Cancer and Pregnancy: National Trends.

Published on Jul 21, 2020in American Journal of Perinatology1.862
· DOI :10.1055/S-0040-1714394
Kimberly K. Ma7
Estimated H-index: 7
(UW: University of Washington),
Sarah E. Monsell23
Estimated H-index: 23
(UW: University of Washington)
+ 2 AuthorsHilary S. Gammill20
Estimated H-index: 20
(UW: University of Washington)
Sources
Abstract
OBJECTIVE  Cancer and pregnancy are likely increasing; however, updated estimates are needed to optimally address the unique needs of this patient population. The study aims to estimate the prevalence of cancer and cancer survivorship at delivery, to test the change in odds of cancer and cancer survivorship at delivery over the 10-year period, and to compare medical conditions, serious events, and obstetric complications between pregnancies with and without cancer at delivery. STUDY DESIGN  We conducted a retrospective analysis of the National Inpatient Sample (NIS), the largest all-payer inpatient health database in the United States. We identified delivery admissions from 2004 to 2013 with a concurrent diagnosis of cancer using International Classification of Disease, ninth revision (ICD-9) codes. Multivariable logistic regression was used to test the change in prevalence of concurrent cancer, cancer survivorship, and pregnancy and to compare outcomes between deliveries with and without cancer. All analyses were adjusted for NIS-provided population weights and strata. RESULTS  During the study period, the NIS represented a national estimate of 40,855,208 deliveries. The odds of cancer increased from 3.41/10,000 deliveries in 2004 to 4.33/10,000 in 2013. This trend was statistically significant, including after adjustment for maternal age (adjusted odds ratio [aOR] = 1.03 [95% confidence interval (CI): 1.01-1.04]). Cancer survivorship at delivery increased significantly (aOR = 1.07 [95% CI: 1.06-1.08]). Women with cancer more often experienced one or more of the following: death, ventilation, cardiac arrest, sepsis, or acute respiratory or renal failure during delivery (aOR for composite outcome 10.7 [95% CI: 6.6-17.2]), even after adjustment in a multivariable logistic regression model. CONCLUSION  The odds of cancer and cancer survivorship at delivery increased from 2004 to 2013, independent of maternal age. Women with cancer were more likely to experience medical or obstetric complications during their delivery compared with women without cancer. These findings highlight the importance of obstetric and oncologic clinical and research collaboration to improve patient care. KEY POINTS · The odds of cancer at delivery increased.. · Women with cancer may have delivery complications.. · Cancer survivorship at delivery increased..
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References50
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#1Efrat Spiegel (JGH: Jewish General Hospital)H-Index: 1
#2Andrea R. Spence (JGH: Jewish General Hospital)H-Index: 10
Last. Haim A. Abenhaim (JGH: Jewish General Hospital)H-Index: 28
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: Background Thyroid cancer is one of the most common cancers in women of reproductive age. Our purpose was to evaluate the association between thyroid cancer and maternal and neonatal outcomes of pregnancy. Methods We conducted a retrospective cohort study using the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS) database from the US. A cohort consisting of women who delivered between 1999 and 2014 was created. Multivariate logistic regression, controlling for ba...
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#1Lori Chait-Rubinek (ND: University of Notre Dame)H-Index: 1
#2Justin A. Mariani (Alfred Hospital)H-Index: 23
Last. Belinda A. Campbell (Peter MacCallum Cancer Centre)H-Index: 16
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Long-term survivors of childhood, adolescent and young adult (AYA) malignancies with past exposure to potentially cardiotoxic treatments are at risk of peripartum cardiac dysfunction. Incidence and risk factors for peripartum cardiac dysfunction and maternal cardiac outcomes in this population were investigated. Eligible long-term survivors were aged <30 years at cancer diagnosis, with ≥1 pregnancy occurring ≥5 years after diagnosis. “Peripartum” cardiac events were defined as occurring within p...
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#1Marian F. MacDorman (UMD: University of Maryland, College Park)H-Index: 63
#2Eugene Declercq (BU: Boston University)H-Index: 39
BACKGROUND: Out-of-hospital births have been increasing in the United States, although past studies have found wide variations between states. Our purpose was to examine trends in out-of-hospital births, the risk profile of these births, and state differences in women's access to these births. METHODS: National birth certificate data from 2004 to 2017 were analyzed. Newly available national data on method of payment for the delivery (private insurance, Medicaid, self-pay) were used to measure ac...
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#1Gil Shechter Maor (McGill University)H-Index: 2
#2Nicholas Czuzoj-Shulman (JGH: Jewish General Hospital)H-Index: 14
Last. Haim A. Abenhaim (McGill University)H-Index: 28
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BACKGROUND: As the age at first pregnancy continues to rise in the United States so does the incidence of breast cancer diagnosed during pregnancy. Our objective was to evaluate temporal trends in the incidence of pregnancy-associated breast cancer (PABC) and to measure neonatal outcomes associated with PABC. METHODS: We conducted a population-based cohort study using the 1999-2012 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) from the United States. Logistic reg...
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#1Jorine de Haan (Katholieke Universiteit Leuven)H-Index: 5
#2Magali Verheecke (Katholieke Universiteit Leuven)H-Index: 12
Last. Frédéric AmantH-Index: 84
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Summary Background Awareness is growing that cancer can be treated during pregnancy, but the effect of this change on maternal and neonatal outcomes is unknown. The International Network on Cancer, Infertility and Pregnancy (INCIP) registers the incidence and maternal, obstetric, oncological, and neonatal outcomes of cancer occurring during pregnancy. We aimed to describe the oncological management and obstetric and neonatal outcomes of patients registered in INCIP and treated in the past 20 yea...
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#1Ingrid A. Boere (EUR: Erasmus University Rotterdam)H-Index: 13
Last. Frédéric AmantH-Index: 84
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PurposeThe incidence of hematologic malignancies during pregnancy is 0.02%. However, this figure is increasing, as women delay conception until a later age. Systemic symptoms attributed to the development of a hematologic cancer may overlap with physiologic changes of pregnancy. A favorable prognosis is contingent upon early diagnosis and treatment. Therefore, a high index of suspicion is required by health care providers. Although timely, accurate diagnosis followed by appropriate staging is es...
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#6Mildred Ramirez (BCM: Baylor College of Medicine)H-Index: 30
Importance The management of lymphoma diagnosed during pregnancy is controversial and has been guided largely by findings from case reports and small series. Objective To determine maternal and fetal outcomes of women diagnosed with Hodgkin lymphoma (HL) or non-Hodgkin lymphoma (NHL) during pregnancy. Design, Setting, and Participants This retrospective analysis studied a cohort of 39 pregnant women diagnosed with HL and NHL (31 HL and 8 NHL) at a single specialized cancer institution between Ja...
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The diagnosis of cancer during pregnancy at least in the Western world is a rare phenomenon, but this might be raised into the future due to late pregnancies in the modern societies. The coexistence of pregnancy and cancer implicates numerous medical, ethical, psychological and sometimes religious issues between the mother, the family and the treating physician. Breast, cervical cancer, melanoma and lymphoma are the most common malignancies diagnosed during pregnancy. Diagnostic or therapeutic i...
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#1Kimberly D. Miller (ACS: American Cancer Society)H-Index: 29
#2Rebecca L. Siegel (ACS: American Cancer Society)H-Index: 68
Last. Ahmedin Jemal (ACS: American Cancer Society)H-Index: 139
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The number of cancer survivors continues to increase because of both advances in early detection and treatment and the aging and growth of the population. For the public health community to better serve these survivors, the American Cancer Society and the National Cancer Institute collaborate to estimate the number of current and future cancer survivors using data from the Surveillance, Epidemiology, and End Results cancer registries. In addition, current treatment patterns for the most prevalen...
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#2Kelvin P. Jordan (Keele University)H-Index: 56
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OBJECTIVE To assess the temporal trends, characteristics and comorbidities, and in-hospital cardiovascular and obstetric complications and outcomes of pregnant women with current or historical cancer diagnosis at the time of admission for delivery. METHODS We analyzed delivery hospitalizations with or without current or historical cancer between January 1, 2004, and December 31, 2014, from the US National Inpatient Sample database. RESULTS We included 43,132,097 delivery hospitalizations with no...
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