Counseling and surveillance of obstetrical risks for female childhood, adolescent, and young adult cancer survivors: recommendations from the International Late Effects of Childhood Cancer Guideline Harmonization Group
Year: 2020
Type: article
Abstract: Female childhood, adolescent, and young adult cancer survivors have an increased risk of adverse pregnancy outcomes related to their cancer- or treatment-associated sequelae. Optimal care for childhood, adolescent, and young adult cancer survivors can be facilitated by clinical practice guidelines that identify specific adverse pregnancy outcomes and the clinical characteristics of at-risk subgroups. However, national guidelines are scarce and vary in content. Here, the International Late Effects of Childhood Cancer Guideline Harmonization Group offers recommendations for the counseling and surveillance of obstetrical risks of childhood, adolescent, and young adult survivors. A systematic literature search in MEDLINE database (through PubMed) to identify all available evidence published between January 1990 and December 2018. Published articles on pregnancy and perinatal or congenital risks in female cancer survivors were screened for eligibility. Study designs with a sample size larger than 40 pregnancies in childhood, adolescent, and young adult cancer survivors (diagnosed before the age of 25 years, not pregnant at that time) were eligible. This guideline from the International Late Effects of Childhood Cancer Guideline Harmonization Group systematically appraised the quality of available evidence for adverse obstetrical outcomes in childhood, adolescent, and young adult cancer survivors using Grading of Recommendations Assessment, Development, and Evaluation methodology and formulated recommendations to enhance evidence-based obstetrical care and preconception counseling of female childhood, adolescent, and young adult cancer survivors. Healthcare providers should discuss the risk of adverse obstetrical outcomes based on cancer treatment exposures with all female childhood, adolescent, and young adult cancer survivors of reproductive age, before conception. Healthcare providers should be aware that there is no evidence to support an increased risk of giving birth to a child with congenital anomalies (high-quality evidence). Survivors treated with radiotherapy to volumes exposing the uterus and their healthcare providers should be aware of the risk of adverse obstetrical outcomes such as miscarriage (moderate-quality evidence), premature birth (high-quality evidence), and low birthweight (high-quality evidence); therefore, high-risk obstetrical surveillance is recommended. Cardiomyopathy surveillance is reasonable before pregnancy or in the first trimester for all female survivors treated with anthracyclines and chest radiation. Female cancer survivors have increased risks of premature delivery and low birthweight associated with radiotherapy targeting the lower body and thereby exposing the uterus, which warrant high-risk pregnancy surveillance.
Authors: Anne-Lotte Lolkje Femke van der Kooi, Renee L. Mulder, Melissa M. Hudson, Leontien C.M. Kremer, Rod Skinner, Louis S. Constine, Wendy van Dorp, Eline van Dulmen-den Broeder, Jeanette Falck-Winther, W. Hamish Wallace, Jason Waugh, Teresa K. Woodruff, Richard A. Anderson, Saro H. Armenian, Kitty W.M. Bloemenkamp, Hilary O.D. Critchley, Charlotte Demoor-Goldschmidt, Matthew J. Ehrhardt, Daniel M. Green, William A. Grobman, Yuriko Iwahata, Iris Krishna, Joop S.E. Laven, Gill Levitt, Lillian R. Meacham, Emily S. Miller, Annemarie Mulders, Angela Polanco, Cécile M. Ronckers, Amber Samuel, Tom Walwyn, Jennifer M. Levine, Marry M. van den Heuvel-Eibrink
Institutions: Erasmus MC, Princess Máxima Center, Erasmus University Rotterdam, St. Jude Children's Research Hospital, Emma Kinderziekenhuis, Amsterdam University Medical Centers, University of Amsterdam, Great North Children's Hospital, Newcastle University, University of Rochester Medicine, University of Rochester, Aarhus University, Danish Cancer Society, Royal Hospital for Children, Royal Hospital for Sick Children, University of Auckland, Northwestern University, MRC Centre for Reproductive Health, University of Edinburgh, City Of Hope National Medical Center, City of Hope, Utrecht University, University Medical Center Utrecht, Wilhelmina Children's Hospital, Université Paris-Sud, Centre de recherche en Epidémiologie et Santé des Populations, Centre Hospitalier Universitaire d'Angers, St. Marianna University School of Medicine, Emory University, National Health Service, Great Ormond Street Hospital, Great Ormond Street Hospital for Children NHS Foundation Trust, Children's Healthcare of Atlanta, Coventry University, Medizinische Hochschule Brandenburg Theodor Fontane, Munroe Regional Medical Center, Renown Regional Medical Center, Cheyenne Regional Medical Center, Princess Margaret Hospital for Children, Perth Children's Hospital, Weill Cornell Medicine
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,900
Award: G7818575306
OpenAlex ID: W3033028736