A new set of guidelines has been developed to aid in the diagnosis and management of blood cancers during pregnancy, an area that has previously lacked standardized clinical guidance. These guidelines aim to provide expert advice for clinicians, ensuring that both the health of the mother and the unborn baby are prioritized during the complex treatment process.
The Rising Incidence of Blood Cancers in Pregnancy
Blood cancers, such as acute leukaemia and aggressive lymphomas, affect approximately 12.5 pregnancies per 100,000, and this incidence has been steadily increasing. Between 1994 and 2013, the number of pregnant women diagnosed with blood cancers rose by 2.7% annually. Contributing factors include the trend of women having children later in life, advancements in diagnostic techniques, and increased healthcare system engagement.
Despite the rarity of blood cancers during pregnancy, these conditions pose significant therapeutic challenges. Due to the delicate balance between treating the cancer effectively and ensuring the safety of the fetus, managing such diagnoses can be particularly complicated for both clinicians and patients.
A Multidisciplinary Approach to Blood Cancer Management
An Australian working group has now published a new position statement in The Lancet Haematology, providing a practical guide for doctors based on the latest evidence and expert consensus. This guideline includes recommendations on several key areas of care:
Diagnosis and Staging: Updated protocols to diagnose and stage blood cancers while considering the implications of pregnancy.
Imaging Safety: Advice on how to safely conduct imaging procedures during pregnancy to assess the extent of the cancer.
Therapy in Pregnancy: A focus on a multidisciplinary approach that involves a combination of oncologists, obstetricians, and other specialists to provide the best care for both the mother and child.
Supportive Care: Guidance on managing the side effects of cancer treatments, including chemotherapy, during pregnancy.
Oncofertility: Addressing concerns about fertility preservation for women undergoing cancer treatment while pregnant.
Pregnancy and Birth Management: Recommendations for managing pregnancy and birth in women diagnosed with blood cancers.
Dr. Georgia Mills, lead author of the guidelines from Macquarie Medical School, highlighted the distress that comes with a cancer diagnosis during pregnancy. She noted that women often experience treatment delays, misinformation, and communication breakdowns, which only exacerbate the anxiety and concerns about both their own health and that of their unborn baby.
“Our goal is to ensure that women and their babies have the best possible health outcomes,” said Dr. Mills. “We aim to prevent delays or denied care, helping patients navigate their treatment journey with accurate information and the right support.”
The Importance of a Multidisciplinary Approach
Dr. Gisele Kidson-Gerber, the senior author of the guidelines, emphasized the importance of a collaborative, multidisciplinary approach to managing blood cancers in pregnancy. “These cases present unique therapeutic challenges. We must balance the need for optimal treatment of the mother with the safety and well-being of the unborn child,” she said. While most cancer treatments, including various forms of chemotherapy, are possible during pregnancy, many patients are unaware of this, and clinicians must provide the appropriate guidance.
The guidelines were drafted with co-design principles, involving patient representatives to ensure that the concerns and needs of patients were adequately understood. This focus on patient-centered care aims to empower women with the knowledge and support they need to make informed decisions about their treatment.
Personal Experience: Victoria Bilsland’s Story
Victoria Bilsland, a patient who was diagnosed with stage 4B nodular-predominant Hodgkin’s lymphoma when she was 17 weeks pregnant, shared her own traumatic experience with cancer during pregnancy. Despite suffering from symptoms that were repeatedly dismissed as pregnancy-related or infections, Bilsland struggled to get an accurate diagnosis, leading her to lose confidence in her doctors. She was advised to consider termination without being given enough information about the risks to her health or the health of her baby.
“The process was a rollercoaster of trauma, depression, and anxiety,” Bilsland recalls. “I was offered termination multiple times, but no one could provide me with the information I needed to make an informed decision. I didn’t know the extent of the cancer or the stage it was at.”
Eventually, Bilsland was placed under the care of a specialized team experienced in managing hematological cancers in pregnancy. She received the necessary treatment and delivered a healthy son at 32 weeks. She hopes that the new guidelines will help doctors make the right decisions quickly and provide better care for patients, reducing potential trauma and improving outcomes.
Endorsement of the Guidelines
The guidelines have received endorsement from major medical societies, including the Society of Obstetric Medicine of Australia and New Zealand and the Haematology Society of Australia and New Zealand. These endorsements further reinforce the importance of standardized, evidence-based care in managing blood cancers during pregnancy.
Conclusion
With the publication of these new guidelines, clinicians now have a comprehensive, patient-centered resource to guide the diagnosis and treatment of blood cancers in pregnant women. By incorporating multidisciplinary care, accurate information, and a focus on patient well-being, these guidelines aim to improve the care and outcomes for both mothers and babies affected by these rare but serious conditions. The hope is that the new approach will reduce delays in diagnosis, alleviate patient anxiety, and ultimately lead to better health outcomes for both women and their babies.
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