Pregnancy Screening in Patients With Cancer

Gustafson, Annika; Goldfrank, Deborah J.; Dunson, William A.; Mulkerin, Daniel; Caires, R; Eaton, Keith D.

doi:10.6004/jnccn.2017.7059

Cited by 5 publications

(11 citation statements)

References 18 publications

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“…Most respondents (84.8%) strongly agreed or agreed that one should screen for pregnancy prior to radiation therapy. However, only 67.1% of respondents reported their department has a pregnancy screening policy (Table 2), which is a finding consistent with a 2016 survey conducted of National Comprehensive Cancer Network member institutions that found 30% of institutions did not have a pregnancy screening policy/recommendation prior to radiation therapy, chemotherapy or surgery [24]. Taken together, these findings suggest that the majority of radiation oncologists are in support of pregnancy screening and implementing departmental policies.…”

Section: Discussionsupporting

confidence: 74%

Pregnancy screening practices and treatment of pregnant patients among radiation oncologists: results of an international survey

Zaki¹,

Zhu²,

Mackley³

et al. 2021

ecancer

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Background:The human embryo or foetus is susceptible to harmful effects of radiation, which include growth delay, malformations, impaired cognitive function, cancer and foetal demise. The purpose of this study is to describe pregnancy screening practices in radiation oncology, so that potential health effects may be avoided and areas of prevention may be identified.Methods: An electronic survey was delivered to 6,304 members of the American Society for Radiation Oncology. The survey subjects were radiation oncologists who are currently practicing in the world. Chi-square tests and a multiple logistic regression model were used to analyse the data. All tests were two-sided and the statistical significance level used was 0.05. This study (STUDY00009765) was approved by an Institutional Review Board.Results: A total of 434 responses from practicing radiation oncologists were received. Of these respondents, 69.1% were practicing in the United States. Of all respondents, 19.8% reported treating paediatric patients and 93.6% reported treating premenopausal patients. Despite 84.8% of radiation oncologists saying they would 'strongly agree' or 'agree' that one should screen for pregnancy prior to radiation therapy, 29.7% of respondents reported their department has no screening policy and 7.1% of respondents reported they do not screen for pregnancy. Having a departmental policy was associated with screening for pregnancy (p-value = 0.0005).Of all respondents, 93 reported treating a known pregnant patient. Of these 93 respondents, 76 reported intentionally treating and 17 reported accidentally treating a pregnant patient. Respondents who did not screen at time of simulation were significantly more likely to treat a pregnant patient than those who screened at time of simulation (p-value = 0.0459). Conclusions:Heterogeneity exists among practicing radiation oncologists regarding pregnancy screening. Institutional policies should be clear and consistent. All members of the radiation oncology team should make every effort to minimise unintended radiation exposure to the embryo or foetus.

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Section: Discussionsupporting

confidence: 74%

Pregnancy screening practices and treatment of pregnant patients among radiation oncologists: results of an international survey

Zaki¹,

Zhu²,

Mackley³

et al. 2021

ecancer

View full text Add to dashboard Cite

show abstract

“…The same survey indicated that having a departmental policy in place for screening for pregnancy was strongly correlated with respondents screening for pregnancy ( p = 0.0005). These results echo those of a 2016 survey of National Comprehensive Cancer Network member institutions, which found that 30% of respondents did not have a guideline or policy in place on screening patients for pregnancy prior to treatment via radiation therapy, surgery, or chemotherapy 5 …”

Section: Introductionsupporting

confidence: 70%

“…These results echo those of a 2016 survey of National Comprehensive Cancer Network member institutions, which found that 30% of respondents did not have a guideline or policy in place on screening patients for pregnancy prior to treatment via radiation therapy, surgery, or chemotherapy. 5 As noted by the NRCP, irradiation of pregnant patients can have severe effects on the developing embryo or fetus,including lethality,cancer,microcephaly,decreased intelligent quotient, epilepsy, congenital malformations, and neurobehavioral effects. 6 These effects are dependent on multiple factors, including the stage of the developing embryo or fetus at the time of irradiation, and the absorbed dose.…”

Section: Introductionmentioning

confidence: 99%

Radiation oncology department policy development for patients who may become pregnant

Fagerstrom

2024

J Applied Clin Med Phys

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In the context of radiation oncology, radiation exposure from radiation therapy simulation, image guidance, and radiation therapy procedures can have severe adverse biological effects on a developing embryo or fetus. Patients who may be pregnant are screened for the possibility of pregnancy to prevent unnecessary or excessive exposure of radiation in utero. Some radiation therapy patients for whom a pregnancy test is indicated may elect to decline the test. In addition, some patients who are found upon screening to be pregnant may decide, with their attending radiation oncologist, to continue with treatment. A radiation oncology department policy was developed to provide guidelines regarding screening and consent. The policy was designed to prevent unnecessary exposure to patients who may be pregnant, and to limit dose to the embryo or fetus in patients for whom treatment is medically indicated. The policy is presented as an example for physicists intending to develop or revise their own practice's policy regarding patients who may become pregnant.

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“…4 Given the lack of rigorous studies, and the limited data indicating the teratogenicity of some chemotherapeutics in the first trimester cannot be extrapolated to immunotherapy. 5,6 This significantly limits data-driven options for malignancy treatment during this period, which in turn compromises patient care. Determining pregnancy status prior to the initiation and each cycle thereafter of CIT is vital to the safety and quality of patient care and needs incorporation into standard practice.…”

Section: Introductionmentioning

confidence: 99%

“…A patient's pregnancy status should therefore be confirmed and documented prior to initiation of CIT and during treatment without assumptions of abstinence, contraception or infertility based on secondary amenorrhoea. 6 There are currently no specific guidelines on pregnancy screening prior to or during CIT. 11 It is our institutional standard to document consent using a standard tick box form to confirm a discussion of common and uncommon side effects of treatment, including longterm and life-threatening complications and impacts on fertility.…”

Section: Introductionmentioning

confidence: 99%

A minority of women of childbearing potential are tested for pregnancy before chemoimmunotherapy: an Australian cancer centre experience

Chadwick,

Kim,

Mills

et al. 2023

Internal Medicine Journal

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BackgroundChemotherapy is potentially harmful to a developing foetus, and there are limited data on the foetal impact of chemoimmunotherapy (CIT). Therefore, determining pregnancy status prior to initiation of CIT should be standard of care.AimsTo determine how many women of childbearing age are tested for pregnancy prior to immunochemotherapy administration.MethodsA retrospective chart review at a large Australian metropolitan cancer referral centre, including 304 women aged 18–51 years with a diagnosis of cancer receiving outpatient‐based CIT between 1 May 2015 and 12 June 2020. We assessed the uptake of pregnancy screening and contraception counselling prior to and during first‐line CIT.ResultsOnly 17.3% of CIT cycles (n = 416) screened patients for pregnancy no more than 90 days prior to administration, and the median time between pregnancy screening and treatment was approximately 3 weeks. One patient with early breast cancer had a spontaneous miscarriage estimated at 3–4 weeks' gestation, and neither the patient nor the treating oncologist was aware of this event. This was also the only patient who had a pregnancy test beyond the first cycle of CIT during their treatment.ConclusionsOur results highlight a concerningly low rate of pregnancy screening in women of childbearing age receiving CIT. The implication of missing a positive pregnancy test in this group of women could result in foetal complications, accidental miscarriage, potential bleeding risks and avoidable psychosocial stress. This highlights the urgent need for guidelines to mandate pregnancy testing in women of childbearing age receiving CIT and evidence‐based implementation tools.

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Pregnancy Screening in Patients With Cancer

Cited by 5 publications

References 18 publications

Pregnancy screening practices and treatment of pregnant patients among radiation oncologists: results of an international survey

Pregnancy screening practices and treatment of pregnant patients among radiation oncologists: results of an international survey

Radiation oncology department policy development for patients who may become pregnant

A minority of women of childbearing potential are tested for pregnancy before chemoimmunotherapy: an Australian cancer centre experience

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