This presentation reflects on an experience of pregnancy-associated cancer (p-CA) along with implications for data, research and practice.
P-CA, defined as cancer diagnosed during pregnancy or within 12 months postpartum, is rare but an increasing subset of early-onset cancer.
Specifically, a rising average maternal age and an alarming surge in the incidence of early-onset colorectal cancer (EOCRC) has seen an increase in pregnancy-associated colorectal cancer
(p-CRC), with significant mortality and morbidity. In Australia, EOCRC is the deadliest cancer for those aged 25-54 years old, with Australia having the highest incidence of EOCRC globally.
P-CRC patients require complex, multidisciplinary care spanning oncology, obstetric/maternity and surgical services at a minimum; however, we are yet to define gold standard models of care, creating unwarranted variation in clinical management and patient outcomes.
There is also an absence of targeted incidence and outcome data for all p-CA in Australia. It’s prudent to note, the gravity of p-CA is not captured by incidence alone. For women and families,
p-CA often involves navigating diagnostic complexities, delayed and/or missed diagnosis, multiple (and often disconnected) specialist services and financial toxicity during a period of heightened physical and emotional vulnerability. Clinical decisions are frequently made in the absence of relevant protocols, and often fall to the patient to coordinate and navigate a system mostly unprepared for them. For communities and healthcare systems, the condition has wide-reaching adverse impacts.
Today personalised oncology is seen as best practice; however, this is very difficult to achieve for a patient cohort that is largely invisible in cancer data and research.
Increasing awareness among clinicians, specific treatment guidelines and targeted data collection are essential to improve timely diagnosis, optimise multidisciplinary care, decrease disparities in outcomes and strengthen the evidence base for this complex and catastrophic condition.