ASCO Issues Comprehensive Guideline on Cancer Care During Pregnancy
The American Society of Clinical Oncology (ASCO) has released a groundbreaking guideline that navigates the intricate balance between cancer treatment and pregnancy care. This comprehensive guide, published in the Journal of Clinical Oncology, addresses critical questions surrounding the management of cancer in pregnant patients, offering valuable insights for healthcare professionals and patients alike.
According to Mikkael A. Sekeres, MD, chief of the Division of Hematology at Sylvester Comprehensive Cancer Center in Miami, cancer diagnoses during pregnancy are rare, occurring in only about one in 1000-2000 pregnancies. However, the implications are profound, requiring careful consideration of both maternal and fetal health. Sekeres emphasizes the importance of shared decision-making, taking into account the cancer's aggressiveness, the toxicity of diagnostic procedures, and patient goals.
The guideline, supported by evidence from retrospective observational studies, case series, and individual case reports, provides essential recommendations for clinical practice. Ann H. Partridge, MD, MPH, director of the Adult Survivorship Program and co-founder of the Program for Young Adults with Breast Cancer at Dana-Farber Cancer Institute in Boston, highlights the delicate balance between care and fetal risks. She stresses the need to understand patient preferences, weigh disease risks, and consider fetal risks associated with therapy and non-therapy options.
Key recommendations include multidisciplinary care teams, involving pharmacists, to develop personalized treatment plans. Informed consent is crucial, with clinicians engaging patients and caregivers in decision-making. Patient autonomy is paramount, recognizing that cancer emergencies may necessitate immediate cancer-directed therapy, potentially requiring pregnancy termination to prevent maternal death.
The guideline offers extensive guidance on diagnostic evaluation, including imaging, biopsy techniques, and systemic therapies. One of the most challenging aspects is managing drugs with unknown teratogenic potential. Sekeres acknowledges the limitations of study designs in understanding these risks, especially for newer therapies like bispecific agents and antibody-drug conjugates, which are often excluded from pregnancy trials.
Partridge emphasizes the need for further research to understand these risks, as current knowledge is limited. The guideline's authors, Sekeres and Partridge, disclose potential conflicts of interest, ensuring transparency and objectivity in their recommendations.
This comprehensive guideline is a valuable resource for healthcare professionals, providing a balanced approach to cancer care during pregnancy, and encouraging ongoing dialogue between patients, healthcare providers, and researchers.
