Contraceptive awareness and practice in breast cancer cases across the cancer care continuum: A mixed method research.

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Background: Premenopausal breast cancer cases account for almost one-third of prevalent cases. There are no specific recommendations about contraceptive use for these patients in the current guidelines. In India studies on contraception and fertility awareness are scarce. Hence this study is planned with the aim to assess the current need of contraceptive counselling in young breast cancer patients and assess the methods utilised by them. Methods: Mixed method research was conducted amongst premenopausal females with confirmed histopathological diagnosis of carcinoma breast and good performance status. A semi-structured questionnaire was used to tap contraceptive knowledge and practice during and after breast cancer treatment for quantitative component. For qualitative component in depth interviews of patients were conducted. Themes related to contraceptive use, choice and counselling were identified through thematic analysis. Results: Total 23 women meeting the selection criteria participated. Most of them were choosing barrier method followed by permanent sterilization (tubectomy) prior to the diagnosis of cancer. Although post diagnosis 3 had abstinence from any kind of sexual activity, 3 reported to be less active (> 2months gap), 7 were using barrier method and one was using calendar method. Six patients were although sexually active but not using contraceptive. Hesitancy of patients, inadequate sensitisation regarding contraception, stigma attached to cancer diagnosis leading to sexual inactiveness, lack of timely communication between Cancer care team and patients and unawareness regarding teratogenic effect of treatment were major themes identified. Conclusions: Ca breast patients have concerns regarding fertility and contraception which need to be addressed at many time points across cancer care continuum. It is better to set up counseling center with team based approach including oncologist, gynecologist, counselors, and psychologist. Person centered care with timely multilateral communication is the need of the hour.