The experience of pregnancy and early motherhood in women diagnosed with gestational breast cancer

Lived Experiences of Pregnant Women With Cancer in South Korea: A Qualitative Study

PURPOSE

The incidence of cancer during pregnancy is increasing, presenting several challenges to the treatment of cancer in pregnant women. However, research focusing on the lived experiences of pregnant women with cancer in South Korea is limited. This study aimed to explore and describe the day-to-day lived experiences of women diagnosed with or treated for cancer during pregnancy and their husbands.

METHODS

The study employed a qualitative descriptive design and utilized purposive sampling to recruit participants. The participants comprised six women living in Korea diagnosed with cancer during pregnancy and one husband of a female participant. In-depth semi-structured interviews were conducted, audiotaped, and transcribed. Five of the participants agreed to a second interview, resulting in a total of 12 individual interviews. A thematic analysis was then performed. The participants' ages ranged from 31 to 40 years, and their diagnoses during pregnancy were either breast or thyroid cancer.

RESULTS

Four main themes were identified: (1) Participants faced various heart-breaking difficulties maintaining their pregnancies throughout cancer treatment; (2) Pregnant women with cancer experienced complex but responsible feelings toward their children; (3) Patients with cancer also fulfilled their roles as parents even with their own diseases; and (4) Family support had a significant impact on the pregnant women to overcome the path.

CONCLUSIONS

These findings provide a comprehensive understanding of the lived experiences of being diagnosed with cancer during pregnancy. A recommended strategy is to develop a nursing education program for pregnant women with cancer to provide necessary information and support, and to help them cope positively with their situation.

Cancer in pregnancy - The obstetrical management

Cancer in pregnancy, defined as a cancer diagnosed during pregnancy, is a rare but severe condition presenting both clinical and ethical challenges. During the last two decades a paradigm shift has occurred towards recommending similar staging and treatment regimens of pregnant and non-pregnant cancer patients. This strategy is a result of an increasing number of reassuring reports on chemotherapy treatment in pregnancy after the first trimester. The management of cancer in pregnancy should be managed in a multidisciplinary team where staging, oncological treatment, social and mental care, timing of delivery, and follow-up of the infant should be planned. Due to the rarity, centralization is recommended to allow experience accumulation. Furthermore, national and international advisory boards are supportive when there is a lack of expertise.

The Association Between Pregnancy Timing and Cumulative Exposure on Survival in Melanoma

BACKGROUND

As melanoma is common among young women, the impact of pregnancy on melanoma prognosis is of interest.

OBJECTIVE

The purpose of this study was to examine the association between pregnancy and survival in female melanoma patients of childbearing age.

METHODS

We performed a population-level, retrospective cohort study of women of childbearing age (18-45 years) diagnosed with melanoma from 2007 to 2017 using administrative data from Ontario, Canada. Patients were categorized according to pregnancy status (i.e. pregnancy before [conception from 60 to 13 months prior to melanoma], pregnancy-associated [conception 12 months prior to and after], and pregnancy after [conception 12 months after] melanoma). Cox models were used to examine melanoma-specific survival (MSS) and overall survival (OS) associated with pregnancy status.

RESULTS

Of 1312 women with melanoma, most did not experience pregnancy (84.1%), with 7.6% experiencing a pregnancy-associated melanoma and 8.2% experiencing a pregnancy after melanoma. Pregnancy before melanoma occurred in 18.1% of patients. Pregnancy before (hazard ratio [HR] 0.67, 95% confidence interval [CI] 0.35-1.28), associated (HR 1.15, 95% CI 0.45-2.97), and after melanoma (HR 0.39, 95% CI 0.13-1.11) was not associated with a difference in MSS compared with those who did not experience a pregnancy during these time periods. Pregnancy status was also not associated with a difference in OS (p > 0.05). Cumulative weeks pregnant were not associated with a difference in MSS (4-week HR 0.99, 95% CI 0.92-1.07) or OS (4-week HR 1.00, 95% CI 0.94-1.06).

CONCLUSIONS

In this population-level analysis of female melanoma patients of childbearing age, pregnancy was not associated with a difference in survival, suggesting that pregnancy is not associated with a worse melanoma prognosis.

What do we know about the psychosocial issues associated with cancer during pregnancy? A scoping review and gap analysis

OBJECTIVES

There is a global increase in the number of women diagnosed with cancer during their pregnancy and a nascent evidence base to guide their supportive care. The purposes of this study were to (1) map research on the psychosocial issues affecting women and their partners on diagnosis and treatment for cancer during pregnancy; (2) determine available supportive care or educational interventions; and (3) identify knowledge gaps for future research and development.

DESIGN

Scoping review.

SEARCH STRATEGY

Six databases were searched (Scopus, CINAHL, PsycINFO, Medline, Intermid, Maternal and Infant Health) to retrieve primary research (January 1995 to November 2021) investigating women and/or their partner's decision-making and their psychosocial outcomes during and after pregnancy.

DATA EXTRACTION AND SYNTHESIS

Sociodemographic, gestational and disease characteristics of participants and psychosocial issues identified were extracted. Leventhal's self-regulatory model of illness provided a framework for mapping study findings enabling evidence synthesis and gap analysis.

RESULTS

Twelve studies were included, conducted in eight countries in six continents. Most women (70% of 217) were diagnosed with breast cancer during pregnancy. Reporting of sociodemographic, psychiatric, obstetric and oncological characteristics that are important in assessing psychosocial outcomes was inconsistent. None of the studies had a longitudinal design and no supportive care or educational interventions were identified. The gap analysis highlighted the lack of evidence about pathways to diagnosis, impact of late effects and how internal/social resources may affect outcomes.

CONCLUSIONS

Research has focused on women with gestational breast cancer. Little is known about those diagnosed with other cancers. We encourage future study designs to capture data on sociodemographic, obstetric, oncological and psychiatric characteristics and adopt a longitudinal approach to explore the longer term psychosocial impact on women and their families. Future research should include outcomes that are meaningful for women (and their partners) and draw on international collaboration to accelerate progress in this field.

Capturing the lived experiences of women with lymphoma in pregnancy: a qualitative study

Lymphoma in pregnancy is a rare and challenging diagnosis that complicates ∼1:6000 pregnancies; posing a series of unique therapeutic, social, and ethical challenges to the patient, her family, and the medical professionals involved. These difficulties are compounded by the paucity of real-world data on the management of LIP, and a lack of relevant support systems for women in this setting. We conducted a retrospective multicenter qualitative study, interviewing women aged ≥18 years of age diagnosed with Hodgkin (HL) or non-Hodgkin lymphoma (NHL) during pregnancy or within 12 months postpartum, between 1 January 2009 and 31 December 2020 from 13 Australasian sites. Semi-structured telephone interviews were conducted, recorded, and analyzed using QSR Int NVivo 12 Pro (March 2020, USA) to quantify salient themes. Of the 32 women interviewed, 20 (63%) were diagnosed during pregnancy (16, 34, and 13% in the 1st, 2nd, and 3rd trimesters, respectively), while 12 (37%) were diagnosed post-partum. Women recalled that their chief concerns at diagnosis were the welfare of their child (n = 13, 41%) and a fear of dying (n = 9, 28%). Perceived diagnostic delay attributed to pregnancy was reported by 41% of participants. Other key themes were communication, educational materials, psychosocial supports, and oncofertility issues. To our knowledge this is the first report capturing the lived experiences of survivors of lymphoma during pregnancy, affording a unique opportunity to consider the management, psychosocial supports, and delivery of care to meet the needs of these women.What is the NEW aspect of your work? To our knowledge, this is the first report capturing and analyzing the healthcare experiences of survivors of Lymphoma in Pregnancy (LIP).What is the CENTRAL finding of your work? Women valued clear and empathic communication, provision of tailored educational materials, access to psychosocial supports (particularly childcare and financial supports), and timely oncofertility management in their healthcare journey.What is (or could be) the SPECIFIC clinical relevance of your work? Women's personal accounts of positive and negative experiences of LIP care provide insights into their specific concerns and needs which can shape healthcare policy and development of a specific framework for managing and supporting patients with LIP (and other cancers).

Prevalence of anxiety and depressive disorders in pregnant women with malignancy

OBJECTIVE

To examine national-level prevalence of anxiety and depressive disorders among pregnant women with malignancy.

METHODS

This is a pre-planned secondary analysis of a previous retrospective cohort study using the Healthcare Cost and Utilization Project's National Inpatient Sample. Study population was 14 648 135 deliveries including 10 145 patients with malignancy from 2016 to 2019. A multivariable binary logistic regression model was fitted to assess the association of malignancy and anxiety or depressive disorder.

RESULTS

Pregnant women with malignancy were 49% more likely to have the diagnosis of either anxiety or depressive disorder compared with those without malignancy (prevalence rate 114 vs. 61 per 1000 cases, adjusted odds ratio [aOR] 1.49, 95% confidence interval [CI] 1.40-1.58). The increase in the risk associated with malignancy on either anxiety or depressive disorder was more than two-fold among patients with brain and other nervous system tumors (aOR 2.69, 95% CI 2.01-3.60), bone and joint tumors (aOR 2.32, 95% CI 1.33-4.04), and leukemia (aOR 2.12, 95% CI 1.81-2.48).

CONCLUSIONS

This national-level analysis suggests that pregnant women with malignancy experience increased rates of psychological distress more often than pregnant women without malignancy.

Women's experiences of gestational breast cancer and their interactions with the healthcare system: A scoping review

AIM

To report the evidence of women's experiences following a diagnosis of gestational breast cancer (GBC) and their interactions with the healthcare system.

DESIGN

A systematic scoping review.

DATA SOURCES

This scoping review systematically searched Medline, CINAHL, Psych INFO, EMBASE and SCOPUS, in addition to six grey literature databases in October 2021. A 2020 PRISMA flow diagram depicting the flow of information.

REVIEW METHODS

Guided by six steps in Arksey and OMalley's Framework (2005). One researcher completed the literature review, and four independently screened the titles and abstracts related to the eligibility criteria.

RESULTS

Totalling 25 articles, these studies comprise 2 quantitative, 20 qualitative, 1 mixed-method and 2 other documents, a book and debate. Thematic analysis was guided by Braun and Clarke (2006) to identify an overarching theme of adjustment that underpinned women's narratives and was reinforced by four major and several minor themes. The four major themes were: psychological impact, motherhood, treatment and communication. The relationship between the themes contextualizes the enormous complexity concerning women's experiences with GBC.

CONCLUSION

Cancer management for GBC is complex and multifaceted. At a time of conflicting emotions for women, Multidisciplinary teams are well placed to provide support, normalize the woman's experience of motherhood, demonstrate an understanding of treatment effects, and communicate in a considerate and empathetic manner with information that is timely and relevant. GBC management involves doctors, nurses, midwives and many other healthcare professionals, which can add to the impost of diagnosis.

IMPACT

This scoping review contributes to a better understanding of women's experience of GBC. The results may inform improvements in the support and communication for these women with GBC and their families.

Exploring the psychological impacts of a gestational cancer diagnosis on women: a literature review

BACKGROUND

One in 1000 women are diagnosed with gestational cancer in the UK. Of these, the greatest number are breast cancer diagnoses. The rate of gestational cancer is expected to increase due to women choosing to become pregnant later in life.

AIMS

To explore the experiences of women with a gestational cancer diagnosis to identify how the support provided to them by the multidisciplinary team could be enhanced.

METHOD

A systematic literature review using Medline, CINAHL Complete and Complementary Index. Seven primary research articles were selected for in-depth analysis. Thematic analysis was completed and developed with academic and peer supervision.

FINDINGS

Three themes were identified: 'time pressures and decision-making, balanced with concerns for the health and wellbeing of the baby and self'; 'fears about parenting' and 'the influence of support'. Within all themes, distress was most commonly caused by poor or inconsistent communication between health professionals, which left women feeling disempowered and anxious about decision-making.

CONCLUSION

Women diagnosed with gestational cancer have unique support needs arising from receipt of a devastating diagnosis at what should be a happy time. The experience of being under the care of two discrete teams can result in uncertainty and distress when inconsistent messages about treatment are given. Support can be significantly enhanced by having a named midwife who attends all multidisciplinary team meetings about the woman concerned, who can assess for distress and who can signpost psychosocial support, based on the individual woman's needs.

Cancer during pregnancy: from the diagnosis to the repercussions on the family experience of maternity

OBJECTIVE

To investigate how the diagnosis of cancer during pregnancy occurred and assess its repercussions on the family experience of maternity.

METHOD

Qualitative research, based on Symbolic Interactionism and conducted according to the Grounded Theory method. Twelve women diagnosed with cancer during pregnancy and 19 of their family members participated in the study. Data was collected from March 2018 to March 2019, using an identification form and an in-depth interview. The analysis followed the stages of open substantive coding.

RESULTS

Data were organized into two categories of analysis: Being surprised by the discovery of cancer during pregnancy, which reveals the course of experiencing pregnancy and being diagnosed with cancer, Suffering from the repercussions of cancer on pregnancy and birth, which describes the repercussions of illness in the experience of pregnancy.

CONCLUSION

Cancer during pregnancy was diagnosed in young women based on signs and symptoms that were confused with those of pregnancy and postpartum. The illness brought anxiety, impotence, fear and affected the experience of maternity, as it prevented women from having their pregnancy as planned and required routines different from those of low-risk pregnancies.

Isolation experienced by women with gestational cancer: could peer support and tailored information be the answer?

Women diagnosed with cancer during pregnancy (gestational cancer) are a small but vulnerable population, with experts suggesting they require greater psycho-social support than either other women with cancer or other pregnant women. However, information on their psychological needs remains sparse. This commentary describes our work exploring the psychological needs of women diagnosed with gestational cancer, areas of unmet need we identified, and our recommendations for future programs and research. We conducted in-depth, semi-structured interviews with 23 Australian women diagnosed with gestational cancer in the preceding 5 years. Our findings depicted a group of women for whom cancer diagnosis and treatment had resulted in a sense of isolation and loneliness. Women reported seeking tailored information about their condition and treatments as well as one-on-one peer support with other gestational cancer survivors, which was challenging for them to access and which existing services struggled to provide. To address these unmet needs, innovative solutions may be necessary. Technology has the potential to connect and match women with one-to-one peer support, and research exploring the efficacy and acceptability of such interventions is required. Creative solutions, such as virtual resource hubs monitored or moderated by experts, would potentially meet the information needs of this group. However, as gestational cancer is relatively rare, the development and evaluation of such interventions would require a collaborative effort across multiple sites, as well as international collaboration and data pooling.

Shared Decision-Making Support Process for Healthcare Professionals for Pregnant Cancer Patients and Their Families

OBJECTIVE

The mean age of cancer diagnosis has decreased, while the mean age of first marriage and child delivery has increased in Japan in recent years. Accordingly, an increasing number of pregnant women are being diagnosed with cancer. Pregnant cancer patients must consider simultaneously receiving cancer treatment and continuing their pregnancy and make related decisions. Healthcare professionals (HCPs) who support patients and their families experience conflict over which care should be prioritized between that for the patient and that of the fetus. Supporting pregnant cancer patients and their families in such complicated situations is challenging. This study aimed to explore the process of support for continuing cancer treatment for, and pregnancy in, cancer patients, based on shared decision-making (SDM) between the patient, her family, and HCPs.

METHODS

This was a qualitative, descriptive study carried out with six nurses, five clinicians, and three obstetricians with experience of providing decision-making support to a pregnant cancer patient and her family. Individual interviews and a focus group interview were conducted.

RESULTS

We identified ten categories, of which the following five are integral to the process of providing support for pregnant cancer patients: "Preparing for SDM with the patient and her family;" "HCPs working in a team while clarifying their individual roles and responsibilities;" "confirming the intentions of the patient and her family in setting the orientation;" "improving the system for HCPs to provide support to the patient during cancer treatment," and "providing the patient with support that helps her make informed decisions."

CONCLUSIONS

Decision-making support is provided to both the patient and her family, and HCPs work in teams to provide support. Moreover, HCPs continue to provide support to the patient and her family after a decision has been made.

Psychological Adjustment in the Context of Perinatal Cancer

Aims: To assess the influence of pregnancy and recent motherhood on the psychological adjustment to cancer in women diagnosed with a perinatal cancer. Procedure: ECHOCALG is an exploratory and comparative study combining quantitative and qualitative methods. Twenty-four women who had received a perinatal cancer diagnosis (75% had breast cancer, 25% had brain or colon cancer, Hodgkin or melanoma) completed the MAC44 scale and responded to a semi-structured clinical interview to identify the psychological adjustment to cancer. Eighteen of them responded to a semi-structured interview to identify the conditions of psychological adaptation to the disease, as well as the defense mechanisms used. The data were compared with that of a control group of nineteen women diagnosed with non-perinatal and non-metastatic breast cancer, aged less than 45.

Results: Women diagnosed with perinatal cancer showed more difficulty adjusting to the disease than control women. Denial and avoidance are strongly correlated with a negative adjustment to cancer. The interviews showed at the start of treatment the presence of defense mechanisms such as denial and trivialization as well as a suspension of the process of psychological adaptation to the disease and the treatments. The distress of a mother is linked to the feeling of being unable to take care of the baby and to cope concomitantly with motherhood and illness, as well as difficulties related to sexuality and emotional and social support.

Conclusion: Pregnancy and recent motherhood have an impact on the adjustment to cancer. Women with perinatal cancer show a negative adjustment and an important psychological distress linked to difficulties of mothering and physical and emotional consequences of treatment.

"Lights and Shadows": An Interpretative Phenomenological Analysis of the Lived Experience of Being Diagnosed With Breast Cancer During Pregnancy

Cancer diagnosed during pregnancy is a rare event. The most common type of malignancy diagnosed in pregnant women is breast cancer, whose incidence is expected to raise in the next future due to delayed childbirth, as well as to the increased occurrence of the disease at young age. Pregnant women diagnosed with breast cancer are exposed to multiple sources of stress, which may lead to poorer obstetric outcomes, such as preterm birth and low birth weight. In addition, pregnancy involves physiological changes in the breasts that may blur the signs of cancer, with delayed diagnosis and poor prognosis. However, the lived experience of these women was investigated in very few studies. Given this scenario, we conducted this qualitative study to describe and understand women’s subjective experience of being diagnosed with breast cancer during pregnancy. The study was conducted following the principles of Interpretative Phenomenological Analysis. Participants were five women with breast cancer diagnosed during pregnancy, purposefully recruited at a public hospital during medical visits and interviewed at treatment initiation. The interview transcripts were analyzed using thematic analysis. The textual analysis led to the identification of three main themes related to: (1) the emotional storm experienced after cancer diagnosis, and the importance of receiving appropriate information and being focused on treatment decisions; (2) physical changes and comparisons with healthy women, associated with feelings of sadness and inadequacy; (3) being positive, feeling free to disclose all kinds of emotions, religion and spirituality as sources of strength. The paradoxical coexistence of pregnancy and cancer represents a stressful experience for women and their loved ones. Adopting a systemic perspective may be important to understand the effects of such a complex condition, also considering its impact on healthcare workers.

Cancer during pregnancy: A qualitative study of healthcare experiences of Australian women

OBJECTIVES

To identify features enhancing the quality of healthcare experiences for women with gestational cancer, and explore the impact of the heterogeneous Australian healthcare system on those experiences.

METHODS

Semi-structured, qualitative interviews were conducted with women diagnosed with any cancer during pregnancy in the last five years. Recruitment occurred during 2018-2019 via social media and professional, clinical and community networks. Questions related to women's experiences of their healthcare, wellbeing and psychosocial needs. Interviews were analysed thematically.

RESULTS

Study participants (n = 23) received treatment in the private sector (n = 10), public sector (n = 8), or both (n = 5). Five interview themes were found: Control over healthcare; Trust in clinicians, hospitals and systems; Coordination of care; An uncommon diagnosis; Holistic, future-oriented care. Women were most likely to have had a positive healthcare experience when (a)care was well-coordinated and adjusted to meet their unique needs/challenges, and (b)women perceived their care went beyond their immediate medical needs and encompassed future psychosocial wellbeing, including preparation for postpartum challenges.

CONCLUSION

Existing 'usual care' in the public and/or private sector for both the pregnancy and the cancer is insufficient to meet these women's needs. Prioritising psychological wellbeing including psychosocial needs, and communication and planning around fertility and postnatal challenges are essential for this population.

"Part of the Ritual": Exploring Patient and Physician Decision Making Regarding Anticoagulation Use in Obstetric Antiphospholipid Syndrome

BACKGROUND

 Antiphospholipid syndrome is associated with recurrent pregnancy loss. Low-molecular-weight heparin (LMWH) and/or aspirin (ASA) prophylaxis during pregnancy to prevent future loss is based on limited trial data with mixed results.

OBJECTIVES

 Given the clinical equipoise, we sought to understand how patients and physicians navigate the decision-making process for use of LMWH and/or ASA in pregnancy.

METHODS

 We interviewed 10 patients and 10 thrombosis physicians in Ottawa, Canada from January 2017 to March 2018. Patients who had ≥1 late pregnancy loss or ≥2 early losses and persistently positive antiphospholipid antibodies based on the revised Sapporo/Sydney criteria were identified in the a Thrombosis Clinic. Patients were also identified by the TIPPS Study screening logs of excluded patients. Data collection and analysis occurred iteratively, in keeping with constructivist grounded theory methodology.

RESULTS

 Our analysis generated three themes, present across both patient and physician interviews, which captured a patient-led decision-making experience: (1) managing high stakes, (2) accepting uncertainty, and (3) focusing on safety. Patients and physicians acknowledged the high emotional burden and what was at stake: avoiding further pregnancy loss. Patients responded to their situation by taking action (i.e., using LMWH injections became a "ritual"), whereas physicians reacted by removing themselves from the final decision by "[leaving] it up to the patient."

CONCLUSION

 Our findings should be considered when designing future research on studying the role for LMWH/ASA in this population, as it suggests that the perceived benefits of treatment go beyond improving pregnancy rates. Rather, patients described potential benefit from the process of taking action, even in the absence of a guaranteed good outcome.

The Experiences and Support Needs of Women With Gestational Breast Cancer in Singapore: A Descriptive Qualitative Study

BACKGROUND

Gestational breast cancer is diagnosed during pregnancy or within the first postpartum year. There is a lack of studies on the experiences of ethnically diverse Asian women with gestational breast cancer.

OBJECTIVE

The aim of this study was to explore the experiences of Asian women with gestational breast cancer so necessary support can be rendered.

METHODS

This qualitative descriptive study used purposive sampling to recruit 7 women with gestational breast cancer who were following up at the breast center of a tertiary women's hospital in Singapore. Semistructured, individual, face-to-face, audio-recorded interviews were used to explore the in-depth experiences of these women. Data were transcribed verbatim and analyzed using thematic analysis.

RESULTS

Three main themes emerged from the thematic analysis: (1) being a sick woman, (2) juggling between being a mother and a patient, and (3) seeking normalcy. Women had to contend with disruptive changes from gestational breast cancer, both emotionally and physically. They were constantly distressed by their altered body images, and family support was vital to help these women cope with their treatments. Alternative support sources included healthcare professionals and the Internet.

CONCLUSION

Gestational breast cancer experiences varied based on the women's encounter perceptions and existing support. Their experiences may be improved through further support to mediate their coping efforts. Future quantitative and qualitative research should explore and evaluate the various aspects of the long-term disease and psychosocial effects of gestational breast cancer.

IMPLICATIONS FOR PRACTICE

Hospitals should include support strategies in antenatal classes and postnatal workshops to lessen disruptions of the motherhood experiences.

Psychological aspects of gestational cancer: A systematic review

OBJECTIVE

Gestational cancer is defined as any type of cancer diagnosed during pregnancy or within 12 months of delivery. To date, existing studies on the psychological aspects of this type of cancer have not been evaluated for methodological quality. The aim of this systematic review was to identify the psychological aspects of gestational cancer.

METHODS

Five journal databases were searched to identify peer-reviewed articles reporting upon the psychological aspects of women with gestational cancer. Studies published from journal inception to December 2019 were included, and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. The Mixed-Method Appraisal Bias Tool was used, to assess the methodological quality of the studies. A narrative description was developed for the psychological outcomes reported in quantitative studies. Qualitative data was synthesized using thematic analysis.

RESULTS

Five papers were eligible for inclusion (two qualitative and three quantitative studies). Factors that contributed to women's psychological distress during gestational cancer included disease characteristics, sociodemographic factors, the baby's health, pregnancy-related factors and cognitive emotion regulation. Four main themes emerged from the qualitative studies; concerns about the baby's health, lost opportunities, "not fitting in," and healthcare decision-making.

CONCLUSIONS

These findings suggest that (a) women with gestational cancer experience psychological distress that is associated with concerns about their babies' health, and (b) their healthcare experiences are affected by communication within multidisciplinary care teams.

Psychological Aspects of Pregnancy and Lactation in Patients with Breast Cancer

Young breast cancer patients face numerous challenges during the cancer trajectory. As in the last decade, women tend to delay pregnancies to a later time in life, and clinicians are often faced with young breast cancer patients who want to start a family or complete it. Becoming a mother is a delicate developmental process in which the woman redefines and restructures her identity as she gets prepared for her new role and responsibilities. When there is a history of cancer or cancer diagnosis is communicated during the pregnancy, fears, worries, and concerns emerge and specific support may be necessary. Follow-ups during the post-partum period are also recommended as lactation issues should not be overlooked. In this chapter, we analyze the psychological aspects of cancer survivors and women with pregnancy-associated breast cancer, and the management of these issues.

Motherhood during or after breast cancer diagnosis: A qualitative study

OBJECTIVE

Little is known about the process of becoming a mother in women who experienced a breast cancer diagnosis (BC). In this qualitative study, we investigated maternal representations in pregnant women with experience of BC and those with no oncological history.

METHODS

A total of 38 women were recruited, 19 women who experienced a BC diagnosis and 19 who had not. To explore maternal representations, semi-structured interviews were conducted and analysed through thematic analysis.

RESULTS

Four main themes were identified: fears and worries, meaning of motherhood, mother-foetus relationship and partner support. Across themes, differences between primiparous and multiparous are reported. Women with gestational breast cancer (GBC) described fear for their own and their child's survival. Women with previous BC recall contrasting emotions. All women with experience of BC perceived breastfeeding as fundamental and inability to do so provoked worry. Relationship with the partner was considered central, while healthy women were projected towards the future triadic relationship.

CONCLUSIONS

Finding a mental space during pregnancy for the representation of the future child could be hard for women with GBC. Dissimilarities in the experience of motherhood in cancer patients provide insight into psychological aspects that should be taken into account in clinical practice.

The Lived Experience of Australian Women Living with Breast Cancer: A Meta-Synthesis

BACKGROUND

Breast cancer is the second most common cancer among Australian women. In 2019, an estimated
19,000 women in Australia were diagnosed with breast cancer, with around 3,058 women dying from the disease in the
same year. Although many qualitative studies published in Australia exist which examine breast cancer from various
perspectives, only limited literature is available which addresses Australian women's lived experience of breast cancer
from diagnosis, treatment and beyond.

METHOD

Meta-synthesis of qualitative studies. Participants who took part in
either semi-structured interviews or surveys with open-ended questions were included. A thematic synthesis analysis
approach was used.

RESULTS

Five themes and 13 sub themes emerged from the data analysis which illustrated the lived
experience of Australian women diagnosed with breast cancer. Emotional burden and women's response towards their
breast cancer diagnosis were key themes. Experience of decision- making , social distress, symptoms beyond changes
in their body, fertility considerations and their role as mothers were some of the challenges during their treatment.
Women coped and adjusted with these challenges through the support of their family, and healthcare providers. Women
developed greater empowerment by making their life choices after treatment. Life choices such as getting into a new
relationship was challenging for single women.

CONCLUSION

Although most women were emotionally supported
following their diagnosis, there are still areas where women could be better supported such as when having to break
the news of their breast cancer diagnosis to their children, provision of ongoing emotional support for caregivers of
women with breast cancer, providing constant emotional and informational support at the point of diagnosis and during
their treatment, tailoring treatments according to different stages of pregnancy, and discussion of fertility treatments
in timely manner by healthcare professionals.

Experience of Japanese pregnant women with cancer in decision-making regarding cancer treatment and obstetric care

AIM

Women who are diagnosed with cancer during pregnancy must make difficult, life-changing decisions that affect their own life and that of their fetus. The psychological impact of distress and anxiety resulting from facing often conflicting choices can greatly influence survival in these women. We conducted this study to clarify the experience of pregnant women with cancer in decision-making and to consider the role of nurses in providing care to pregnant women with cancer during their decision-making.

METHODS

This qualitative study included post-partum Japanese women diagnosed with cancer who had made any treatment or pregnancy decisions. Data collection was conducted using semi-structured interviews and medical record review. Data were analyzed using qualitative content analysis and classified into subcategories, categories, themes, and phases.

RESULTS

Participants comprised eight women with leukemia and cervical, breast, and digestive cancers. The decision-making experiences of these eight pregnant women with cancer were categorized into three phases: the interaction between the woman and her fetus, family members, and medical staff; confrontation with dilemma and uncertainty; and redefinition of the women's own decisions.

CONCLUSIONS

The experience of Japanese pregnant women with cancer in decision-making has two aspects: verbal and nonverbal communication with their surroundings and reflection. The role of a nurse is to guarantee these women continuous communication channels and frank dialogue, to empower them in expressing their thoughts and informational needs to medical staff and family members.

Management of pregnancy-associated pancreatic cystic tumors: Review of the literature and results of a Pancreas Club Inc. Survey

BACKGROUND/OBJECTIVES

Management of patients with pregnancy-associated cyst pancreatic cystic tumors (PA-PCT) is complicated by lack of large series.

METHODS

A systematic literature review was conducted to extrapolate data on management of PA-PCT, and make a questionnaire on pending issues to be administered to the members of the Pancreas Club Inc.

RESULTS

The literature review demonstrated a total of 35 PA-PCT in 34 women, described exclusively in the form of case reports, and permitted the identification of eleven key questions to be addressed in the survey. The combined analysis of literature review and survery responses provided several information. First, PA-PCT are predominantly located in the body-tail of the pancreas, cause non-specific symptoms, are of large size (mean size: 11.2 ± 4.5 cm), and are nearly always malignant or premalignant, making timing of surgery, and not indication for surgery, the main issue in the management of these tumors. Second, there is a risk of PA-PCT rupture during pregnancy. Ruptured PA-PCT had a mean size 13.5 ± 4.9 cm, but no prognostic factor could be identified. Survey opinions suggested that this occurrence is quite rare, even for large tumors. Third, most pregnancies were conducted to term (mean gestational age: 40.5 ± 0.7 weeks), with a vaginal delivery. Fourth, all procedures were carried out through an open approach and the spleen was rarely preserved. Survey indicated instead that laparoscopy could play a role, and that the spleen should be preserved when feasible.

CONCLUSIONS

PA-PCT require individualized treatment. The definition of a management algorithm requires the implementation of an International Registry.

Psychological issues and construction of the mother-child relationship in women with cancer during pregnancy: a perspective on current and future directions

Background

Cancer during pregnancy is a rare event. However, knowledge about treatment has progressed in recent years with improved maternal and neonatal outcomes. The number of women who decide to continue their pregnancy and undergo cancer treatment is increasing.

Main body

Women face two critical events simultaneously; oncological illness and pregnancy, with different and conflicting emotions. In addition, the last trimester of gestation sets the ground for construction of the mother-child relationship, which is of great importance for the child’s development. Studies have showed that maternal exposure to stressful events during pregnancy is linked to adverse outcomes in children. Although several authors consider cancer to be a ‘critical life event’, studies that address the psychosocial implications of cancer in expecting mothers are scarce. There are no studies addressing the possible negative impact of a cancer diagnosis during pregnancy on the mother-child relationship and on the child’s development. It is important to emphasize the need for in-depth knowledge of the contributing psychological factors involved in order to provide holistic, individualised, and supportive care.

Conclusion

An analysis of cognitive aspects, emotional processes, and maternal attachment in cases of cancer during pregnancy may contribute to the development of a model of care, both in an evolutionary and in a psycho-oncology context, with implications for clinical practice.

Meanings of abortion in context: accounts of abortion in the lives of women diagnosed with breast cancer

BACKGROUND

A breast cancer diagnosis and an abortion can each be pivotal moments in a woman's life. Research on abortion and breast cancer deals predominantly with women diagnosed during pregnancy who might be advised to have an abortion. The other-discredited but persistent-association is that abortions cause breast cancer. The aim here was to understand some of the ways in which women themselves might experience the convergence of abortion and breast cancer.

METHODS

Among 50 women recruited from the Australian Breast Cancer Family Study and interviewed in depth about what it meant to have a breast cancer diagnosis before the age of 41, five spontaneously told of having or contemplating an abortion. The transcripts of these five women were analysed to identify what abortion meant in the context of breast cancer, studying each woman's account as an individual "case" and interpreting it within narrative theory.

RESULTS

It was evident that each woman understood abortion as playing a different role in her life. One reported an abortion that she did not link to her cancer, the second was relieved not to have to abort a mid-treatment pregnancy, the third represented abortion as saving her life by making her cancer identifiable, the fourth grieved an abortion that had enabled her to begin chemotherapy, and the fifth believed that her cancer was caused by an earlier abortion.

CONCLUSIONS

The women's accounts illustrate the different meanings of abortion in women's lives, with concomitant need for diverse support, advice, and information.

The psychosocial experiences of women with breast cancer across the lifespan: a systematic review

OBJECTIVE

To summarize the psychosocial experience of women with breast cancer from a lifespan perspective by examining the findings of qualitative studies.

METHODS

A meta-aggregate review of 24 qualitative studies was undertaken. To be included, studies must include women with a breast cancer diagnosis and focus on younger or older women (as defined by the study), or compare a psychosocial issue across the lifespan. Eight databases were searched systematically.

RESULTS

Study participants ranged in age from 26 to 91 years. Sixteen studies focused on younger women, six focused on older women, and two included women across the lifespan. A total of 155 findings were extracted from the studies and were aggregated into 11 categories. These were synthesized into four synthesized findings: (a) dealing with cancer, (b) the importance of caring, (c) the aftermath of cancer, and (d) fertility and infertility.

CONCLUSIONS

Further research is required to explore these findings, and to examine the needs of older women in particular. Delineating the similarities and differences in the needs of women across the lifespan will inform the development of psychosocial interventions for all women with breast cancer.

Misunderstood as mothers: women's stories of being hospitalized for illness in the postpartum period

AIM

This paper aims to explore women's experiences with healthcare providers to ascertain ways health care may be improved for women disrupted in their mothering.

BACKGROUND

Women can find it difficult to relinquish care even when they are acutely unwell requiring hospitalization. Despite mothering being a priority for women, many healthcare professionals do not understand the importance of continuing to mother during maternal illness.

DESIGN

This research used a qualitative methodology drawing on principles of feminism and storytelling.

METHODS

Women's stories were collected through face-to-face interviews, email and via the telephone. The twenty-seven women who participated were from either Australia or the USA, had between one and six children and identified themselves as having been disrupted in their mothering by illness. Data were collected in 2011 and were analysed thematically.

FINDINGS

The majority of participants had been hospitalized at some point in time for acute illness. A subset of participants reported feeling judged by nurses and that their efforts to continue to mother their newborn children despite their illness were misunderstood and not facilitated.

CONCLUSION

Findings from this study suggest that women are more likely to remember times that health professionals failed to understand the primacy that mothering held for them or facilitate their efforts to continue to mother despite illness. Nurses and midwives should regularly reflect on their personal values in regard to mothering, validate women's attempts to mother to the best of their ability during illness and find ways to support and empower women in their mothering.

Psychosocial impact of a cancer diagnosis during pregnancy

Although a rare occurrence, cancer is sometimes diagnosed during or shortly after pregnancy. This article reviews two recent studies that specifically examine the psychosocial impact of a cancer diagnosis during pregnancy. Researchers have identified risk factors that may exacerbate women's anxiety, stress or distress during these co-occurring events. Nurses are in a unique position to support women dealing with a cancer diagnosis during pregnancy.