Cancer patients who are of reproductive age (especially women) can be a challenge to treat when it comes to fertility, birth control during treatment, and treatment administration during pregnancy. And for women diagnosed with cancer during pregnancy, safe treatment options need to be considered.
Cancer patients who are of reproductive age (especially women) can be a challenge to treat when it comes to fertility, birth control during treatment, and treatment administration during pregnancy.
Whether a woman is diagnosed with breast, cervical, melanoma, thyroid, colon, or a hematologic malignancy, fertility needs to be discussed with all patients-this is a multidisciplinary approach.
These issues were discussed at a session titled “Pregnancy, Cancer, and Chemotherapy: Can They Coexist?” at the Oncology Nursing Society 2014 Congress by Linda Person, RN, MSN, AOCN, Tanya Price, RN, MSN, CNS, OCN, and Robin Herman, RN, MN.
Consider the following scenarios:
1. A 39-year-old female diagnosed with advanced breast cancer and 32-week gestation-patient had amenorrhea 2 to 3 months when she started chemotherapy.
2. A 32-year-old female, 26 weeks pregnant, complains of respiratory distress-mediastinal mass revealed lymphoma.
3. A 29-year-old female recently married and diagnosed with sarcoma requiring chemotherapy.
4. A 29-year-old with advanced cervical cancer was to receive concurrent treatment with chemotherapy and radiation-pregnancy test was performed after radiation treatment was administered and right before chemotherapy was to start.
How would you have handled each of these cases?
As you can see with cases 1 and 4, legal implications may be indicated here-pregnancy tests were not performed in a timely manner, putting both the mother and fetus at risk. The second case would require a discussion on safe and effective treatment options for the patient and the fetus. While no pregnancy is indicated with the third case, fertility options for the future will need to be discussed before treatment begins.
There are treatment options available for those women (and men) wanting to have children in the future, but will require cancer treatment in the interim. Cytotoxic drugs such as, cyclophosphamide, cisplatin, doxorubicin, and paclitaxel may pose the highest risk to fertility, as well as radiation treatment. Fertility preservation methods need to discussed and considered here: ovarian transposition, embryo-cryo preservation, immature or mature cryopreservation, ovarian tissue cryopreservation, and sperm banking for the male patient. The option of surrogacy and adoption should be discussed as well.
For women diagnosed with cancer during pregnancy, safe treatment options need to be considered. For starters, we need to consider the gestational age of the fetus at the point of diagnosis, type and stage of disease, and the mother’s preference during this time. Treatment is generally contraindicated during the first trimester, administered during the second trimester, and stopped during the third trimester.
Specific cancer drugs need to be looked at an on individual basis. For example, taxane drugs may not be effective during pregnancy, trastuzumab may affect amniotic fluid levels and have an impact on renal development in the fetus, and tamoxifen should not be used during pregnancy.
Frequent follow-up with these patients is imperative, as well as regular communication with the Ob/Gyn. For those patients requiring fertility preservation, again, communication must take place before treatment begins. Direct these particular patients to the appropriate medical team for this (ie, a fertility specialist).