Cancer in pregnancy: a survey of current clinical practice

Objective: To evaluate physicians' attitudes and knowledge regarding the treatment possibilities for patients with cancer in pregnancy. Study design: A 30-item questionnaire was mailed electronically to physicians across Europe, who were potentially involved in care of pregnant patients and/or cancer, using the membership directories of different professional societies. Results: 142 surveys were eligible for analysis. A median of 2 (range 0-100) patients with cancer in pregnancy were treated per center in 2010. The vast majority of respondents (94%) agreed that management of pregnant patients with cancer should be decided by a multidisciplinary team. When cancer is diagnosed in the first or early second trimester of pregnancy, 44% of respondents prefer termination of pregnancy: if the patient wishes to preserve the pregnancy, 77% consider deliberate delay and treatment later in pregnancy. When cancer is diagnosed in the late second or third trimester of pregnancy, 58% prefer preterm delivery in order to start cancer treatment in the postpartum period: 37% would not give chemotherapy or radiotherapy during pregnancy. Treatment during pregnancy with the aim of a term delivery is preferred by 41% of respondents. Univariate logistic regression analysis found a trend that non-academic hospitals prefer termination of pregnancy (odds ratio [OR] = 0.68; 95% CI, 0.28-1.63; P = 0.39), and also no treatment during pregnancy (OR = 0.70; 95% CI, 0.33-1.50; P = 0.36). Conclusion: Termination of pregnancy, delay of maternal treatment and iatrogenic preterm delivery are frequently applied strategies in the management of pregnant cancer patients. These results suggest that current treatment is not in line with recent evidence, and there is room for improvement on the oncologic treatment of pregnant women. Centralization of treatment is needed. (C) 2012 Elsevier Ireland Ltd. All rights reserve