Cancer diagnosis while pregnant should not lead to treatment delay or end of pregnancy

http://www.eurekalert.org/pub_releases/2015-09/eeco-cdw092515.php

Public Release: 28-Sep-2015
Cancer diagnosis while pregnant should not lead to treatment delay or end of pregnancy
ECCO-the European CanCer Organisation

Women who are pregnant when diagnosed with cancer can start treatment for their disease immediately and do not need to terminate their pregnancy due to worries over the effects of therapy on the development of their child.

In a special session on cancer in pregnancy at the 2015 European Cancer Congress [1] on Monday, Professor Frédéric Amant said that new results from a study of 129 children, aged between one and three, born after prenatal exposure to cancer treatment, showed normal development of their mental processes and heart function when compared to a matching group of children from the general population.

"Our results show that fear of cancer treatment is no reason to terminate a pregnancy, that maternal treatment should not be delayed and that chemotherapy can be given. The study also shows that children suffer more from prematurity than from chemotherapy, so avoiding prematurity is more important than avoiding chemotherapy," said Prof Amant, who is a gynaecological oncologist at the University Hospitals Leuven (Leuven, Belgium) and at Antoni van Leeuwenhoek (Amsterdam, The Netherlands). The study is being published simultaneously in the New England Journal of Medicine

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However, the researchers found that the scores tended to increase by an average of 2.2 points for every week in gestational age, after controlling for age, gender, country, ethnicity and parental education level. "Delayed development of mental processes appeared to be related to premature birth," he said.

Premature birth was more frequent among children born to mothers with cancer, regardless of whether or not they received prenatal treatment, than in the general population in the countries participating in the study. They had a median gestational age of 36 weeks, ranging from 27-41 weeks; 79 (61.2%) children were born at less than 37 weeks, compared to 7-8% in the general population.

"In most cases, they were born prematurely due to a medical decision to induce preterm so as to continue cancer treatment after the delivery," said Prof Amant. "In some cases preterm delivery was spontaneous and it is possible that cancer treatment plays a role in this. But we do not know what exactly triggers preterm delivery. It could be that chemotherapy induces preterm contractions or vaginal inflammation with preterm rupture of the membranes."

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However, he warned that the results had some limitations. "Our data include many types of chemotherapy, but we cannot guarantee that all types of chemotherapy are safe.

"We need to look at larger numbers of children and larger numbers exposed to each drug in order to be able to document the potential effects of individual drugs. In addition, we cannot extrapolate to newer drugs, including targeted drugs. We need longer follow-up to see if there are any long-term toxic effects in cases where cisplatin was administered before birth. For these reasons we will continue to follow these children until the age of 18 years and we will enlarge the group. This will allow us to document longer-term effects and to draw conclusions for specific drugs. In addition we will investigate to what extent anti-cancer drugs are diluted in the body during pregnancy, and also at the psycho-emotional needs of mothers and their partners."

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