New guidelines have been developed to help treat blood cancers during pregnancy

A new set of guidelines have been developed to help diagnose and expertly treat serious blood cancers during pregnancy.

Blood cancers such as acute leukemia and aggressive lymphomas occur in approximately 12.5 pregnancies per 100,000 and their incidence continues to increase.

They increased by 2.7 percent annually between 1994 and 2013 due to factors including women having children later, improved diagnostic techniques and increased involvement of the health care system.

The Australian Working Group has published a new position paper in its latest edition, based on current evidence and expert consensus.

It is a practical guide for doctors, containing recommendations on diagnosis and staging, safety of imaging tests in pregnancy, therapy in pregnancy including a multidisciplinary approach, supportive care, oncofertility, and management of pregnancy and childbirth.

Lead author Dr Georgia Mills from Macquarie Medical School says a cancer diagnosis during pregnancy is extremely distressing for the patient and her family.

Moreover, women may experience delays in treatment, inaccurate information and disruptions in communication, which increase anxiety about a cancer diagnosis and fear for their unborn child.

Patients also described a lack of sensitivity about fertility preservation, breastfeeding, the risks of medications for the unborn child, and a lack of information and support groups.

We want women and their babies to experience the best possible health outcomes, not delays or denials of care.”

Dr Georgia Mills, Macquarie Medical School

Senior author Dr. Gisele Kidson-Gerber says taking a multidisciplinary approach was paramount in developing the guidelines.

“Blood cancers in pregnant women pose unique therapeutic challenges, yet there have been no clinical guidelines for diagnosis and treatment,” he says.

“As physicians, we must balance the need for optimal treatment of the mother with the safety and well-being of the unborn child.

“Most treatments are possible during pregnancy, including many forms of chemotherapy, but this is not what patients expect.”

The guidelines were developed according to co-design principles, with the participation of a patient representative on the working group, to ensure a good understanding of patients’ concerns.

Victoria Bilsland was diagnosed with stage 4B nodular predominant Hodgkins lymphoma when she was 17 weeks pregnant.

However, because her symptoms were repeatedly dismissed as pregnancy pain or a possible infection, even getting a diagnosis was a challenge that led her to lose faith in doctors.

“I was told I ‘needed spine surgery’ and was ‘considering terminating my pregnancy,’ and when I refused to end treatment because we still didn’t know the extent of the cancer, I was advised to ‘think logically,’” she says.

“I was offered to terminate the pregnancy several times, but I had no information about the risk for me and my baby, what stage the cancer was at or even where it was located.

“How could I make an impossible decision without information? And why couldn’t anyone give me information about cancer and pregnancy?

“This process has been a roller coaster of trauma, depression and anxiety.”

Ultimately placed under the care of a specialist team experienced in the treatment of hematological malignancies during pregnancy, she received appropriate treatment and gave birth to a healthy son at 32 weeks.

He hopes the new guidelines will help other doctors make the same decision in a timely manner, putting the patient first and limiting potential trauma.

The guidelines were approved by the councils of the Society of Obstetric Medicine of Australia and New Zealand and the Hematology Society of Australia and New Zealand.