Pregnancy outcome and survivorship in cancer patients

Reporter: Jacob Shabason, MD
The Abramson Cancer Center of the University of Pennsylvania
Ultima Vez Modificado: 10 de junio del 2013

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Presenter: Nir Pillar, MD
Presenter's Affiliation: Department of Oncology, Sheba Medical Center, Ramat Gan, Israel

Background

  • Due to improvements in cancer detection and therapies, there is now an increased prevalence of female cancer patients and survivors of childbearing age.
  • Much research has been devoted to study the effect of cancer treatments on fertility.
  • However, there is a paucity of data regarding pregnancy outcomes in both female cancer survivors and woman undergoing cancer therapy.
  • In this retrospective study, the authors aim to study whether cancer survivors or active cancer patients have an increased risk of obstetric complications.

Materials and Methods

  • This study is a population-based cohort study using data from the NIS of the Healthcare Cost and Utilization Project from 2000-2006.
  • The rate of maternal and fetal obstetric complications was determined in pregnant women with and without the diagnosis of cancer.
  • The authors were not able to determine if the woman had a newly diagnosed cancer, was undergoing cancer therapy or had a cancer in remission.

Materials and Methods

  • A total of 6,732,293 births were included in the analysis.
  • 15,191 of these births had a maternal cancer diagnosis (0.2%).
  • Pregnant women with a cancer diagnosis had an increased risk of premature labor, ectopic pregnancy, hysterectomy, oorpherctomy, the need for blood transfusions, unable to be discharged directly home or death (full details in table below).
  • The increased risk in complications was seen across different cancer types (full details in table below).
  • The rate of maternal death (3.6/ 1000 vs. 0.12/ 1000 births) was higher in cancer survivors/ sufferers.
  • The rate of fetal death (8.3/1000 vs. 3.9/ 1000 births) was higher in cancer survivors/ sufferers.
  • Multivariate logistic regression analysis revealed that both age and cancer diagnosis was significantly and independently associated with pregnancy complications.
 

No Cancer- Reference group

Gynecologic pelvic tumor

RR

Non-Gynecologic pelvic tumor

RR

Hematologic Cancer

RR

Non-Pelvic Solid Tumor

RR

Premature labor

613,567

512

1.43*

62

1.92*

379

1.47*

664

1.29*

Ectopic

29,497

34

1.98*

3

1.93

21

1.69*

35

1.42*

Oophorectomy

7,309

133

31.25*

7

18.26*

11

3.58*

31

5.07*

Hysterectomy

6,257

176

48.32*

3

9.14*

1

0.38

18

3.44*

Transfusion

50,263

88

3.007*

18

6.82*

111

5.26*

123

2.93*

Not discharged home

38,271

30

1.34

9

4.48*

65

4.05*

74

2.31*

Death

821

1

2.09

2

46.45*

15

43.57*

9

13.12*

* P value < 0.05.

                 

Author's Conclusions

  • This is the first large-scale study that examines the prevalence of obstetric complications in cancer patients and survivors.
  • Patients with cancer or cancer survivors who become pregnant appear to be at an increased risk of major obstetrical complications including maternal and fetal death, however the absolute risk of these complications is very low.
  • These patients should be identified as high risk and should have more intensive prenatal care.
  • Limitations include:
    • The inability to distinguish between cancer survivors, those newly diagnosed who defer therapy until after pregnancy, and those with active disease undergoing therapy.
    • The fact that this is retrospective study with the potential for significant reporting bias.

Clinical Implications

  • There is very little known about the risk of pregnancy complications in women with cancer or cancer survivors.
  • The authors presented a retrospective study evaluating the risk of a variety of important obstetric complications in women with a cancer diagnosis.
  • Across different types of cancer there was a significant increase in the relative risk of all the complications analyzed including premature labor, ectopic pregnancy, hysterectomy, oorpherctomy, the need for blood transfusions, unable to be discharge directly home or death. However the absolute risk of these complications was still very small.
  • Further research needs to focus on separating the risk of complications for patients in remission and those with active disease undergoing cancer therapy.
  • In addition, it is important to study how different cancer therapies (surgery, radiation and chemotherapy) affect the risk of obstetric complications.
  • Overall this study provides evidence to support placing women with cancer in a high-risk category so they can be monitored more closely with the goal of mitigating the potential complications.

English
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Cancer Survivorship Has Little Effect on Birth Outcomes

Oct 20, 2014 - Most infants born to female and male survivors of childhood and adolescent cancer are not at increased risk of overall complications, but may be at increased risk of preterm delivery or low birth weight, according to two studies published in the October issue of the Archives of Pediatrics & Adolescent Medicine.



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