Abstract
BACKGROUND: Younger women diagnosed with breast cancer are more likely to have survival concerns related to fertility, which may influence their treatment decisions. OBJECTIVE: This qualitative study explores how young women make cancer treatment decisions and the role of fertility concerns in that process. METHODS: We used purposeful sampling to identify a diverse group of 20 young breast cancer survivors, half of whom had a child after breast cancer. We conducted open-ended telephone interviews and used cross-case, inductive analysis to identify themes. RESULTS: The main themes were (1) "I was young, I wanted to do everything possible to move forward with my life and not to have the cancer come back"; (2) "Fertility concerns are different for every woman"; (3) "My oncologist was great… a huge part of my survivorship"; and (4) "They didn't tell me about my options, and I didn't think about fertility until it was too late." CONCLUSIONS: Although fertility was important to many participants, treatment decisions were mainly motivated by survival concerns. Fertility concerns depended on life circumstances, and the timing in relation to diagnosis varied. There is a need for improved information regarding the impact of treatment on fertility and fertility preservation options, even if concerns are not expressed at diagnosis. IMPLICATIONS FOR PRACTICE: It is critical that cancer care providers provide timely information regarding fertility. Oncology nurses are particularly well positioned to serve this role by communicating with patients about their fertility concerns and reproductive planning prior to treatment and throughout the course of survivorship.