Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2022

A minority of women of child bearing potential are tested for pregnancy before chemoimmunotherapy: an Australian Cancer Centre experience (#396)

Verity Chadwick 1 , Michaela Kim 2 , Georgia Mills 3 , Catherine Tang 4 , Antoinette Anazodo 2 5 6 , Rachel Dear 2 7 , Rachael Rodgers 8 9 , Orly Lavee 2 3 , Samuel Milliken 2 3 , Georgia McCaughan 3 , John Moore 2 3 , Nada Hamad 3 10 11 , Joshua Hurwitz 12
  1. Royal North Shore Hospital, St Leonards, NSW, Australia
  2. School of Medicine, University of New South Wales, Sydney, NSW, Australia
  3. Department of Haematology, St Vincent’s Hospital, Darlinghurst, NSW, Australia
  4. Department of Haematology and Flow Cytometry, Laverty Pathology, Macquarie Park, NSW, Australia
  5. Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
  6. Nelune Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
  7. Department of Oncology, St Vincent’s Hospital, Sydney, NSW, Australia
  8. Department of Reproductive Medicine, Royal Hospital for Women, Sydney, NSW, Australia
  9. School of Women’s and Children’s Health, University of New South Wales, Randwick, NSW, Australia
  10. St Vincent's Clinical School, University of New South Wales , Randwick, NSW, Australia
  11. School of Medicine, University of Notre Dame, Daringhurst, NSW, Australia
  12. Medical Oncology, The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia

Background: Chemotherapy is potentially harmful to a developing foetus and there is limited data on the foetal impact of chemoimmunotherapy. Therefore, determining pregnancy status prior to initiation of chemoimmunotherapy should be standard of care.

 

Method: We reviewed electronic records from a large metropolitan cancer referral centre to evaluate the uptake of pregnancy screening and contraception documentation prior to and during first-line CIT. We searched our electronic outpatient medical record database for Women of Child Bearing Potential (WoCBP) who were diagnosed with a malignancy and received outpatient-based chemoimmunotherapy between May 1 2015 and June 12 2020.

 

Results: A total of 415 WoCBP with a median age of 41 years (range 19-55) were included. Only 17.1% were screened for pregnancy within 90 days prior to chemoimmunotherapy. One patient with early breast cancer had a spontaneous miscarriage estimated at 3-4 weeks gestation, and neither the patient nor the treating oncologist were aware of this event. This was also the only patient who had a pregnancy test beyond the first cycle of chemoimmunotherapy during the course of their treatment.

 

Conclusion: Our results highlight a concerningly low rate of pregnancy screening in WoCBP receiving CIT.  The implication of missing a positive pregnancy test in this group of women could result in foetal complication, accidental miscarriage, potential bleeding risks and avoidable psychosocial stress. This highlights the urgent need for guidelines to mandate pregnancy testing in WoCBP receiving chemoimmunotherapy and evidence based implementation tools.