Professor Ian Judson explores new research into the safety of chemotherapy during pregnancy
Finding out that you have cancer comes as a big shock to most people – but what if you are also pregnant? Do you delay treatment until the baby is born, carry on with treatment during pregnancy or have a termination? What impact does chemotherapy have on your unborn child?
A recent study in the Lancet suggested that children of women exposed to chemotherapy for cancer treatment in pregnancy develop as well as children in the general population.
“Up until recently we’ve only had anecdotal case reports to go by,” Professor Judson told host Jenni Murray. “We’ve known that, of the drugs we can use, a drug called doxorubicin is safe from the case reports and we’ve successfully used it in a number of women.”
However the impact of using other chemotherapy drugs had been less clear, he said.
The Lancet study involved 70 children who were monitored for up to 18 years from the time they were exposed to chemotherapy in the womb. The children had received a variety of chemotherapy combinations, delivered with full intensity, and the mothers had a range of cancers including breast, ovarian and cervical.
“The growth of these children has been entirely normal, their brain development has been entirely normal,” he said, adding that specific problems that had been linked to particular types of chemotherapy had also not been found. “You can’t deliver (chemotherapy) in the first trimester - in the first 14 weeks of development the organs are being formed - but after 14 weeks it is safe.”
Professor Judson said there may still be occasions when a termination may be necessary, such as if an aggressive type of cancer was diagnosed early in pregnancy. In this case the intensity of treatment may not be compatible with the developing foetus.
As the study had also found that developmental disorders could occur if the baby was delivered early, a close collaboration between the oncologist and obstetrician was crucial, while the patient’s wishes were also important.
“It should be a joint decision between the doctor and the patient,” he said. “We had until recently sparse information to guide that decision.”
Professor Judson said cancer during pregnancy was rare, occurring in around one out of every 1,000 pregnancies. However, as women were leaving pregnancy until later in life and age was a risk-factor for cancer, it could become “somewhat more common” in future.
Long-term cognitive and cardiac outcomes after prenatal exposure to chemotherapy in children aged 18 months or older: an observational study
by Frederic Amant et al published online in The Lancet Oncology on February 12.
The Lancet Oncology’s special report on malignancies during pregnancy
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