The concurrence of cancer and pregnancy can pose complex medical, psychosocial and ethical issues for patients and their loved ones, as well as for their healthcare team. In a patient with cancer who is pregnant, management decisions must consider any additional risks to the patient due to their pregnant state, and the risks to the foetus. These are often dependent on the gestational age, with limited data to provide information on the risks. Furthermore, if pregnancy termination is desired either due to patient preference or to optimize cancer outcomes, accessibility of reproductive health services may complicate options. Here we outline approaches to manage cancer during pregnancy with a focus on patient preferences, patient and fetal risks, and team-based clinical management.
References
Ugai, T. et al. Is early-onset cancer an emerging global epidemic? Current evidence and future implications. Nat. Rev. Clin. Oncol. 19, 656–673 (2022).
United Nations Economic Commission for Europe (UNECE) Statistical Database. Mean age of women at birth of first child. UNECE https://w3.unece.org/PXWeb/en/Table?IndicatorCode=34 (accessed 16 October 2023).
Cottreau, C. M. et al. Pregnancy-associated cancer: A U.S. population-based study. J. Womens Health (Larchmt) 28, 250–257 (2019).
Cairncross, Z. F. et al. Long-term mortality in individuals diagnosed with cancer during pregnancy or postpartum. JAMA Oncol. 9, 791–799 (2023).
Lenaerts, L. et al. Comprehensive genome-wide analysis of routine non-invasive test data allows cancer prediction: A single-center retrospective analysis of over 85,000 pregnancies. EClinicalMedicine 35, 100856 (2021).
Sorouri, K., Loren, A. W., Amant, F. & Partridge, A. H. Patient-centered care in the management of cancer during pregnancy. Am. Soc. Clin. Oncol. Educ. Book 43, e100037 (2023).
Amant, F. et al. Pediatric outcome after maternal cancer diagnosed during pregnancy. N. Engl. J. Med. 373, 1824–1834 (2015).
Amant, F. et al. Gynecologic cancers in pregnancy: guidelines based on a third international consensus meeting. Ann. Oncol. 30, 1601–1612 (2019).
Mayr, N. A., Wen, B. C. & Saw, C. B. Radiation therapy during pregnancy. Obstet. Gynecol. Clin. North Am. 25, 301–321 (1998).
van Gerwen, M. et al. Association of chemotherapy timing in pregnancy with congenital malformation. JAMA Netw. Open 4, e2113180 (2021).
Maggen, C. et al. Impact of chemotherapy during pregnancy on fetal growth. J. Matern. Fetal Neonatal Med. 35, 10314–10323 (2022).
Korakiti, A. M. et al. Long-term neurodevelopmental outcome of children after in utero exposure to chemotherapy. Cancers (Basel) 12, 3623 (2020).
Wolters, V. et al. Management of pregnancy in women with cancer. Int. J. Gynecol. Cancer 31, 314–322 (2021).
La Nasa, M., Gaughan, J. & Cardonick, E. Incidence of neonatal neutropenia and leukopenia after in utero exposure to chemotherapy for maternal cancer. Am. J. Clin. Oncol. 42, 884 (2019).
Khazzaka, A., Rassy, E., Sleiman, Z., Boussios, S. & Pavlidis, N. Systematic review of fetal and placental metastases among pregnant patients with cancer. Cancer Treat. Rev. 104, 102356 (2022).
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A.H.P. receives royalties from Walters Kluwer for authorship of UpToDate. L.V. declares no competing interests.
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Varella, L., Partridge, A.H. Approaching cancer during pregnancy. Nat Rev Cancer 24, 159–160 (2024). https://doi.org/10.1038/s41568-023-00647-6
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DOI: https://doi.org/10.1038/s41568-023-00647-6
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