Cancer during pregnancy: Improving outcomes for mothers and babies
As the most recent census showed, women in Australia are having children later in life. And while rare, it has also been found that more women are being diagnosed with cancer while they’re pregnant.
Professor Elizabeth Sullivan is dedicated to researching how a cancer diagnosis during pregnancy affects mothers and their babies.
The lack of information currently available limits the ability of doctors to provide best quality care and adds to the stress that women with cancer in pregnancy feel.
With funding from Cancer Council NSW, Professor Sullivan has conducted a state-wide investigation into cancer during pregnancy.
Here are four key takeaways from the project:
1. The incidence of pregnancy-associated cancer is increasing
Professor Sullivan and her team found that over recent decades, there has been an overall increase in pregnancy-associated cancers in NSW. They calculated that the incidence of cancer in pregnancy increased from less than 3 out of every 1000 women giving birth in 1994 to over 4 out of every 1000 women giving birth in 2013.
This represented a 3% increase every year. While this increase was partly due to the increasing age of women giving birth over the study period, other factors may have played a role. These include a greater awareness among women and their physicians of the occurrence of cancer during pregnancy, an increase in the number of women seeking care in the first two month of pregnancy, and an increase in cancer detection rates due to the improved diagnostic procedures.
The most common cancers in pregnancy are breast cancer, melanoma, blood cancers and gynaecological cancers. But interestingly, the annual increase in diagnoses was not consistent for all types of cancer. For example, there was no significant increase in the occurrence of gynaecological cancer in pregnancy. This may be since during the study, public health strategies were introduced to prevent the spread of HPV (human papillomavirus), a virus that is linked to the development of cervical cancer.
2. Women with cancer during pregnancy are more likely to give birth early
The team also discovered that women diagnosed with cancer during pregnancy were over three times more likely to give birth preterm (before 37 weeks) than women with no cancer diagnosis.
It was also found that women diagnosed with cancer during pregnancy were up to eight times more likely to have their labour induced or to give birth via a planned caesarean-section.
3. Babies born to women with cancer are not at increased risk of death
Despite planned preterm birth being more common among women diagnosed with cancer while pregnant, the research found that the risk of stillbirth and newborn death is no greater than women without cancer giving birth.
It is important to understand, however, that these newborn babies are more likely to experience poorer outcomes associated with premature birth including a higher risk of low birthweight, needing to be admitted to higher care and longer periods of hospitalisation.
4. More work is still needed to ensure equality of care and outcomes
The COPE project team will continue researching specific cancer types that are more commonly diagnosed during pregnancy and fill in the gaps in knowledge around the impact of a cancer diagnosis during pregnancy. This includes carrying out further studies into the survivorship of women with pregnancy-associated cancer, quality of care and the long-term outcomes of babies born to women with pregnancy-associated cancer.
They are also planning to investigate cancer treatment approaches for women diagnosed during pregnancy. By examining the impact of different groups of cancer treatments on cancer prognosis for women diagnosed during pregnancy and on the outcomes for their children, they aim to provide clinicians and women diagnosed with cancer during pregnancy a better evidence-base from which to make decisions regarding treatment.
To complement the findings from the state-wide investigation, the team are also collating qualitative information on the experiences of women with pregnancy-associated cancer, including:
Trust in clinicians
Coordination of care
These results will then be used to create resources that are designed to provide some much-needed support for women with cancer in pregnancy and their families, while also providing healthcare teams with further insights into cancer care for pregnant women.
Professor Sullivan’s research has been funded by a Cancer Council project grant awarded in 2018.