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Keywords:

  • non-Hodgkin's lymphoma in pregnancy;
  • interdisciplinary teams;
  • best outcomes

Poster Presentation

  1. Top of page
  2. Poster Presentation

Background

Lymphoma is now the fourth most diagnosed malignancy during pregnancy, occurring in approximately 1:6,000 births. With the delay in childbearing and the increase in primiparous maternal age it can be expected that cancer will be diagnosed more frequently in pregnant women. Since non-Hodgkin's lymphomas occur in an older patient population than Hodgkin's lymphomas, this may account for fewer reports of non-Hodgkin's lymphoma patients with coexisting pregnancies. When a diagnosis is made, issues surrounding decisions regarding the approach to treatment options are extremely complex and must include the medical and obstetric health of both the mother and fetus.

Case

A gravida 1, para 0, 25-year-old married patient had multiple encounters with the healthcare system during her first and second trimester until being diagnosed with non-Hodgkin's lymphoma at 27 to 28 weeks. An interdisciplinary team was formed and invites went out to the perinatology, oncology, obstetrics, spiritual services, palliative care, and social services departments. The patient's initial plan was to start the first round of chemotherapy to help with her pain and reduce the nodules in her neck. It was clear to the team that a plan with ongoing communication must be determined. Less than 2 weeks later the patient was readmitted for intractable head pain. A lumbar puncture confirmed cancer cells in her cerebral spinal fluid. She would now need to be treated with chemotherapy in her brain through placement of an Ommaya reservoir, a device surgically implanted under the scalp used to carry medicine to the brain and spinal cord. Her delivery was scheduled and would be complicated by her extremely low platelet and white blood cell counts.

The most critical and challenging issues for the team involved managing the patient's pain, treating her cancer, and monitoring maternal well-being and fetal development. Her care was complicated by her physical location in the hospital, family dynamics, and need for prenatal education and rest. She gave birth to a female infant vaginally at 30 + 6 weeks.

Conclusion

The diagnosis of cancer during pregnancy is rare but may increase in the future. Through an interdisciplinary team effort that includes the obstetric nurse, we can accept the challenges that accompany the pregnant oncology patient and promote evidenced-based best practice to provide continuity of physical, psychological, and spiritual care for optimal outcomes.