Guidelines for Cancer Treatment during Pregnancy: Ethics-Related Content Evolution and Implications for Clinicians

Abstract

(1) Background: Current scientific evidence suggests that most cancers, including breast cancer, can be treated during pregnancy without compromising maternal and fetal outcomes. This, however, raises questions regarding the ethical implications of clinical care. (2) Methods: Using a systematic literature search, 32 clinical practice guidelines for cancer treatment during pregnancy published between 2002 and 2021 were selected for analysis and 25 of them mentioned or made references to medical ethics when offering clinical management guidance for clinicians. (3) Results: Four bioethical themes were identified: respect for patient’s autonomy, balanced approach to maternal and fetal beneficence, protection of the vulnerable and justice in resource allocation. Most guidelines recommended informing the pregnant patient about available evidence-based treatment options, offering counselling and support in the process of decision making. The relational aspect of a pregnant patient’s autonomy was also recognized and endorsed in a significant number of available guidelines. (4) Conclusions: Recognition and support of a patient’s autonomy and its relational aspects should remain an integral part of future clinical practice guidelines. Nevertheless, a more structured approach is needed when addressing existing and potential ethical issues in clinical practice guidelines for cancer treatment during pregnancy.

Experiences of cohabiting partners of women diagnosed with cancer during pregnancy: a qualitative study

“…A recent review identifying ethical concepts covered in the treatment guidelines for CDP found patient autonomy dominated [ 32 ]. While relational autonomy—the involvement of the partner and or family in decision-making—was included within this principle, reference to relational autonomy was only found in 10 of the 25 included guidelines.…”

Caring for Pregnant Patients with Cancer: A Framework for Ethical and Patient-Centred Care

“…Ethical questions raised by the healthcare team, patients and/or their families are not always the same and might be conflicting, such as when one party does not feel comfortable with care decisions that are either taken or desired by another party involved [33,34]. For these reasons, taking care of pregnant cancer patients requires a multidisciplinary clinical team that should also include decisional counsellors [35,36], psychologists and ethicists [37], in addition to the oncological core medical team [1,[38][39][40].…”

“…Ethical questions raised by the health patients and/or their families are not always the same and might be conflicti when one party does not feel comfortable with care decisions that are either ta sired by another party involved [33,34]. For these reasons, taking care of pregn patients requires a multidisciplinary clinical team that should also include counsellors [35,36], psychologists and ethicists [37], in addition to the oncol medical team [1,[38][39][40]. To provide patient-centric, ethically and legally informed care for pregn patients, a holistic view should be taken towards patient's treatment, care and c It is essential to consider individual circumstances of each pregnant cancer pat each patient is seen as a person embedded in the realities of their lives and t that a cancer diagnosis brings to themselves and their pregnancy care.…”

Chemotherapy in Pregnancy

“…The decision to continue the pregnancy should be based on carefully discussing cancer prognosis, treatment, and future fertility with the patient and her partner and the multidisciplinary team. 9 …”