Résumé
Introduction In recent decades, the living conditions of breast cancer (BC) survivors have received particular attention, especially among the youngest who face problems related to fertility and sexuality. The main objective of this population-based study was to identify clinical, social and economic determinants of sexuality, fertility and Health Related Quality of Life (HRQoL), and describe other living conditions of young BC survivors in France. Methods Non-metastatic invasive BC women diagnosed from 2009 to 2016, aged ≤ 40 years at diagnosis were identified through the FRANCIM Network. Participants completed self-reported questionnaires including standardized measures (sexuality, HRQoL, anxiety, depression, social deprivation and social support), and fertility issues from June 2021 to December 2022. Sexuality profiles were identified by ascending hierarchical classification and fertility profiles were identified by latent class models. The main determinants of HRQoL were identified using mixed regression model. Results In total, 563 BC survivors from 14 French cancers Registries participated in the survey (response rate of 31%). The mean age at diagnosis was 35.9 (SD=3.8). Main tumors characteristics were AJCC stage 2-3 (61%), Hormone Receptor positive (76%), HER2 positive (24%), and Tumor grade ≥2 (91%). Patients underwent lumpectomy (72%), chemotherapy (85%), radiotherapy (85%), endocrine therapy (71%) and targeted therapies (23%). More than 5 years after diagnosis, 48% reported sexual dysfunction. About 47% of women received information about the impact of BC treatment on fertility, and 34% about fertility preservation. Among 18% of women who had a pregnancy project at diagnosis, 35% became pregnant after treatment. The number of spontaneous pregnancies decreases from 97% before diagnosis to 36% after treatment whereas the number of pregnancies with Medically Assisted procreation increases respectively from 8% to 10%. The average score of general health scale was 60.9. The highest average score of HRQoL was in the physical functioning scale (82.2) and the lowest was in vitality (48.2). Ascending hierarchical clustering allowed to identify 3 distinct sexuality profiles from worse sexual function to better respectively: profile 1 (20%), profile 2 (30%) and profile 3 (50%) of the studied population. Social deprivation and treatment with endocrine therapy (especially tamoxifen) were associated with an increased risk of sexual dysfunction. We identified 3 classes using a latent class model. In class 1, women had a pregnancy project at diagnosis but few of them had children and were referred to a reproduction specialist. At the end of treatments, the pregnancy rate was high in this group. Class 2 includes women who have a pregnancy project at diagnosis and who have given up at the end of treatment. At diagnosis, women in class 3 had children and had no specific pregnancy plans and they were menopausal at time of study with therefore a low rate of pregnancy after treatments. Classes differed in age at diagnosis (p=0.0000), fertility preservation (p=0.0000), information received about treatment impact on fertility (p=0.0002) and fertility preservation (p=0.0000), comorbidities (p=0.0040) and income (p=0.0000). The main determinants of general health were anxiety (p=0.0006), depression (p< 0.0001) and comorbidities (p= 0.0065). Conclusions This study showed that more than five years after the diagnosis of BC, almost one in two young BC survivors, diagnosed before 40 years old, experienced difficulties related to sexuality. Specific interventions in the field of supportive care (recourse to specialists, psychological support and improvement of communication within the couple) for this population should focus in managing sexual dysfunction and improving HRQoL. It would also be suitable for women to receive the necessary information on fertility at diagnosis at diagnosis in order to prepare them for after cancer. Citation Format: Emerline Assogba, Caroline Mollévi, Anne-Sophie Woronoff, Agnès Dumas, Ariane Mamguem, Charles Coutant, Isabelle Desmoulins, Sylvain Ladoire, Sandrine Dabakuyo. Sexuality and fertility profiles, Health-Related Quality of Life and other living conditions of young breast cancer survivors in France: a national cross-sectional study by the French Network of Cancer Registries (FRANCIM) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-11-04.