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Du K, Liu Y, Zhang L, Peng L, Dong W, Jiang Y, Niu M, Sun Y, Wu C, Niu Y, Ding Y. Lapatinib combined with doxorubicin causes dose-dependent cardiotoxicity partially through activating the p38MAPK signaling pathway in zebrafish embryos. Biomed Pharmacother 2024; 175:116637. [PMID: 38653111 DOI: 10.1016/j.biopha.2024.116637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/09/2024] [Accepted: 04/19/2024] [Indexed: 04/25/2024] Open
Abstract
Because of its enhanced antitumor efficacy, lapatinib (LAP) is commonly used clinically in combination with the anthracycline drug doxorubicin (DOX) to treat metastatic breast cancer. While it is well recognized that this combination chemotherapy can lead to an increased risk of cardiotoxicity in adult women, its potential cardiotoxicity in the fetus during pregnancy remains understudied. Here, we aimed to examine the combination of LAP chemotherapy and DOX-induced cardiotoxicity in the fetus using a zebrafish embryonic system and investigate the underlying pathologic mechanisms. First, we examined the dose-dependent cardiotoxicity of combined LAP and DOX exposure in zebrafish embryos, which mostly manifested as pericardial edema, bradycardia, cardiac function decline and reduced survival. Second, we revealed that a significant increase in oxidative stress concurrent with activated MAPK signaling, as indicated by increased protein expression of phosphorylated p38 and Jnk, was a notable pathophysiological event after combined LAP and DOX exposure. Third, we showed that inhibiting MAPK signaling by pharmacological treatment with the p38MAPK inhibitor SB203580 or genetic ablation of the map2k6 gene could significantly alleviate combined LAP and DOX exposure-induced cardiotoxicity. Thus, we provided both pharmacologic and genetic evidence to suggest that inhibiting MAPK signaling could exert cardioprotective effects. These findings have implications for understanding the potential cardiotoxicity induced by LAP and DOX combinational chemotherapy in the fetus during pregnancy, which could be leveraged for the development of new therapeutic strategies.
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Affiliation(s)
- Ke Du
- School of Public Health, Qingdao University, Qingdao 266021, China; The Biomedical Sciences Institute of the Affiliated Hospital, Qingdao University, Qingdao 266021, China
| | - Yuting Liu
- School of Public Health, Qingdao University, Qingdao 266021, China; The Biomedical Sciences Institute of the Affiliated Hospital, Qingdao University, Qingdao 266021, China
| | - Lu Zhang
- Department of Clinical Laboratory, Qingdao Women's and Children's Hospital, Qingdao 266034, China
| | - Lixia Peng
- The Biomedical Sciences Institute of the Affiliated Hospital, Qingdao University, Qingdao 266021, China
| | - Wenjing Dong
- The Biomedical Sciences Institute of the Affiliated Hospital, Qingdao University, Qingdao 266021, China
| | - Yajie Jiang
- School of Public Health, Qingdao University, Qingdao 266021, China; The Biomedical Sciences Institute of the Affiliated Hospital, Qingdao University, Qingdao 266021, China
| | - Mingming Niu
- School of Public Health, Qingdao University, Qingdao 266021, China; The Biomedical Sciences Institute of the Affiliated Hospital, Qingdao University, Qingdao 266021, China
| | - Yuanchao Sun
- The Biomedical Sciences Institute of the Affiliated Hospital, Qingdao University, Qingdao 266021, China
| | - Chuanhong Wu
- The Biomedical Sciences Institute of the Affiliated Hospital, Qingdao University, Qingdao 266021, China
| | - Yujuan Niu
- The Biomedical Sciences Institute of the Affiliated Hospital, Qingdao University, Qingdao 266021, China
| | - Yonghe Ding
- School of Public Health, Qingdao University, Qingdao 266021, China; The Biomedical Sciences Institute of the Affiliated Hospital, Qingdao University, Qingdao 266021, China; Department of Biochemistry and Molecular Biology, Division of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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Bernardez B, Mangues-Bafalluy I, Callejo VM, Ávila JJF, Rodríguez JAM, Aradilla MAP, Bautista MJM. Risk stratification model for the pharmaceutical care of oncology patients with solid or hematologic neoplasms. FARMACIA HOSPITALARIA 2024; 48:T108-T115. [PMID: 38461113 DOI: 10.1016/j.farma.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 03/11/2024] Open
Abstract
OBJECTIVE We aimed to develop of a risk stratification model for the pharmaceutical care (PC) of patients with solid or hematologic neoplasms who required antineoplastic agents or supportive treatments. METHOD The risk stratification model was collaboratively developed by oncology pharmacists from the Spanish Society of Hospital Pharmacy (SEFH). It underwent refinement through three workshops and a pilot study. Variables were defined, grouped into four dimensions, and assigned relative weights. The pilot study collected and analyzed data from participating centers to determine priority levels and evaluate variable contributions. The study followed the Kaiser Permanente pyramid model, categorizing patients into three priority levels: Priority 1 (intensive PC, 90th percentile), Priority 2 (60th-90th percentiles), and Priority 3 (60th percentile). Cut-off points were determined based on this stratification. Participating centers recorded variables in an Excel sheet, calculating mean weight scores for each priority level and the total risk score. RESULTS The participants agreed to complete a questionnaire that comprised 22 variables grouped into 4 dimensions: demographic (maximum score =11); social and health variables and cognitive and functional status (maximum = 19); clinical and health services utilization (maximum = 25); and treatment-related (maximum = 41). From the results of applying the model to the 199 patients enrolled, the cutoff points for categorization were 28 or more points for priority 1, 16 to 27 points for priority 2 and less than 16 for priority 3; more than 80% of the total score was based on the dimensions of 'clinical and health services utilization' and 'treatment-related'. Interventions based on the pharmaceutical care model were recommended for patients with solid or hematological neoplasms, according to their prioritization level. CONCLUSION This stratification model enables the identification of cancer patients requiring a higher level of pharmaceutical care and facilitates the adjustment of care capacity. Validation of the model in a representative population is necessary to establish its effectiveness.
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Affiliation(s)
- Beatriz Bernardez
- Departamento de Medicina, Universidad de Santiago de Compostela, Santiago de Compostela, España; Unidad de Farmacia Oncológica, Servicio de Farmacia, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España; Grupo de Farmacología, Instituto de Investigación Santiago de Compostela (IDIS), Santiago de Compostela, España.
| | - Irene Mangues-Bafalluy
- Servicio de Farmacia, Hospital Universitario Arnau de Vilanova de Lleida, Lleida, España; Grupo de Farmacoepidemiología y Farmacodinamia, Institut de Recerca Biomèdica, IRBLleida, Lleida, España
| | - Virginia Martínez Callejo
- Unidad de Farmacia Oncológica, Servicio de Farmacia, Hospital Universitario Marqués de Valdecilla, Santander, España
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Bernardez B, Mangues-Bafalluy I, Callejo VM, Ávila JJF, Rodríguez JAM, Aradilla MAP, Bautista MJM. Risk stratification model for the pharmaceutical care of oncology patients with solid or hematologic neoplasms. FARMACIA HOSPITALARIA 2024; 48:108-115. [PMID: 37884399 DOI: 10.1016/j.farma.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVE We aimed to develop of a risk stratification model for the pharmaceutical care of patients with solid or hematologic neoplasms who required antineoplastic agents or supportive treatments. METHOD The risk stratification model was collaboratively developed by oncology pharmacists from the Spanish Society of Hospital Pharmacy (SEFH). It underwent refinement through 3 workshops and a pilot study. Variables were defined, grouped into 4 dimensions, and assigned relative weights. The pilot study collected and analyzed data from participating centers to determine priority levels and evaluate variable contributions. The study followed the Kaiser Permanente pyramid model, categorizing patients into 3 priority levels: Priority 1 (intensive PC, 90th percentile), Priority 2 (60th-90th percentiles), and Priority 3 (60th percentile). Cut-off points were determined based on this stratification. Participating centers recorded variables in an Excel sheet, calculating mean weight scores for each priority level and the total risk score. RESULTS The participants agreed to complete a questionnaire that comprised 22 variables grouped into 4 dimensions: demographic (maximum score=11); social and health variables and cognitive and functional status (maximum=19); clinical and health services utilization (maximum=25); and treatment-related (maximum=41). From the results of applying the model to the 199 patients enrolled, the cut-off points for categorization were 28 or more points for priority 1, 16-27 points for priority 2, and less than 16 for priority 3; more than 80% of the total score was based on the dimensions of "clinical and health services utilization" and "treatment-related." Interventions based on the pharmaceutical care model were recommended for patients with solid or hematological neoplasms, according to their prioritization level. CONCLUSION This stratification model enables the identification of cancer patients requiring a higher level of pharmaceutical care and facilitates the adjustment of care capacity. Validation of the model in a representative population is necessary to establish its effectiveness.
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Affiliation(s)
- Beatriz Bernardez
- Departamento de Medicina, Universidad de Santiago de Compostela, Santiago, Spain; Unidad de Farmacia Oncológica, Servicio de Farmacia, Hospital Clínico, Universitario de Santiago de Compostela, Santiago, Spain; Grupo de Farmacología, Instituto de Investigación Santiago de Compostela (IDIS), Santiago, Spain.
| | - Irene Mangues-Bafalluy
- Servicio de Farmacia, Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Grupo de Farmacoepidemiología y Farmacodinamia, Institut de Recerca Biomèdica, IRBLleida, Lleida, Spain
| | - Virginia Martínez Callejo
- Unidad de Farmacia Oncológica, Servicio de Farmacia, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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Lundberg FE, Gkekos L, Rodriguez‐Wallberg KA, Fredriksson I, Johansson ALV. Risk of obstetric and perinatal complications in women presenting with breast cancer during pregnancy and the first year postpartum in Sweden 1973-2017: A population-based matched study. Acta Obstet Gynecol Scand 2024; 103:684-694. [PMID: 36959086 PMCID: PMC10993363 DOI: 10.1111/aogs.14555] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION For women presenting with breast cancer during pregnancy, treatment guidelines were historically restricted to only surgical treatment. Over the past decades, chemotherapy administered during pregnancy has been gradually introduced. Although breast cancer treatments during ongoing pregnancy have been deemed safe, detailed information on potential obstetric risks is lacking. We aimed to assess the risk of adverse obstetric and perinatal outcomes of breast cancer in pregnancy and within 1 year postpartum and in relation to trimester at breast cancer diagnosis, tumor stage, and cancer treatment during pregnancy. MATERIAL AND METHODS Population-based matched study. Women diagnosed with breast cancer during pregnancy in 1973-2017 were identified in the Swedish Cancer Register and the Medical Birth Register, with additional information from the National Quality Register for Breast Cancer. Each birth with maternal breast cancer (n = 208 pregnant, n = 672 postpartum) was matched by age, calendar year, and birth order to 10 unexposed births from cancer-free women in the population (n = 2080 and n = 6720). Adjusted conditional logistic and multinomial regression models were used to estimate odds ratios and relative risk ratios, commonly denoted relative risks (RR) with 95% confidence intervals (CI), of adverse obstetric and perinatal outcomes. RESULTS Breast cancer during pregnancy was associated with higher risks of preterm birth, both planned (RR 67.1, 95% CI 33.2-135.6) and spontaneous preterm birth (RR 3.8, 95% CI 2.0-7.5), and low birthweight (<2500 g: RR 7.5, 95% CI 4.9-11.3). The associated risks were higher if the breast cancer was diagnosed in the second trimester, and of similar magnitude irrespective of stage and treatment groups. There was a higher risk of low birthweight for gestational age (<25th centile) if breast cancer was diagnosed in the first trimester (RR 2.8, 95% CI 1.1-7.3). Risks of other pregnancy complications were similar to those of unexposed women, as were risks of neonatal mortality and malformations. Postpartum breast cancer was only associated with bleeding during pregnancy (RR 1.6, 95% CI 1.0-2.8). CONCLUSIONS Preterm birth and related adverse outcomes were more common in women diagnosed with breast cancer during pregnancy. Reassuringly, breast cancer was not associated with other maternal pregnancy complications or adverse outcomes in children.
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Affiliation(s)
- Frida E. Lundberg
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
| | - Leo Gkekos
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Kenny A. Rodriguez‐Wallberg
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Department of Reproductive Medicine, Division of Gynecology and ReproductionKarolinska University HospitalStockholmSweden
| | - Irma Fredriksson
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Breast, Endocrine Tumors and SarcomaKarolinska University HospitalStockholmSweden
| | - Anna L. V. Johansson
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Cancer Registry of NorwayOsloNorway
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Huang X, Zhang C, Zhu J, Li Y, Tang J. Influence of cancer in pregnancy on obstetric and neonatal outcomes: an observational retrospective cohort study. J Gynecol Oncol 2024; 35:35.e74. [PMID: 38522950 DOI: 10.3802/jgo.2024.35.e74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/18/2023] [Accepted: 02/11/2024] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVE The study aimed to review the oncological characteristics and treatment of pregnancy-associated cancers and analyze the obstetric and neonatal outcomes to provide evidence-based recommendations for reproductive function preservation, oncological treatment, and obstetric management. METHODS We conducted an observational retrospective cohort study among pregnant patients with cancer in 7 Chinese tertiary A hospitals from 2003 to 2021. We conducted multiple logistic regression to determine the influence of various factors on preterm birth and small-for-gestational-age infants, log-binomial regression to analyze temporal changes, and χ² tests to explore the effects of cancer type/treatment. RESULTS Of 204 women, 17% terminated their pregnancies; 59% received pre-delivery treatment. Every 6 years, the rates of pregnancy termination (relative risk [RR]=0.48; 95% confidence interval [CI]=0.35-0.67) and iatrogenic preterm births (RR=0.73; 95% CI=0.54-0.98) reduced, and that of pre-delivery treatment increased, mainly due to increased rates of surgery (RR=1.87; 95% CI=1.31-2.67). Maternal systemic diseases were related to small-for-gestational-age infants (odds ratio [OR]=12.02; 95% CI=1.82-79.43). Chemotherapy with taxanes plus platinum-based agents was related to adverse obstetric outcomes (OR=1.87; 95% CI=1.42-2.46; p<0.05). Thyroid (OR=0.36; 95% CI=0.22-0.57) and ovarian cancer (OR=0.70; 95% CI=0.50-0.98) were associated with fewer cesarean sections. Thyroid cancer was associated with fetal growth restriction (OR=5.21; 95% CI=1.21-22.55). CONCLUSION Rates of pregnancy termination in cancer declined. Taxane plus platinum-based chemotherapy was associated with adverse obstetric outcomes. Cancer type influenced outcomes. TRIAL REGISTRATION Chinese Clinical Trial Register Identifier: ChiCTR2100044292.
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Affiliation(s)
- Xuan Huang
- Department of Pharmacy, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - Chen Zhang
- Department of Pharmacy, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - Jialei Zhu
- Department of Pharmacy, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - Yueyan Li
- Department of Pharmacy, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - Jing Tang
- Department of Pharmacy, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China.
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Chan A, Liao CI, Reddy M, Johnson C, Stewart C, Reiser H, Kapp DS, Aryasomayajula C. The Potential Impact of Decreasing Access to Abortion on Pregnant Teenagers with Cancer in the United States. J Pediatr Adolesc Gynecol 2024; 37:87-88. [PMID: 37783394 PMCID: PMC11064160 DOI: 10.1016/j.jpag.2023.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/31/2023] [Accepted: 09/15/2023] [Indexed: 10/04/2023]
Affiliation(s)
- Ava Chan
- Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Cheng-I Liao
- Department of Obstetrics and Gynecology, Pingtung Veterans General Hospital, Pingtung, Taiwan
| | - Megan Reddy
- Palo Alto Medical Foundation Research Institute, Palo Alto, California.
| | - Caitlin Johnson
- California Pacific Medical Center Research Institute, San Francisco, California
| | - Chelsea Stewart
- University of California Los Angeles, Los Angeles, California
| | - Hannah Reiser
- University of California Los Angeles, Los Angeles, California
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Chinmayi Aryasomayajula
- Department of Obstetrics and Gynecology, Kaiser Permanente Santa Clara Homestead Medical Center, Santa Clara, California
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Yu H, Bao P, Qiao J, Pang Y, Zang J, Wu C, Wang C, Wu F. Adverse birth outcomes among offspring born to women diagnosed with cancer: a population-based cohort study. Am J Obstet Gynecol MFM 2023; 5:101036. [PMID: 37245606 DOI: 10.1016/j.ajogmf.2023.101036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/04/2023] [Accepted: 05/22/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND With increasing cancer incidence and survival rates, the prevalence of maternal cancer and its effect on adverse birth outcomes are important for prenatal care and oncology management. However, the effects of different types of cancer at different gestational stages have not been widely reported. OBJECTIVE This study aimed to describe the epidemiologic characteristics of pregnancy-associated cancers (during and 1 year after pregnancy) and evaluate the association between adverse birth outcomes and maternal cancers. METHODS Of 983,162 cases, a history of maternal cancer, including pregestational cancer, pregnancy-associated cancer, and subsequent cancer, was identified in 16,475 cases using a health information network. The incidence and 95% confidence interval of pregnancy-associated cancer were calculated with the Poisson distribution. The adjusted risk ratio with 95% confidence interval of the association between adverse birth outcomes and maternal cancer were estimated using the multilevel log-binomial model. RESULTS A total of 38,295 offspring were born to mothers with a cancer history. Of these, 2583 (6.75%) were exposed to pregnancy-associated cancer, 30,706 (80.18%) had a subsequent cancer diagnosis, and 5006 (13.07%) were exposed to pregestational cancer. The incidence of pregnancy-associated cancer was 2.63 per 1000 pregnancies (95% confidence interval, 2.53‰-2.73‰), with cancer of the thyroid (1.15‰), breast (0.25‰), and female reproductive organs (0.23‰) being the most common cancer types. The increased risks of preterm birth and low birthweight were significantly associated with cancer diagnosed during the second and third trimester of pregnancy, whereas increased risks of birth defects (adjusted risk ratio, 1.48; 95% confidence interval, 1.08-2.04) were associated with cancer diagnosed in the first trimester. Increased risks of preterm birth (adjusted risk ratio, 1.16; 95% confidence interval, 1.02-1.32), low birthweight (adjusted risk ratio, 1.24; 95% confidence interval, 1.07-1.44), and birth defects (adjusted risk ratio, 1.22; 95% confidence interval, 1.10-1.35) were observed in thyroid cancer survivors. CONCLUSION Careful monitoring of fetal growth should be implemented for women diagnosed with cancer in the second and third trimester to ensure timely delivery and balance the benefits of neonatal health and cancer treatment. The higher incidence of thyroid cancer and increased risk of adverse birth outcomes among thyroid cancer survivors suggested that the regular thyroid function monitoring and regulation of thyroid hormone levels are important in maintaining pregnancy and promoting fetal development among thyroid cancer survivors before and during pregnancy.
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Affiliation(s)
- Huiting Yu
- School of Public Health, Fudan University, Shanghai, People's Republic of China (Dr Yu and Dr Wu); Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China (Dr Yu, Dr Bao, Dr Qiao, Dr Pang Dr Zang, and Dr Wang); Shanghai Institute of Preventive Medicine, Shanghai, People's Republic of China (Dr Yu)
| | - Pingping Bao
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China (Dr Yu, Dr Bao, Dr Qiao, Dr Pang Dr Zang, and Dr Wang)
| | - Jiaying Qiao
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China (Dr Yu, Dr Bao, Dr Qiao, Dr Pang Dr Zang, and Dr Wang)
| | - Yi Pang
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China (Dr Yu, Dr Bao, Dr Qiao, Dr Pang Dr Zang, and Dr Wang)
| | - Jiajie Zang
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China (Dr Yu, Dr Bao, Dr Qiao, Dr Pang Dr Zang, and Dr Wang)
| | - Cheng Wu
- Shanghai Diabetes Institute, National Office for Primary Diabetes Care, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China (Dr Bao)
| | - Chunfang Wang
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China (Dr Yu, Dr Bao, Dr Qiao, Dr Pang Dr Zang, and Dr Wang)
| | - Fan Wu
- School of Public Health, Fudan University, Shanghai, People's Republic of China (Dr Yu and Dr Wu); Department of Military Health Statistics, Naval Medical University, Shanghai, People's Republic of China (Dr Wu).
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Houlihan OA, Buckley D, Maher GM, McCarthy FP, Khashan AS. Maternal and perinatal outcomes following a diagnosis of Hodgkin lymphoma during or prior to pregnancy: A systematic review. BJOG 2023; 130:336-347. [PMID: 36424902 PMCID: PMC10107208 DOI: 10.1111/1471-0528.17347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/02/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The initial peak incidence of Hodgkin lymphoma (HL) occurs during reproductive years. OBJECTIVES Synthesise published literature on the relationship between HL and maternal and perinatal outcomes. SEARCH STRATEGY Systematic search of PubMed/Medline, Cochrane Library, Scopus, Embase and Science Direct from inception to June 2022, supplemented by hand-searching reference lists. SELECTION CRITERIA Two reviewers independently reviewed titles, abstracts and full-text articles. Published studies containing original data were eligible. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and appraised study quality. Outcomes for pregnant women with a previous/current diagnosis of HL were compared separately with women never diagnosed with HL. Where data permitted, meta-analyses of odds ratios and proportions were performed. Certainty of evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. MAIN RESULTS Of the 5527 studies identified, 33 met the inclusion criteria. In the groups with HL before pregnancy and HL during pregnancy, adjusted odds ratios were not statistically significant for congenital malformation (aOR 1.7, 95% CI 0.9-3.1, and aOR 1.84, 95% CI 0.81-4.15, respectively), preterm birth (PTB) (aOR 0.99, 95% CI 0.65-1.51, and aOR 6.74, 95% CI 0.52-88.03, respectively) and miscarriage (aOR 0.78, 95% CI 0.55-1.10, and aOR 0.38, 95% CI 0.05-2.72, respectively). The aORs for all other outcomes were not statistically significant, except for blood transfusion (aOR 1.38, 95% CI 1.05-1.82) and venous thromboembolism (VTE) (aOR 7.93, 95% CI 2.97-21.22) in the group for HL during pregnancy. The proportion of anaemia was also increased in this group (69%, 95% CI 57%-80% vs 4%, 95% CI 4%-5%, respectively). The GRADE certainty of findings ranged from low to very low. CONCLUSIONS Rates of most adverse pregnancy outcomes among women with a previous/current HL diagnosis are not increased significantly compared with the general pregnant population. Women with HL diagnosed during pregnancy may have a higher PTB rate and increased likelihood of VTE, anaemia and blood transfusion; however, small study numbers and the low to very low GRADE certainty of findings preclude firm conclusions.
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Affiliation(s)
- Orla A Houlihan
- School of Public Health, University College Cork, Cork, Ireland
| | - Daire Buckley
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Gillian M Maher
- School of Public Health, University College Cork, Cork, Ireland.,INFANT Research Centre, University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland.,INFANT Research Centre, University College Cork, Cork, Ireland
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Prognosis, counseling, and indications for termination of pregnancy. Abdom Radiol (NY) 2022; 48:1612-1617. [PMID: 36538080 DOI: 10.1007/s00261-022-03772-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
As the coincidence of pregnancy and cancer rise, clinicians must be prepared to counsel their patients on the complex relationship between maternal and fetal health. In most types of cancer, maternal prognosis mirrors that of non-pregnant women. However, challenges associated with the timing of diagnosis and treatment can present additional risks. Consequently, pregnant cancer patients must be counseled early and effectively with regard to how their pregnancy status affects treatment options and the range of expected outcomes for both mother and fetus. Some patients choose to terminate pregnancy after such counseling, though the specific course of action depends on the cancer in question, the stage at diagnosis, and the personal priorities and values of the patient.
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10
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Management of Pregnancy Associated Breast Cancer: a Review. CURRENT BREAST CANCER REPORTS 2022. [DOI: 10.1007/s12609-022-00464-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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11
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Silverstein J, Van Loon K. The Implications of the Supreme Court Decision to Overturn Roe v Wade for Women With Pregnancy-Associated Cancers. JAMA Oncol 2022; 8:1394-1395. [PMID: 35951314 DOI: 10.1001/jamaoncol.2022.3785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jordyn Silverstein
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California
| | - Katherine Van Loon
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
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12
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Silverstein J, Van Loon K. Invited Commentary: Role of the Radiologist in Pregnancy-associated Cancer. Radiographics 2022; 42:E158-E159. [PMID: 35839140 DOI: 10.1148/rg.220163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jordyn Silverstein
- From the Department of Medicine (J.S., K.V.L.) and Helen Diller Family Comprehensive Cancer Center (K.V.L.), University of California, San Francisco, 550 16th St, 6th Floor, Box 3211, San Francisco, CA 94143
| | - Katherine Van Loon
- From the Department of Medicine (J.S., K.V.L.) and Helen Diller Family Comprehensive Cancer Center (K.V.L.), University of California, San Francisco, 550 16th St, 6th Floor, Box 3211, San Francisco, CA 94143
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