Maternal Cancer Diagnosis Research Articles

School performance and educational achievement in children exposed to maternal cancer in utero

BackgroundIn utero exposure to maternal cancer and cancer treatment might influence the child’s cognitive development. This study investigated if exposure to maternal cancer during fetal life impacted school performance and...

Long-Term Morbidity and Mortality in Children After In Utero Exposure to Maternal Cancer.

In utero exposure to maternal cancer and cancer treatment might influence the child's short- and long-term health and development. The objective of the study was to investigate short- and long-term somatic and psychiatric outcomes in children exposed to maternal cancer in utero. This nationwide cohort study identified all liveborn children in Denmark between January 1978 and December 2018. Exposure was defined as maternal cancer diagnosis during pregnancy, and in a subgroup analysis, exposure to chemotherapy in utero. The main outcomes of interest were overall mortality, somatic diagnoses, and psychiatric diagnoses identified in the National Health Registers. Follow-up started at birth and ended at an event, death, emigration, or end of 2018. Hazard ratios of end points adjusted for potential confounders were estimated using Cox regression analysis. Of 2,526,163 included liveborn children, 690 (0.03%) were exposed to maternal cancer in utero. Compared with unexposed fetuses, children exposed in utero had no higher overall mortality, adjusted hazard ratio 0.8 (95% CI, 0.4 to 1.5), nor increased risk of congenital malformations, overall somatic or psychiatric disease. During the period 2002-2018, of 378 (0.03%) children exposed to cancer in utero, 42 (12.5%) were exposed to chemotherapy. Among these 42 children, in utero exposure to chemotherapy was not associated with selected somatic diseases nor to congenital malformations when compared with in utero exposure to maternal cancer without chemotherapy. Overall, findings did not indicate excess risk of mortality or severe morbidity among children exposed to cancer in utero. Fetal exposure to chemotherapy was not associated with adverse health outcomes in childhood.

Child development at 6 years after maternal cancer diagnosis and treatment during pregnancy

BackgroundData on the long-term effects of prenatal exposure to maternal cancer and its treatment on child development are scarce. MethodsIn a multicenter cohort study, the neurologic and cardiac outcomes of 6-year-old children born to women diagnosed with cancer during pregnancy were compared with the outcome of children born after an uncomplicated pregnancy. Assessment included clinical evaluation, comprehensive neuropsychological testing, electrocardiography and echocardiography. ResultsIn total, 132 study children and 132 controls were included. In the study group, 97 children (73.5%) were prenatally exposed to chemotherapy (alone or in combination with other treatments), 14 (10.6%) to radiotherapy (alone or in combination), 1 (0.8%) to trastuzumab, 12 (9.1%) to surgery alone and 16 (12.1%) to no treatment. Although within normal ranges, statistically significant differences were found in mean verbal IQ and visuospatial long-term memory, with lower scores in the study versus control group (98.1, 95% confidence interval [CI]: 94.5–101.8, versus 104.4, 95% CI: 100.4–108.4, P = 0.001, Q < 0.001 [Q refers to the false discovery rate adjusted P value], and 3.9, 95% CI: 3.6–4.3, versus 4.5, 95% CI: 4.1–4.9, P = 0.005, Q = 0.045, respectively). A significant difference in diastolic blood pressure was found, with higher values in chemotherapy-exposed (61.1, 95% CI: 59.0 to 63.2) versus control children (56.0, 95% CI 54.1 to 57.8) (P < 0.001, Q < 0.001) and in a subgroup of 59 anthracycline-exposed (61.8, 95% CI: 59.3 to 64.4) versus control children (55.9, 95% CI: 53.6 to 58.1) (P < 0.001, Q = 0.02). ConclusionsChildren prenatally exposed to maternal cancer and its treatment are at risk for lower verbal IQ and visuospatial long-term memory scores and for higher diastolic blood pressure, but other cognitive functions and cardiac outcomes were normal at the age of 6 years. Clinical trial registrationThe study is registered at ClinicalTrials.gov, NCT00330447.

Data describing child development at 6 years after maternal cancer diagnosis and treatment during pregnancy.

This manuscript is an accompanying resource of the original research article entitled “Child development at 6 years after maternal cancer diagnosis and treatment during pregnancy” and present data that compare the outcome of 6-year-old-children born to women diagnosed with cancer during pregnancy (with or without treatment during pregnancy) (study group) with children born after an uncomplicated pregnancy (control group). Oncological, obstetrical and neonatal data were collected. Neurodevelopment was examined by clinical evaluation and neuropsychological testing (including intelligence, attention and memory tests) and by general health and behavior questionnaires. Cardiac evaluation included electro- and echocardiography. Univariate analyses of covariance were used to investigate between-group differences. A subgroup analysis was performed in chemotherapy-exposed children versus controls and anthracycline-exposed versus controls. Additionally, the incidence of behaviour problems was compared to matched controls for children whose mothers died and for those with surviving mothers.

1830P - Child development at 6 years after maternal cancer diagnosis and treatment during pregnancy

BackgroundData on the long-term effects of prenatal exposure to maternal cancer and its treatment on child development are scarce. MethodsIn a multicentre cohort study, the neurologic and cardiac outcomes of 6-year-old children born to women diagnosed with cancer during pregnancy (study group) were compared to the outcome of children born after an uncomplicated pregnancy (control group) (ClinicalTrials.gov, NCT00330447). Neurodevelopment was assessed by clinical evaluation and neuropsychological testing (including intelligence, attention and memory tests) and by general health and behaviour questionnaires. Cardiac evaluation included electro- and echocardiography. ResultsIn total, 132 study children and 132 controls (mean age 6.2 years) were included. In the study group, 97 children (73.5%) were prenatally exposed to chemotherapy (alone or in combination with other treatments), 14 (10.6%) to radiotherapy (alone or in combination), 1 (0.8%) to trastuzumab, 12 (9.1%) to surgery alone and 16 (12.1%) to no treatment. Although within normal ranges, the mean Verbal IQ score was significantly lower in the study versus control group (98.9 vs 103.0, p=0.001, q<0.001). Also, children in the study group had a significantly lower score for visuospatial long-term memory compared to the control group (3.9 vs 4.5, p=0.005, q=0.043). No significant differences were found in Full Scale IQ, Performance IQ, Processing Speed, memory span, verbal and visuospatial short-term memory, attention and behaviour problems or in cardiac dimensions and left ventricular function. ConclusionsChildren prenatally exposed to maternal cancer and its treatment may be at risk for lower Verbal IQ and visuospatial long-term memory scores, but other cognitive functions and cardiac outcomes were normal at the age of 6 years. Clinical trial identificationNCT00330447. Legal entity responsible for the studyUniversity Hospitals Leuven, Belgium. FundingEuropean Union’s Horizon 2020 research and innovation programme under grant agreement No. 647047, Research Foundation-Flanders (F.W.O)., Stichting tegen Kanker, Belgian Cancer Plan, Koningin Wilhemina Fonds (K.W.F.), Kom Op Tegen Kanker, Stichting Mitialto and Charles University grant Progres Q-34. DisclosureAll authors have declared no conflicts of interest.

Individual predictors of adolescent adjustment to maternal cancer: The role of perceived stress, coping, social support, attachment, and self-efficacy.

Cancer is among the leading causes of morbidity and mortality around the world. The National Cancer Registry of Ireland reported in 2015 that there were 9312 new cases of female cancers per year, breast cancer being the most common type diagnosed. Research has identified that parental cancer is a stressful situation that can have a strong impact on adolescents' lives; however, some adolescents can turn a negative event into a way of enhancing their skills and psychological resources. This variability needs to be explored further to identify how individual differences contribute to different adjustment experiences for adolescents whose mothers are diagnosed with cancer, namely differences in adolescent coping, self-efficacy, social support, life satisfaction, and attachment. The objective of this study was to examine the relative impact of perceived stress, coping, perceived social support, maternal attachment, and self-efficacy on adolescent adjustment (mood and life satisfaction). Data was collected from 40 adolescents within 38months of a maternal cancer diagnosis. They completed online questionnaires assessing perceived stress, coping, perceived social support, attachment, self-efficacy, and adjustment (life satisfaction, negative affect, positive affect, depression, and anxiety). Hierarchical regression analyses showed that perceived stress and coping were the strongest predictors of adjustment explaining variance on all adjustment indices. Maternal attachment, perceived social support, and self-efficacy were less powerful predictors of adjustment. The model, however, failed to explain any variance on depression and anxiety. Moderation analyses revealed that social support moderated the relationship between perceived stress and positive affect for adolescents with high levels of perceived social support. Findings show that lower perceived stress and positive coping were the best predictors of adjustment in adolescents facing maternal cancer. Results suggest that adolescents could be screened for levels of perceived stress and coping style to identify adolescents who are at risk of poor adjustment when they are adjusting to maternal cancer.

Congenital malformation in offspring of female cancer survivors: a national cohort study.

Current evidence on congenital malformations in the offspring of cancer survivors is largely inconsistent. Therefore, through this study we aimed to explore the prevalence of congenital malformations in the offspring of cancer survivors. To this end, female cancer survivors were identified from the Swedish Cancer Register and were further linked to the Swedish Medical Birth Register and Hospital Discharge Register to identify congenital malformation in their children at birth or during adulthood between 1987 and 2010. Multivariate logistic regression was used to estimate odds ratios and 95% confidence intervals for the association between congenital malformation and maternal cancer diagnosis. A total of 816 congenital malformations were noted among 9266 children of maternal cancer survivors, and the rate was 8.8%, whereas the rate in the general population was 7.7%. After adjusting for some confounding factors, we found that the risk for congenital malformation in children of cancer survivors was significantly increased with an odds ratio of 1.11 and 95% confidence interval of 1.04-1.20 as compared with that in controls. The increased risk was largely consistent irrespective of maternal age at diagnosis of cancer. The risk for congenital malformation was increased among offspring of female cancer survivors, which calls for further attention directed toward those cancer survivors who plan to have children.

Protecting: A Grounded Theory Study of Younger Children's Experiences of Coping With Maternal Cancer.

A diagnosis of parental cancer affects all members of the family unit, especially young school-age children. Few studies, however, have explored children's experiences at the time when their parents are actually receiving treatment. Understanding the children's experiences will provide additional insight into children's coping abilities. The purpose of this study is to develop a grounded theory of children's day-to-day experiences as they live with their mother who has been recently diagnosed with, and is receiving treatment for, early-stage breast cancer. Using classic grounded theory methodology, data were collected through 28 interviews with 7- to 11-year-old children whose mothers had been diagnosed with early-stage breast cancer during the previous 4 months. Protecting was the main concern of the children during their mothers' diagnosis and treatment phase. The children addressed this concern through 3 cyclical and iterative processes of shifting normality, shielding and transitioning. The findings provide a mechanism for understanding how the perceived loss of the "well" mother raised concerns for the children and resulted in adaptations of roles and responsibilities and a period of biographical disruption. This understanding could serve as a catalyst for how we relate with children and engage with parents to enhance children's coping strategies during a maternal cancer diagnosis. New insights provided by this theory can guide clinical practice and generate hypotheses to test interventions to support children and their parents to cope during the time of maternal cancer diagnosis.

Stillbirth and neonatal death among female cancer survivors: A national cohort study.

The number of cancer survivors continues to increase worldwide. Many of these survivors have had children of their own. It is less well-known whether radiation therapy or chemotherapy could affect the risk of stillbirth and neonatal death for these children. To explore this research questions, we identified all women diagnosed with cancer between 1958 and 2012 from the Swedish Cancer Register and they were further linked to the Swedish Medical Birth Register to identify their subsequent child birth between 1973 and 2012. Multivariate logistic regression was used to estimate odds ratios and 95% confidence intervals for the association between stillbirth and neonatal death and maternal cancer diagnosis. As compared to the children without maternal cancer, the risk of stillbirth was significantly higher among children of female cancer survivors born within three years after cancer diagnosis with an OR of 1.92 (95% CI 1.03-3.57). The incidence of neonatal death did not show a significant change. For women with more than one pregnancy after cancer diagnosis, the risk of stillbirth and neonatal death was lower for the second child birth compared to the first child birth. Our study suggested that the risk of stillbirth was negatively associated with the time after cancer diagnosis, providing evidence that the adverse effect associated with cancer treatment may diminish with time.

Pregnancy outcome and survivorship in cancer patients.

1503 Background: Advances in cancer detection and treatment have resulted in increased prevalence of female cancer survivors at childbearing age. While the association between cancer treatment and fertility has been thoroughly investigated, data regarding pregnancy outcome of cancer survivor are scarce. The aim of this study is to determine whether cancer survivors and sufferers have increased risk of obstetric complications. Methods: A population-based cohort study using data from the NIS of the Healthcare Cost and Utilization Project, focusing on 2000-2006. The rate of maternal and fetal obstetric complications was determined in pregnant women with and without diagnosis of cancer. Results: A total of 6,732,293 births were included in the analysis, of these 15,191 had maternal cancer diagnosis (0.2%). Pregnant women with cancer diagnosis had increased risk for premature labor, ectopic pregnancy, and need for blood transfusion. Moreover, the rate of maternal (3.6/ 1000 births) and fetal (8.3/1000 births) mortality was higher amongst women with cancer compared to non-cancer bearing women- (0.12/ 1000 births) and (3.9/ 1000 births) respectively. Multivariate logistic regression revealed that both age and cancer diagnosis were significantly and independently associated with pregnancy complications. Conclusions: This is the first large-scale study to determine the prevalence of obstetric complications in cancer patients. Pregnant women with a diagnosis of cancer are at increased risk of major obstetric complications, including maternal and fetal death, although the absolute risk is relatively low. It may therefore be prudent to define such pregnancies as “high-risk” and advocate intense prenatal care for these patients. [Table: see text]

4 EONS Distinguished Merit Award The Impact of a Maternal Cancer Diagnosis on School-age Children

4 EONS Distinguished Merit Award The Impact of a Maternal Cancer Diagnosis on School-age Children

The psychological impact of a cancer diagnosed during pregnancy: determinants of long‐term distress

Cancer occurs during one in 1000-5000 of the approximately 6 million yearly US pregnancies identified by the American Pregnancy Association. Although a newly diagnosed cancer is associated with substantial distress, little is known about cancer's emotional impact on women when diagnosed during pregnancy, and no studies have been conducted on the subject. The Cancer and Pregnancy Registry was developed by Elyce H. Cardonick MD, specialist in Maternal and Fetal Medicine and Associate Professor of Obstetrics and Gynecology at Robert Wood Johnson Medical School, to examine the consequences of maternal cancer diagnosis and treatment during pregnancy on maternal, fetal, and neonatal outcomes, including the impact of in utero exposure to chemotherapy. Participants were asked to complete questionnaires, including measures of psychological distress, permitting the examination of variables associated with long-term psychological distress in women following a cancer diagnosis in pregnancy. Seventy-four women completed the Brief Symptom Inventory-18 and Impact of Event Scale on average 3.8 years (SD 2.5) following their cancer diagnosis. Potential variables related to distress included information on: sociodemographics, disease, pregnancy, birth, cancer treatment, and health status. Multiple regression analyses revealed that women were at higher risk of long-term distress if they had not received fertility assistance, had been advised to terminate the pregnancy, had had a preterm baby, had had a cesarean delivery, had not produced sufficient milk to breastfeed, had been experiencing a recurrence, and/or had undergone surgery post-pregnancy. Results are discussed in light of our current knowledge of the normal developmental phase of pregnancy and motherhood.

Impact d’un diagnostic de cancer maternel pendant la grossesse sur les interactions précoces parent-bébé

Very few studies have explored the impact of a diagnosis of maternal cancer during pregnancy on the mother, early mother-infant interaction and the infant’s psychological development. Beyond the traumatic effect of receiving such news during pregnancy, a mother’s cancer may have harmful, long-lasting consequences both for the mother, in her experience of motherhood, and for the infant’s development. Based on our clinical experience in the infancy and perinatal fields, this paper examines the impact of a diagnosis of prenatal maternal cancer on the parental couple and on early parent-infant interaction.