A new set of guidelines has been developed to facilitate the diagnosis and expert management of serious blood cancers during pregnancy.
About 12.5 per 100,000 pregnancies are affected by blood cancers such as acute leukemia and aggressive lymphomas, and their incidence is increasing.
Between 1994 and 2013, they increased by 2.7 percent per year, due to factors such as women having children later, improved diagnostic techniques and increased commitment from the health system.
An Australian working group has published a new position statement in the latest edition of The Hematology Lancetbased on current evidence and expert consensus.
It constitutes a practical guide for physicians, including recommendations on diagnosis and staging, safety of imaging during pregnancy, therapy during pregnancy incorporating a multidisciplinary approach, supportive care, oncofertility and management of pregnancy and childbirth.
Lead author Dr Georgia Mills from Macquarie Medical School says a cancer diagnosis during pregnancy is incredibly distressing for a patient and her family.
But on top of that, women may face treatment delays, inaccurate information and communication problems, increasing worry associated with a cancer diagnosis and fears for their unborn baby.
Patients also described a lack of awareness regarding fertility preservation, breastfeeding, medication risks for the unborn baby, and a lack of information and support groups. .
We want women and their babies to experience the best possible health outcomes, without delay or denial of care. »
Dr Georgia Mills, Macquarie School of Medicine
Lead author Dr. Gisele Kidson-Gerber says taking a multidisciplinary approach was of paramount importance in preparing the guidelines.
“Blood cancers in pregnancy present unique treatment challenges, but there were no clinical guidelines for diagnosis or management,” she says.
“As clinicians, we must balance the need for optimal treatment for the mother with the safety and well-being of the unborn child.
“Most treatments are possible during pregnancy, including many forms of chemotherapy, but this is not what patients expect. »
The guidelines were written using co-design principles, with a patient representative on the working group to ensure patient concerns were well understood.
Victoria Bilsland was diagnosed with stage 4B predominantly nodular Hodgkin lymphoma when she was 17 weeks pregnant.
But with her symptoms repeatedly dismissed as pregnancy pains or a possible infection, just getting a diagnosis was a struggle that led her to lose faith in doctors.
“I was told I needed spinal surgery and was considering an abort, and when I declined the abort because we still didn’t know the extent of the cancer, we advised me to think logically,” she says.
“I was offered to terminate my pregnancy several times, but I had no information about the risks to me or my baby, nor the stage of the cancer or even where it was.
“How could I make an impossible decision without information? And why can’t anyone give me information about cancer and pregnancy?
“The process has been a roller coaster of trauma, depression and anxiety. »
Eventually placed in the care of a specialist team experienced in the management of hematological cancers during pregnancy, she received appropriate treatment and delivered a healthy son at 32 weeks.
She hopes the new guidelines will help other doctors make the same decision in a timely manner, putting the patient first and reducing potential trauma.
The guidelines were approved by the councils of the Society of Obstetric Medicine of Australia and New Zealand and the Hematology Society of Australia and New Zealand.
