When Pregnancy Becomes Bittersweet: Hearing "You Have Advanced Bone Cancer" at 34 Weeks

Background: The concurrence of cancer and pregnancy is a relatively rare problem, complicating approximately 1 in 1000 pregnancies. Since more women are delaying childbearing and the incidence of cancer in the 30-49 years age group is increasing, it can be expected that cancer will be diagnosed more often in pregnant women. Symptoms common to cancer are also common to pregnancy leading to a diagnosis being delayed or completely overlooked. When the diagnosis is made, issues regarding the approach to treatment of the cancer during pregnancy are highly complex since the health of both mother and fetus need to be addressed.

Case: H.G. was a 32 year old patient, pregnant with her third child, when she was diagnosed with a left femur high grade sarcoma at 34 weeks. At 20 weeks she had complained of hip and back pain and a treatment for sciatica was started. Despite physical therapy, her pain became intolerable and she required crutches to walk.  At 34 weeks, an MRI was done revealing the sarcoma. Immediate plans were made to transfer her to a tertiary care center where she would receive Betamethasone to promote fetal lung maturity, proceed to cesarean section when  complete and then undergo orthopedic surgery. She would need to start chemotherapy shortly thereafter.

     Meetings  included an obstetrician, anesthesiologist, neonatologist, oncologist, orthopedist, clinical nurse specialists, chaplaincy and social services. It was essential that all team members have a clear plan in place. The clinical nurse specialists were essential in forming a nursing care plan and apprising the nursing staff. One of the most critical and challenging issues was preventing a pathological fracture. If this were to happen, malignant cancer cells from the sarcoma could enter the patient’s blood stream causing metastases to other parts of the body.

Conclusion: The perinatal nurse, as a member of an interdisciplinary health care team, has unique challenges as she cares for the family whose anticipated joy of welcoming a new baby is dampened by the diagnosis of cancer. Cancer during pregnancy is still considered rare, but the threat of occurrence increasing in the coming years is a reality. We must be ready to accept the many challenges that accompany caring for the pregnant oncology patient and promote evidence based practice so that this patient population will receive not only the physical, but psychological and spiritual care they will need during this very trying time.

Keywords: cancer, pregnancy, support, teamwork, communication