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 aspects of managing cancer in pregnant patients, offering valuable insights for healthcare professionals.
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 approximately one in 1000-2000 pregnancies. However, the implications are profound, impacting both the mother and the fetus. Sekeres emphasizes the importance of shared decision-making, considering the cancer's aggressiveness, treatment toxicity, and patient goals.
The guideline tackles essential clinical questions, including diagnostic criteria, cancer management, and obstetrical considerations. While the evidence supporting these recommendations is primarily derived from low-quality sources like retrospective studies and case reports, the authors believe the guidelines offer valuable real-world data 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 importance of understanding patient preferences, weighing disease risks, and considering fetal risks with optimal therapy. Partridge emphasizes the need for transparency in data and individual patient considerations.
Key recommendations include multidisciplinary care teams, including pharmacists, to develop personalized treatment plans. Clinicians should engage patients and caregivers in informed consent discussions. Patient autonomy and personal preferences are paramount, with the understanding that cancer emergencies may require immediate cancer-directed therapy, potentially impacting pregnancy.
The guideline provides extensive information on diagnostic evaluation, imaging, biopsy procedures, and systemic therapies. One of the most challenging aspects is managing drugs with unknown teratogenic potential. Sekeres acknowledges the limitations of study designs and the lack of data on newer therapies, leading to cautious approaches in treatment timing.
Partridge admits that the teratogenic risks of bispecific agents and antibody-drug conjugates are not well understood, despite biological concerns. This area of study remains complex and requires further investigation.
ASCO's guideline is a valuable resource for healthcare professionals, offering a comprehensive approach to cancer care during pregnancy. It emphasizes the need for individualized care, patient involvement, and ongoing research to improve outcomes for both mothers and their babies.
