive symptoms and that young survivors would benefit from additional information and support related to reproductive issues. A manuscript outlining these results is currently under review. This study’s findings also provide direction for future research and additional evidence of a need for interventions to improve patient-provider discussions about reproductive issues prior to treatment and later in survivorship.