Aims: To describe the incidence, outcomes and care patterns of pregnancy-associated cancer (PAC) in Victoria, identify health-system factors and required improvements.
Methods: A retrospective, population-based study of pregnancies complicated by cancer in Victoria (2020-2024) was conducted using admitted episode data from public and private hospitals. PAC was defined as cancer diagnosed during pregnancy or within 12 months postpartum. Pregnancy outcomes were classified as live birth or non-live birth. Associations with maternal age, tumour stream and health-system factors, including alignment of cancer and pregnancy care within a women's Integrated Cancer Service (ICS), were examined using univariate analyses. Fertility preservation uptake was assessed by age, tumour stream and ICS.
Results: Among 824 pregnancies with cancer, 701 (85.1%) resulted in a live birth. Most cancer care occurred postpartum (615), with 39% treated during pregnancy. The crude incidence was 218.5 per 100,000 births (95% CI: 202.5-235.0), stable over time. Maternal age was associated with outcome (p<0.001), with markedly lower odds of live birth among women aged ≥40 years. Surgical management predominated (>80%), underscoring peri-operative coordination needs. Care configuration influenced outcomes: women receiving both cancer and pregnancy care within their ICS had the most favourable outcomes, while discordant care, particularly where pregnancy care occurred outside the ICS, was associated with reduced odds of live birth (OR 0.28, 95% CI: 0.17-0.48). Tumour distribution was led by breast (32.4%), thyroid/endocrine (14.2%) and haematological cancers (11.7%), with no outcome differences by tumour stream (p=0.25). Fertility preservation uptake varied by age, tumour type and region, declining with increasing age.
Conclusions: The study demonstrates that inequities exist by age and care coordination. Strengthening integrated, cross-sector pathways between oncology and maternity services and improving access to fertility preservation, are key priorities. Enhanced linked data and patient experience measures are required to support informed, equitable service planning for this complex cohort.