CAnceR IN PreGnancy (CARING) - a retrospective study of cancer diagnosed during pregnancy in the United Kingdom.
Journal
British journal of cancer
ISSN: 1532-1827
Titre abrégé: Br J Cancer
Pays: England
ID NLM: 0370635
Informations de publication
Date de publication:
21 Feb 2024
21 Feb 2024
Historique:
received:
24
11
2023
accepted:
29
01
2024
revised:
25
01
2024
medline:
22
2
2024
pubmed:
22
2
2024
entrez:
21
2
2024
Statut:
aheadofprint
Résumé
The incidence of cancer diagnosed during pregnancy is increasing. Data relating to investigation and management, as well as maternal and foetal outcomes is lacking in a United Kingdom (UK) population. In this retrospective study we report data from 119 patients diagnosed with cancer during pregnancy from 14 cancer centres in the UK across a five-year period (2016-2020). Median age at diagnosis was 33 years, with breast, skin and haematological the most common primary sites. The majority of cases were new diagnoses (109 patients, 91.6%). Most patients were treated with radical intent (96 patients, 80.7%), however, gastrointestinal cancers were associated with a high rate of palliative intent treatment (63.6%). Intervention was commenced during pregnancy in 68 (57.1%) patients; 44 (37%) had surgery and 31 (26.1%) received chemotherapy. Live births occurred in 98 (81.7%) of the cases, with 54 (55.1%) of these delivered by caesarean section. Maternal mortality during the study period was 20.2%. This is the first pan-tumour report of diagnosis, management and outcomes of cancer diagnosed during pregnancy in the UK. Our findings demonstrate proof of concept that data collection is feasible and highlight the need for further research in this cohort of patients.
Sections du résumé
BACKGROUND
BACKGROUND
The incidence of cancer diagnosed during pregnancy is increasing. Data relating to investigation and management, as well as maternal and foetal outcomes is lacking in a United Kingdom (UK) population.
METHODS
METHODS
In this retrospective study we report data from 119 patients diagnosed with cancer during pregnancy from 14 cancer centres in the UK across a five-year period (2016-2020).
RESULTS
RESULTS
Median age at diagnosis was 33 years, with breast, skin and haematological the most common primary sites. The majority of cases were new diagnoses (109 patients, 91.6%). Most patients were treated with radical intent (96 patients, 80.7%), however, gastrointestinal cancers were associated with a high rate of palliative intent treatment (63.6%). Intervention was commenced during pregnancy in 68 (57.1%) patients; 44 (37%) had surgery and 31 (26.1%) received chemotherapy. Live births occurred in 98 (81.7%) of the cases, with 54 (55.1%) of these delivered by caesarean section. Maternal mortality during the study period was 20.2%.
CONCLUSIONS
CONCLUSIONS
This is the first pan-tumour report of diagnosis, management and outcomes of cancer diagnosed during pregnancy in the UK. Our findings demonstrate proof of concept that data collection is feasible and highlight the need for further research in this cohort of patients.
Identifiants
pubmed: 38383704
doi: 10.1038/s41416-024-02605-x
pii: 10.1038/s41416-024-02605-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Knight M, Bunch K, Tuffnell D, Shakespeare J, Kotnis R, Kenyon S, Kurinczuk JJ, editors. on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2015-17. (Oxford: National Perinatal Epidemiology Unit, University of Oxford 2019).
Ma KK, Monsell SE, Chandrasekaran S, Gadi VK, Gammill HS. Cancer and pregnancy: national trends. Am J Perinatol. 2022;39:144–53.
doi: 10.1055/s-0040-1714394
pubmed: 32693414
Maggen C, Wolters V, Cardonick E, Fumagalli M, Halaska MJ, Lok CAR, et al. Pregnancy and cancer: the INCIP project. Curr Oncol Rep. 2020;22:17.
doi: 10.1007/s11912-020-0862-7
pubmed: 32025953
pmcid: 7002463
Amant F, Han SN, Gziri MM, Vandenbroucke T, Verheecke M, Van Calsteren K. Management of cancer in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2015;29:741–53.
doi: 10.1016/j.bpobgyn.2015.02.006
pubmed: 25797199
Office of National Statistics. Childbearing for women born in different years, England and Wales: (2019). https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/conceptionandfertilityrates/bulletins/childbearingforwomenbornindifferentyearsenglandandwales/2019 . Accessed 6 Oct 2019.
United Nations. World Population Prospects, https://population.un.org/wpp/Download/Standard/Fertility/ . 2022. Accessed 6 Oct 2023.
Dow E, Freimund A, Smith K, Hicks RJ, Jurcevic P, Shackleton M, et al. Cancer diagnoses following abnormal noninvasive prenatal testing: a case series, literature review, and proposed management model. JCO Precis Oncol. 2021. https://doi.org/10.1200/PO.20.00429 , 1001-12.
Amant F, Deckers S, Van Calsteren K, Loibl S, Halaska M, Brepoels L, et al. Breast cancer in pregnancy: recommendations of an international consensus meeting. Eur J Cancer. 2010;46:3158–68.
doi: 10.1016/j.ejca.2010.09.010
pubmed: 20932740
Peccatori FA, Azim HA Jr, Orecchia R, Hoekstra HJ, Pavlidis N, Kesic V, et al. Cancer, pregnancy and fertility: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24:vi160–170.
doi: 10.1093/annonc/mdt199
pubmed: 23813932
Vandenbroucke T, Verheecke M, Fumagalli M, Lok C, Amant F. Effects of cancer treatment during pregnancy on fetal and child development. Lancet Child Adolesc Health. 2017;1:302–10.
doi: 10.1016/S2352-4642(17)30091-3
pubmed: 30169185
Public Health England. Cancer before, during and after pregnancy. (2018).
Jones CM, Olsson-Brown A, Dobeson C. NOTCH: the national oncology trainees collaborative for healthcare research. Clin Oncol. 2020;32:632–5.
doi: 10.1016/j.clon.2020.05.005
Maggen C, Lok CA, Cardonick E, van Gerwen M, Ottevanger PB, Boere IA, et al. Gastric cancer during pregnancy: a report on 13 cases and review of the literature with focus on chemotherapy during pregnancy. Acta Obstetricia et Gynecologica Scandinavica. 2020;99:79–88.
doi: 10.1111/aogs.13731
pubmed: 31529466
Halaska MJ, Uzan C, Han SN, Fruscio R, Dahl Steffensen K, Van Calster B, et al. Characteristics of patients with cervical cancer during pregnancy: a multicenter matched cohort study. An initiative from the International Network on Cancer, Infertility and Pregnancy. Int J Gynecol Cancer. (2019). https://doi.org/10.1136/ijgc-2018-000103 .
Kocián P, de Haan J, Cardonick EH, Uzan C, Lok CAR, Fruscio R, et al. Management and outcome of colorectal cancer during pregnancy: report of 41 cases. Acta Chirurgica Belgica. 2019;119:166–75.
doi: 10.1080/00015458.2018.1493821
pubmed: 30010511
de Haan J, Verheecke M, Van Calsteren K, Van Calster B, Shmakov RG, Mhallem Gziri M, et al. Oncological management and obstetric and neonatal outcomes for women diagnosed with cancer during pregnancy: a 20-year international cohort study of 1170 patients. Lancet Oncol. 2018;19:337–46.
doi: 10.1016/S1470-2045(18)30059-7
pubmed: 29395867
Webster K, NMPA Project Team. Ethnic and Socio-economic Inequalities in NHS Maternity and Perinatal Care for Women and their Babies: Assessing care using data from births between 1 April 2015 and 31 March 2018 across England, Scotland and Wales. (2021).
Harris J, Ream E, Armes J, Gibson F, Marcu A, Parsons CT, et al. What do we know about the psychosocial issues associated with cancer during pregnancy? A scoping review and gap analysis. BMJ Open. 2023;13:e063283.
doi: 10.1136/bmjopen-2022-063283
pubmed: 36868601
pmcid: 9990617
Scott SE, Walter FM, Webster A, Sutton S, Emery J. The model of pathways to treatment: conceptualization and integration with existing theory. Br J Health Psychol. 2013;18:45–65.
doi: 10.1111/j.2044-8287.2012.02077.x
pubmed: 22536840
Agaronnik ND, El-Jawahri A, Lindvall C, Iezzoni LI. Exploring the process of cancer care for patients with pre-existing mobility disability. JCO Oncol Pract. 2021;17:e53–61.
doi: 10.1200/OP.20.00378
pubmed: 33351675
Royal College of Obstetrics and Gynaecology. Pregnancy and Breast Cancer. (March 2011).
Bural GG, Laymon CM, Mountz JM. Nuclear imaging of a pregnant patient: should we perform nuclear medicine procedures during pregnancy? Mol Imaging Radionucl Ther. 2012;21:1–5.
doi: 10.4274/Mirt.123
pubmed: 23487481
pmcid: 3590960
Wiles R, Hankinson B, Benbow E, Sharp A. Making decisions about radiological imaging in pregnancy. BMJ. 2022;377:e070486.
doi: 10.1136/bmj-2022-070486
pubmed: 35470230
pmcid: 9036096
Zanotti-Fregonara P, Hindie E. Performing nuclear medicine examinations in pregnant women. Phys Med. 2017;43:159–64.
doi: 10.1016/j.ejmp.2017.05.043
pubmed: 28506452
MBRRACE-UK. Maternal mortality 2019-21., https://www.npeu.ox.ac.uk/mbrrace-uk/data-brief/maternal-mortality-2019-21 . Accessed 20 Nov 2023.
Amant F, von Minckwitz G, Han SN, Bontenbal M, Ring AE, Giermek J, et al. Prognosis of women with primary breast cancer diagnosed during pregnancy: results from an international collaborative study. J Clin Oncol. 2013;31:2532–9.
doi: 10.1200/JCO.2012.45.6335
pubmed: 23610117
The Scottish Government. The Best Start - caesarian section rates: review report., (2021).
Vera W, Joosje H, Charlotte M, Elyce C, Ingrid B, Liesbeth L, et al. Management of pregnancy in women with cancer. Int J Gynecologic Cancer. 2021;31:314.
doi: 10.1136/ijgc-2020-001776
Office for National Statistics (ONS), Birth characteristics in England and Wales: 2021. Released 19 January 2023, ONS website, statistical bulletin. Accessed 14 Jan 2024.
Reynoso EE, Shepherd FA, Messner HA, Farquharson HA, Garvey MB, Baker MA. Acute leukemia during pregnancy: the toronto leukemia study group experience with long-term follow-up of children exposed in utero to chemotherapeutic agents. J Clin Oncol. 1987;5:1098–106.
doi: 10.1200/JCO.1987.5.7.1098
pubmed: 3474357
Delon C, Brown KF, Payne NWS, Kotrotsios Y, Vernon S, Shelton J. Differences in cancer incidence by broad ethnic group in England, 2013-7. Br J Cancer. 2022;126:1765–73.
doi: 10.1038/s41416-022-01718-5
pubmed: 35233092
pmcid: 9174248
Healthcare Quality Improvement Partnership. National Pregnancy in Diabetes Audit Report 2020, https://www.hqip.org.uk/resource/national-pregnancy-in-diabetes-audit-report-2020/ . Accessed 1 Dec 2023.