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Tips on how nurses can help, advise and support women with cancer in pregnancy and their families
Cancer during pregnancy is rare, but as more women are having children later in life, cancer during a pregnancy may become more common. Patients may have questions about the safety of treatments and their effects on their unborn child. Nurses can offer information and support to help pregnant women deal with uncertainties and anxiety.
Cancer Nursing Practice. 22, 5, 10-11. doi: 10.7748/cnp.22.5.10.s4
Published: 04 September 2023
How common is cancer in pregnant women?
Two women a day are diagnosed with cancer in or around pregnancy, says Mummy’s Star, a charity dedicated to women and birthing people diagnosed with cancer during pregnancy or within 12 months of giving birth. Although any kind of cancer can happen during pregnancy, it is still rare, says Macmillan Cancer Support. The most common cancers to be diagnosed when someone is pregnant are: breast cancer, cervical cancer, melanoma, lymphoma and acute leukaemia.
Can cancer symptoms be confused with pregnancy or birth-related symptoms?
Changes experienced by the body during and after pregnancy mean that some early cancer signs can be mistaken, according to Mummy’s Star. Breast changes that can happen in pregnancy may mean a lump is not suspected as a symptom of cancer. Other cancer symptoms that may be mistaken as pregnancy-related include vaginal bleeding, tiredness and breathlessness, new or changing moles and changes to bowel habits.
How can nurses work with midwives?
According to Jude Jones, midwifery adviser at Mummy’s Star, the key to high-quality care is building collaborative working relationships, including with midwives.
‘Cancer nurse specialists don’t need to become experts in pregnancy,’ she says. ‘In an ideal situation, you’ll be able to create a special relationship with the named midwife, so you can both give your professional expertise. Working together and recognising our own boundaries is important. Ask how you can support each other.’
How does pregnancy affect treatment options?
Research shows pregnant women with cancer can usually be treated as effectively as women who are not pregnant, says Macmillan Cancer Support. But, because cancer in pregnancy is uncommon, there is less evidence from large scale trials to guide treatment options, says the charity. Some treatments may need to be avoided or delayed until later in the pregnancy or after the birth.
Chemotherapy is the most common treatment for cancer and this will not usually be started until after the woman is 14 weeks pregnant.
If surgery with a general anaesthetic is needed, this may also be delayed until the patient is at least 14 weeks pregnant. Most operations are safe during pregnancy, says Macmillan. Operations in the abdomen or pelvis may have a higher risk of complications, increasing if the person is more than 25 weeks pregnant. Radiotherapy is not usually given during pregnancy, as even a low dose may harm the fetus. Hormonal therapy drugs, often used to treat breast cancer, are also not given during pregnancy, as they have a high risk of causing birth defects. Most targeted and immunotherapy drugs cannot be used during pregnancy.
What is the advice on terminating a pregnancy?
For those diagnosed with cancer, it is not normally necessary to end the pregnancy due to the cancer, says Macmillan, as women can usually have effective treatment while pregnant.
Termination is usually only advised when there is a serious risk to the person’s health, such as when the cancer is fast-growing and the pregnancy is at an early stage, as some treatments cannot start until after the 14th week of a pregnancy; urgent treatment that is not safe for the baby is required; or an operation is needed that is not possible during pregnancy.
Some women may decide on termination for their own reasons, including wanting to focus on getting well for their family, or feeling they cannot get on with treatment and recovery while pregnant. Nurses should respect individual choices and signpost to specialist support where necessary, says the charity.
Feeling sick: not all antisickness drugs are safe to use during pregnancy. Metoclopramide or ondansetron may be prescribed, and steroids can also be used
Infection: infection can occur in pregnant women receiving chemotherapy, and while most antibiotics are safe to take, certain drugs such as tetracyclines should be avoided
Anaemia: chemotherapy or losing blood during surgery may cause anaemia. If a person has a low number of red blood cells they may need a blood transfusion, which is safe to have during pregnancy
Pain: paracetamol is the first choice of painkiller for people who are pregnant. Recommendations for other painkillers, such as ibuprofen or steroids, vary depending on the stage of the pregnancy
Tiredness: nurses can advise pregnant women not to plan too much, to rest, and to take up gentle exercise, such as short walks
Source: Macmillan Cancer Support
What kinds of practical and emotional support should you offer your patient who is pregnant?
Nurses can reassure patients that the worry and anxiety they are feeling is normal and likely to be experienced by anyone who has a cancer diagnosis, says Ms Jones, although the hormonal changes in pregnancy may exacerbate those feelings.
‘For women with families, often the last thing they are considering is themselves,’ she says. ‘But it may be that she can be more open with you about how she’s feeling, than she can with others. If she feels she can confide in someone, that’s the key thing.’
What happens after the birth?
Welcoming the baby’s birth is vital, says Mummy’s Star, with some women reporting their status as a new mum is often forgotten. Nurses can show ‘small acts of compassion such as remembering to congratulate a mum on her new arrival, asking how things are going at home, or trying to fit appointment times around naps or feeds. This can all help the mum to feel she is not missing out on this special time due to her illness,’ says the charity.
The advice on breastfeeding depends on the stage of treatment. If chemotherapy ended a few weeks before the baby was born, breastfeeding straight away may be possible, says Macmillan. If chemotherapy continues after the birth, breastfeeding is not advised. If someone is having radiotherapy in areas away from their chest, it is usually safe to continue breastfeeding, says the charity. Those having targeted therapy, immunotherapy or hormonal therapy drugs should not breastfeed.