Women missing ‘vital’ pre-chemo pregnancy testing

Cancer care

By Geir O'Rourke

17 Nov 2023

The failure to require routine pregnancy screening before initiating chemoimmunotherapy in Australia is putting women of childbearing age at risk of serious pregnancy and foetal complications, it is being argued.

The message follows research at Sydney’s St Vincent’s  Hospital Kinghorn Cancer Centre, which found just 17% of premenopausal adult female cancer patients had received pregnancy testing prior to chemoimmunotherapy between 2015 and 2020.

In addition, only 19% had documentation of past or present contraception methods, while none had documentation regarding counselling on recommended forms of contraception.

These figures underscored the urgent need for guidelines to mandate pregnancy testing in women of childbearing age undergoing cancer treatment, concluded the researchers in Internal Medicine Journal (link here).

“Our results highlight a concerningly low rate of pregnancy screening in women of childbearing age receiving chemoimmunotherapy,” they wrote.

“The implication of missing a positive pregnancy test in this group of women could result in foetal complication, accidental miscarriage, potential bleeding risks and avoidable psychosocial stress. “

Beyond that, evidence-based implementation tools were needed to ensure all patients at risk of pregnancy underwent routine testing, the authors argued.

Some 304 patients aged between 19 and 51 were included in the study, receiving a combined 416 chemoimmunotherapy cycles for a range of solid and haematological malignancies.

As an example of the consequences of failing to provide pregnancy screening, they highlighted the case of one patient with early breast cancer who had a positive test during her fourth cycle of adjuvant chemotherapy with paclitaxel.

The outcome in this case was a spontaneous miscarriage estimated at 3-4 weeks gestation, the researchers noted.

“Sadly this example is not a first and will not be the last, until this issue is proactively addressed through guidelines, policy and evidence-based implementation strategies,” they wrote.

The average time between screening and treatment initiation was 20 days, according to the researchers.

Interestingly, around one third of patients in the study who received immunotherapy were screened for pregnancy, significantly higher than the screening rates for those treated with other modalities.

This could be reflective of clinical trial participation requiring mandatory screening, although the overall low rate was still a concern given the limited data on the safety of immunotherapy agents in pregnancy, the authors said.

“Clinical trials including women of childbearing age are needed to determine the safety of cancer therapies in pregnancy, and until proven safe, pregnancy screening prior to immunotherapy treatment remains essential for informed consent and the safety of the child and mother, with institutions ultimately responsible for implementation and ensuring compliance,” they wrote.

“It is time for medical bodies to prioritise women’s reproductive rights throughout the diagnosis and treatment of cancer, with updated policies mandating pregnancy screening and contraception counselling prior to and during cancer treatment.”

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