Study Offers Support for Cancer Treatment During Pregnancy

Tests on children go against the prevailing wisdom of counseling women to deliver preterm or even terminate pregnancy before chemotherapy.

Comments: 44

  1. This is a small, limited study. No policy can be decided by so little data. Personally, I would not have chemo based on this study were I pregnant. My background is MD Phd with years of research for NIH and NIMH.

  2. in my opinion, I don't think that women who are diagnosed with cancer while they are pregnant should be treated right away unless its urgent, or if they come up with something less harmful. they say it doesn't effect the baby now, but have you ever thought of what the harsh treatments could cause long term? there's always that chance of everything going wrong.

  3. How do you define "urgent"? With many cancers, delaying treatment for months is likely to vastly reduce the likelihood that the treatment could save the mother's life. Seems fairly "urgent" to me.

  4. in my opinion I think that it is right to continue treatment after the baby is born. this is because if you treat the person while pregnant the baby can also come out with something wrong with it and you don't want that.

  5. If you don't treat the person while pregnant, the baby can come out without a mother. And you don't want that, either.

  6. No patient should be denied treatment due to pregnancy status.

  7. I agree with you, Jennifer, and would like to add, no woman should be made to choose between abortion and treatment of her cancer. If a pregnant woman, made aware of whatever is known (not necessarily guessed) of the risks to her fetus, decides to have cancer treatment and let the baby take its chances, she should be able to do that.

  8. We're not supposed to take Tylenol, nicotine or caffeine because of the dangers involved, but chemo is okay during pregnancy?

  9. Cost vs. benefit.

  10. jeoffry, I think you meant "risk", not "cost". You're right.

  11. Tylenol is fine during pregnancy. It's aspirin and ibuprofen to stay away from.

  12. I can't imagine how scary it is to be pregnant and be diagnosed with cancer. It seems like it's choosing between your life and the baby's life. I honestly would not know how to choose. I hope we can get more definitive data. When I was pregnant with my daughter (thru conceiveeasy), I found this little lump. I got so scared but, thankfully, it was nothing. When it's just not your life on the line but the life of an unborn baby, it takes that scare factor to another level.

  13. So, go ahead and have chemo during pregnancy and your kid will be fine...but don't have a glass of wine, even just one, because that can cause untold damage.

    I know it's more complex than that, but for lots of people reading pregnancy-related headlines, that will be the takeaway. Just saying.

  14. An unjustifiable conclusion, or even inference, to be made from such a small and time limited study. The real question is what kind of institutional IRB allowed this study to be performed.

  15. I am a physician with clinical research training. I am also a woman of child-bearing age. It was completely appropriate for the Institutional Review Board to have approved this study. The children in this study were born to women who had already been diagnosed with cancer and treated during pregnancy. In other words, they didn't randomize the children as to whether their mothers would get cancer or be exposed to chemo. Of course there are many limitations. The number of subjects is understandably small, given that cancer in pregnancy is a relatively uncommon occurrence. In addition, not all of the women in the study underwent chemo during pregnancy. The study only looked at children between the ages 18-36 months and a lot of the issues with exposure to chemo may not manifest for years. That being said, if ever I was in the tragic position of deciding whether to undergo chemo during a pregnancy, I would much rather know about the experiences of these women and their children.

  16. But as a physician would you recommend someone who has cancer, even if they're NED, to get pregnant. B/c of the chance of recurrence?

  17. "The study had limitations." That seems to be a colossal understatement. The number of children studied was quite small, the children were only eighteen months and three years old, a limited number of cancer chemotherapy drugs were used prenatally, and so on. While the preliminary results seem to be optimistic for the unfortunate women and their children, extrapolating treatment protocols from this information is an exiguous judgment.

  18. I have a friend who was treated during pregnancy for a serious type of cancer. She was the first pregnant woman treated by her oncologist, and one of a few treated with her form of cancer. Now, 10 years later, she is doing fine, and so is her child. If she had not been treated, that kid would likely not have a mother now.

  19. You know you are right. My greatest lesson from what I went through is that the disease is totally 100% individual and each person responds differently even if the pathology of the tumor is exactly the same as another person's tumor. It is a pernicious and vicious disease and operates quite by stealth.

  20. I am surprised by all the negative comments here. Yes this study was small but thank God that is because most pregnant women don't get cancer. But the take away from the study is positive- 129 children exposed to chemo during pregnancy seem to be developing normally! I am an OB nurse and have seen just a couple of women who had to do chemo during pregnancy. It is a horrible scenario for them. Some of these women tried for years to get pregnant- they were happy to have a choice other than termination. Many times delaying chemo allows the cancer to spread and then we end up with motherless children. There will be more studies. But for now lets take the good news that this study brings- cancer during pregnancy doesn't have to mean losing the child or the mother.

  21. Dear Jen,
    My apologies but it's just realistic pessimism: a cancer diagnosis during pregnancy nearly always means losing the mother, before long. There are people who survive forty years after a cancer diagnosis. But it's usually considered quite an achievement to make it to ten years. People who get diagnosed with a terminal illness, and then bear a child, are doing that child a considerable amount of harm later on.

  22. Dan Stackhouse - you are just wrong. The most common tumor diagnosed in pregnancy is breast cancer - which is highly treatable and even curable.

  23. Dear Me from My Home,
    I know you're a widely renowned oncologist and all, but I've read up on this, and the most common cancers during pregnancy are breast cancer, cervical cancer, lymphoma, melanoma, and thyroid cancer. I'm not talking about benign tumors which aren't a problem generally and wouldn't even require chemo. All these cancers have fatality rates depending on the stage they're diagnosed in. Including breast cancer. If you've got a batch of data disproving my notion here though that'd be great.

  24. Another interesting question is "What are the outcomes of pregnant women undergoing chemotherapy, as compared with matched non-pregnant women undergoing chemotherapy?" In other words, does pregnancy have an adverse outcome on the success of cancer therapy?

  25. You always defer treatment (chemothearpy, radiation, or surgery) in a pregnant female unless it is a necessity. Chemotherapy alone is rarely curative for solid tumors, so if the patients here had chemotherapy alone the goal of treatment was to prevent tumor growth until a definitive treatment (surgery and/or radiation) can be given after the birth.

  26. One concern I have with scientific studies like this one being reported in the popular media is that there doesn't seem to be an explicit recognition of what makes a strong scientifically-valid study. I'm not a scientist, but 100 children seems like a very small sample size. Something I've learned reading Emily Oster's wonderful book "Expecting Better" (I'm currently pregnant with my second child) is that you really have to dig into these studies to know if they're reliable or not. So many of the "rules" around pregnancy today are based on shoddy studies. But once they get reported as actual science, it's very hard to shake their impact. Oster is a trained PhD economist and has the tools to do this, and my guess is that she would look at this study and say that, while it is encouraging, we need a lot more data before any changes are made in the decision of delaying chemo and/or terminating pregnancy.

  27. Hi
    I reported this story, and yes, you're right 129 children is only 129 children. But given that pregnancy in cancer is rare, this study provides important information for the clinician who is facing their 1st or 2nd case and is trying to help a pregnant patient assess her choices. Would we deny that clinician and those pregnant women information, because not yet enough cases have accumulated?

  28. I am concerned that the study was done on such a small group. Furthermore they test at 18 months and 3 years. As someone who went through chemo - and in my case - I was allergic to one of the medicines - and as someone who is still feeling the effects on my body a couple of years out I wonder how confident we can be that chemo will not have an effect further down the road.
    I am also concerned that the study was done using certain chemo drugs - there are many out there. There are also studies that show that some women develop heart problems tens years out from having chemo and as a matter of fact my cardiologist told me that they see women with heart problems 10 years out from treatment. One particularly toxic chemo is Adriamycin or the red devil as they call it.
    We are continuing to learn however and I am open to persuasion. Just not right now.

  29. Hi Elizabeth, Thanks for your thoughtful comment. Most chemotherapy drugs were studied, not all. You are right on that count. The author of the NEJM accompanying editorial points out that if there were to be a problem in offspring that was prenatally exposed to chemotherapy it would be tricky to pinpoint which agent was the culprit, given that several are given at once.

  30. Doxorubicin, which was specifically discussed in the article is the generic name for Adriamycin. You are correct in noting that cardiac problems related to the use of doxorubicin may occur up to a decade after treatment, so the 3-year duration of this followup study does not prove the children will not be affected eventually. However, it is reassuring that their hearts have developed normally to this point.

    Good luck to you as you continue to recover from treatment.

  31. I agree. I am open to persuasion. However will also note that so many cancer treatments - during and post chemo depending on the pathology of the tumor - have a side effect of 1) weakening bones and 2) can lead to heart valve malfunction and therefore heart failure.
    Herceptin is given to breast cancer patients whose tumor showed HER2 positive and estrogen positive as I was. Herceptin is given one full year after chemo and during that year you have to have an echo cardiogram every 3 months to ensure your heart valves are not deteriorating. In my case they stopped me three treatments short of a year as my heart began to show some stress with the treatment.
    I just wonder further down the road how this could affect the child seeing that during nine months of pregnancy the child would be exposed to at least 4 - 5 months of Herceptin if the mother fits that profile.
    We have come a long way and I am profoundly grateful for all those who work in this arena. I am just a bit skeptical of long term outcomes. I also hold on to some magical thinking that says somehow the baby is protected in that special environment called the mother's womb!! Ha!

  32. Since no chemotherapy was given during the first trimester during organ formation, one wouldn't expect that sort of teratogenic effect. That the therapy hasn't affected function in the children's first years of live is positive, though given the limitations, not definitive. A fetal 'organ' that is often forgotten is the developing immune system-- the thymus and other lymphoid tissue and bone marrow cells. One wonders whether/which chemotherapeutic agents can alter the immune system's development, and what long-term effect that might have on the child.

  33. Hi I reported this story. The 129 children prenatally exposed to cancer treatment in this study were followed to 3 years, not just one year.

  34. Will follow-up continue into the future? It would seem that problems would be more likely to occur later in the children's lives rather than in the first three years.

  35. @CSL - 3 years in this tiny sample doesn't mean much. The risk of immune system cancers and/or autoimmune disease would not be known for manu years.

  36. Seems short sighted to me. So the babies were born without noticeable defects; is their DNA damaged? Are they more prone to cancer themselves? Without long term study it's hasty to say there are no teratogenic effects at all.

    But there's a bigger problem that the article completely ignores. Cancer is always fatal. Oh, it can be beaten into remission for years, even long enough to die of something else, but when there's anything more extensive than a stage one localized tumor, it's going to be around for good.

    So, should someone whose lifespan will in all likelihood be more brief, really be bringing a newborn into that? Shouldn't they at least go through treatment, get into remission, then get an estimate as to how long they've got?

    I don't mean to be heartless about this, but I've seen it before in my family. People get a diagnosis, maybe outlive the prognosis by a year or two, then the cancer wins. If someone has something extensive like blood cancer and wants to have a child anyway, that strikes me as incredibly selfish and vicious, to be bearing a kid who will have to deal with their mother's death, probably within a decade.

    People can go ahead and yell at me about this, but I still don't like the notion of having kids when one cannot live long enough to support them.

  37. Not all cancers are fatal, by any means. Not all pregnant women with cancer choose to become pregnant knowing they have cancer; some find out they have cancer when they are pregnant.

  38. Dear Hammond,
    Sure, not all cancers are fatal, but many are, usually it depends on the stage it's diagnosed. But I didn't mean to imply that people were choosing to become pregnant after a cancer diagnosis, rather that people were choosing to have the baby anyway after the diagnosis, as this study is discussing.

    I just think it's a bad choice until the woman is certain that the cancer is not giving her less than ten years to live. And it's tempting to say it's up to the parents, whatever they want to do is fine, but we don't really think that way or we'd be fine with child abuse.

  39. I had a biopsy at 34 weeks gestation; cancer diagnosis at 35 weeks. Are you seriously saying that I should have aborted a perfectly healthy, viable baby given that I have aggressive breast cancer and don't know how long I will survive?

    Life is not guaranteed for any of us. You make the best decision you can based on the information in front of you. Then you raise your children like everyone else.

  40. Geez seriously. No ill effects by age three? That's a relief, but deleterious effects of any toxin often take many years--sometimes decades--to manifest themselves. I hope these children--and their mothers--have long happy lives of good health. But I wouldn't be reassured by this study.

    Cancer in pregnancy is a double heartbreak. Let's pray it remains rare, and that very few women must weigh their own survival against their babies' wellbeing.

  41. It is worthy of note that the article's title says this study offers 'support' for the treatment of cancer in pregnant women. It does not say the study proves all pregnant women with cancer should be treated.

    Some of the comments suggest confusion on this matter.

  42. Don't let nay-sayers and fear denigrate the importance and validity of this study. Anecdotal, as it may be: my wife was diagnosed with breast cancer in 1990 during her first trimester of pregnancy and underwent radical mastectomy. After much soul searching and consultation with MDs and toxicologists, it was determined that there was no credible toxicological literature for the three chemo agents she would receive, that would warrant terminating the pregnancy. In fact, even in 1990, there had been normal children born to mothers in similar circumstances with the chemo agents of choice in several countries, and these doctors provided encouragement.
    Our son was born 4 weeks premature and 4.5#, but otherwise healthy. He has since graduated from an Ivy League university, where he was also an NCAA Division 1 athlete and four year .letterman. At 6'4", 215#, we can surmise that he overcame the premature birth issues as well.

  43. Wow. Just wow. Here's a study that makes it seem as if, IN SOME CASES, women can be treated for their cancers and still have a healthy child. Granted, it's a limited study but it appears to be done ethically. It's not the be-all-and-end-all, but it is hopeful.

    When I was going through chemo, not pregnant at the time, there was a lady in the chemo room who was in the latter stages of pregnancy. My understanding was that she was being given extra doses of one chemo drug rather than getting switched to the second chemo drug that most of us got. The reason was that the first chemo drug was known to not cross the placental barrier which the second drug was known to do. I heard that both she and her baby were doing well. Note that this was for breast cancer, I can't speak to other cancers.

    And really, every woman has to make the decision to abort, treat her cancer, or not treat her cancer for herself and her circumstances. It's no one else's business

  44. Anecdotal as well, but I was treated for breast cancer over 10 years ago while pregnant. The lump was discovered at a 10 week appt. I went through surgeries and months of chemo before my daughter was born and radiation afterwards. She is now 11 and cognitively and physically doing quite well. I can't imagine life without her. Yes, my pregnancy did determine which chemo drugs my doctors chose to administer, and yes, some doctors advised immediate termination. We were lucky to have doctors who did their research and knew enough to offer options.