Pregnant women can undergo chemotherapy

Expecting mothers who suffer from cancer can finally breathe a sigh of relief as a recent study has found that chemotherapy treatment after the first trimester does not harm the unborn child.

Hundreds of women are diagnosed with cancer every year while they are pregnant, and they battle an agonising decision over the best course of action.

In some cases women opt for an abortion, particularly when they are in the early stages of pregnancy and if the cancer is very aggressive.

Others risk their own survival by refusing treatment until after the baby is born.

Around one in 2,000 pregnancies are affected by cancer and this rate is increasing by 2.5 percent a year as women have children later in life and cancer cases are on a rise.

"Treatment of malignancy in pregnancy is still associated with unacceptable errors: eg, the sometimes unjustified termination of pregnancies or the choice of an inadequate strategy for treatment of a tumour with the risk of compromised survival," the Telegraph quoted researchers Philippe Morice, Catherine Uzan, and Serge Uzan as saying.

"The situation remains challenging since in some situations an advanced cancer can be fatal for mother and foetus," Dr Frederic Amant said.

"In other situations we were able to save the child though we lost the mother immediately after the delivery, for example by keeping her alive with a terminal brain tumour. Sometimes the woman's partner declares that they feel unable to raise the child in case the mother would not survive her cancer and termination of pregnancy is opted for."

Lead author of two of the studies, Dr Amant, at the Leuven Cancer Institute, in Belgium, said that the new insights gained during research would assist in cancer treatment and also provide hope for both mother and her child in most of the cases.

He also believed that most mothers feel stronger and are motivated to undergo cancer treatment and bear the side effects, since she feels that she's fighting not only for herself but also for her child.

"Whether the patient already has children, her desire to continue the present pregnancy, the opinion of the partner and the predicted outcome determine her choices and reactions when breast cancer is diagnosed during pregnancy.

"The patient and her partner should be informed about the different treatment options and the physician should explain that termination of pregnancy does not seem to improve maternal outcome, but the decision to continue or end the pregnancy is a personal one," Amant said.

Researchers in Belgium followed up 70 children whose mothers were treated with chemotherapy while they were in the womb.

They were found to have normal development, IQ, hearing, heart function and general health.

Those who were born prematurely had lower IQ scores, which is believed to be connected to the early birth rather than the drugs, as this is seen in babies not exposed to chemotherapy, the researchers said.

The findings suggest that early delivery so the mother can begin chemotherapy may affect the baby's health, the researchers said.

The study was published in Lancet Oncology.

"We show that children who were prenatally exposed to chemotherapy do as well as other children," Dr Amant said.

"Our findings do not support a strategy of delay in chemotherapy administration or iatrogenic (ie physician induced) preterm delivery with post-partum chemotherapy administration to avoid harm to the fetus."

"The decision to administer chemotherapy should follow the same guidelines as in non-pregnant patients. In practice, it is possible to administer chemotherapy from 14 weeks gestational age onwards with specific attention to prenatal care," dr. Amant said.

The study added that longer term follow-up of the children is necessary to identify if there are any fertility issues or increased risk of cancer from chemotherapy drugs that damage DNA.

One twin in the study did have significant neuro-developmental problems and it cannot be ruled out that this was connected to the chemotherapy, the researchers said, however they thought it unlikely due to the exact nature of the issues.

There were also six children who showed differences in their intelligence and behavioural scores but the cause of this needs further clarification, experts said.

"This study can reassure pregnant women, and their physicians, that the benefits of maternal treatment do not seem to be outweighed by any long-term consequences for the exposed fetus with regards to cardiac or neurological function. Behavioural and emotional issues need further clarification and follow up," dr Elyce Cardonick said.

"If we can present this reassuring data to pregnant women with cancer, women might be more likely to accept treatment during pregnancy when indicated," dr Cardonick said.

An article on breast cancer in pregnancy in The Lancet by Dr Amant and others said terminating a pregnancy does not improve the mother's prognosis and that in most cases normal treatment can be used.

Pregnancy can mask many of the signs of breast cancer meaning it is more likely to be diagnosed at a later stage, he said.

A collection of research studies was published in a special edition of The Lancet medical journal.

Similar Threads: