41 days to go…Mass appeal….prognosis for the mother pregnant with cancer unchanged.

41 days to go…..

Yesterday’s article by Professor Frédéric Amant, focused mostly on outcomes in children of women who went ahead with pregnancies, despite being diagnosed with cancer and treated for it while pregnant. It was reassuring in that it showed there was no evidence of ill-effects in the areas of the children’s general health or mental development, cardiac problems in those exposed to chemotherapy in the womb.

Today’s article is from the prestigious medical journal: The Lancet on Professor Amant’s major impact on this area of research and on how the mother / maternal outcome is unaffected by cancer treatment in pregnancy. The video is from the end of a talk he gave in Dublin at the International Symposium on Maternal Health where he again articulates that women can be treated as successfully for cancer while pregnant as not pregnant. Even in the following article where he refers to individual cases where a mother has an abortion because the father does not feel he could cope with a newborn alone, this is not a decision directed by the medical profession but a decision made by the couple. In other words, whereas yesterday’s article was focused on how children of women who go to term having been treated for cancer in pregnancy have no ill effects to date, today’s, shows that women themselves do no worse having had cancer treatment while pregnant and that termination of pregnancy / abortion does not improve outlook / prognosis.

http://www.thelancet.com Vol 379 February 11, 2012 511

“Usually obstetricians and oncologists don’t spend much
time together”, Frédéric Amant told The Lancet. “And this
meant a certain group of women were not getting the care
they needed: pregnant women with cancer.” Providing the
right care for these women is a key focus of Amant’s work as
Professor in the Department of Obstetrics and Gynaecology
at the Catholic University of Leuven, Belgium. For Amant, an
early experience of caring for a pregnant woman with cervical
cancer was pivotal in shaping the course of his career: “She
told me her early diagnosis was thanks to the pregnancy. So
she wanted to give her baby the chance he had given her.”
Amant’s patients are a major influence on his work, but
his first interest in medicine came much earlier during his
childhood on his family’s farm near Leuven, Belgium. Two
of his uncles were training to be doctors as he grew up,
“so I found myself buried in advanced medical texts well
ahead of my years. I can’t really remember wanting to be
anything other than a doctor”, he says. Although he retains
an interest in nature that reflects his rural upbringing—he
is a co-founder of a non-profit organisation that promotes
forestation in Belgium—Amant followed his uncles into
the profession and completed his medical degree at the
Catholic University of Leuven. After training in obstetrics,
gynaecology, and surgery, he specialised in gynaecological
oncology. It’s a specialty that he finds continually
motivating because of “the challenges of complex surgery
for a life-threatening disease, combined with personal
contact with patients and research opportunities”.
Amant is a lead author of The Lancet’s Series on malignancy
in pregnancy. About one or two per 2000 pregnancies are
complicated by cancer, with the most common being breast
cancer (40%) and blood cancers (20%). Amant, who is Chair
of the European Society of Gynaecological Oncology’s task
force on cancer in pregnancy, says that “this simply reflects
the normal range of cancers in women of reproductive age,
and there is nothing to suggest the pregnancy causes the
cancers”. The biggest challenge is educating the public that
chemotherapy is possible in pregnancy without harm to the
baby. “Women find it hard to believe they shouldn’t have
an aspirin, but can take these very strong chemotherapy
drugs during pregnancy”, Amant says. “At first, we did not
have much evidence regarding the unborn children. But
now more than 120 children have been born to women
treated with chemotherapy in our ongoing international
collaborative study, and they are doing as well as the general
population, so that offers reassurance.” Most of the babies
who didn’t do so well were born preterm after being induced
early, rather than as a result of exposure to the drugs.
“Fear of chemotherapy should not be a reason to
terminate pregnancy”, Amant says, adding that “there is no
evidence termination improves outcomes for the mother”.
And while it’s true that radiotherapy poses more of a
danger during pregnancy, especially later in the gestation,
Amant says that “in most cases, especially breast cancer,
women are started on chemotherapy (as they would be if
not pregnant) and can then be treated with radiotherapy
postpartum if necessary”. The key messages Amant
wants to come from the Series, and a related paper in
Lancet Oncology, are “that it’s rarely necessary to change the
standard chemotherapy treatment regimen for pregnant
women with cancer, and that chemotherapy does not
harm the unborn child”. He adds that “Staging scans should
be limited to avoid overexposing the fetus to radiation,
and radiotherapy of upper body parts with fetal shielding is
possible during first and second trimester only.”
Day to day, Amant’s working life is an emotional roller
coaster. While in most cases, mother and baby can be helped
through this difficult time, there are always heartbreaking
tales. As the father of four children himself, Amant recognises
how painful these decisions can be for expectant parents.
“Sometimes, a mother-to-be’s cancer is so far advanced it
kills her and her unborn child before anything can be done.
In other advanced cases, the dying mother is kept alive, for
example with a brain tumour in a coma—to enable the baby
to be born to term”, says Amant. “In other cases, the parents
may decide to terminate the pregnancy because the father
cannot go on alone. It is impossible to imagine how difficult
such a decision would be”, acknowledges Amant.
Alongside this clinical work, Amant has a strong research
record. While still a registrar, his 1999 publication in the British
Journal of Obstetrics and Gynaecology of a randomised trial of
misoprostol for the prevention of post-partum haemorrhage
lay the foundation for larger scale trials. As well as driving
forward the agenda on cancer in pregnancy, he is an expert on
uterine cancer. “It is Frédéric’s ability to respectfully balance
strong personalities as Principal Investigator in groundbreaking
projects, as well as his generous contributions in
other collaborative studies, that make him to a true leader”,
says Helga B Salvesen, from the University of Bergen, Norway,
who co-founded the European Network for Individualized
Treatment in Endometrial Cancer with Amant. Eric de Jonge,
from the Department of Obstetrics and Gynaecology at
Ziekenhuis Oost-Limburg, Belgium, agrees. “Frédéric’s vision,
work ethic, and his ability to establish durable contacts based
on mutual professional respect have enabled him to build a
remarkable research network. Supported by unconditional
cooperation from his peers he drives ‘his’ pioneering project:
cancer and pregnancy.”

Tony Kirby
Frédéric Amant: leading the agenda on cancer in pregnancy
See Series pages 558,
570, and 580
See Lancet Oncol Online/Articles
For the University Hospitals
Leuven site on cancer in
pregnancy see http://www.
For European Society of
Gynaecological Oncology’s task
force on cancer in pregnancy
see http://www.esgo.org/

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