Pregnancy screening practices and treatment of pregnant patients among radiation oncologists: results of an international survey

Abstract

Background:The human embryo or foetus is susceptible to harmful effects of radiation, which include growth delay, malformations, impaired cognitive function, cancer and foetal demise. The purpose of this study is to describe pregnancy screening practices in radiation oncology, so that potential health effects may be avoided and areas of prevention may be identified.Methods: An electronic survey was delivered to 6,304 members of the American Society for Radiation Oncology. The survey subjects were radiation oncologists who are currently practicing in the world. Chi-square tests and a multiple logistic regression model were used to analyse the data. All tests were two-sided and the statistical significance level used was 0.05. This study (STUDY00009765) was approved by an Institutional Review Board.Results: A total of 434 responses from practicing radiation oncologists were received. Of these respondents, 69.1% were practicing in the United States. Of all respondents, 19.8% reported treating paediatric patients and 93.6% reported treating premenopausal patients. Despite 84.8% of radiation oncologists saying they would 'strongly agree' or 'agree' that one should screen for pregnancy prior to radiation therapy, 29.7% of respondents reported their department has no screening policy and 7.1% of respondents reported they do not screen for pregnancy. Having a departmental policy was associated with screening for pregnancy (p-value = 0.0005).Of all respondents, 93 reported treating a known pregnant patient. Of these 93 respondents, 76 reported intentionally treating and 17 reported accidentally treating a pregnant patient. Respondents who did not screen at time of simulation were significantly more likely to treat a pregnant patient than those who screened at time of simulation (p-value = 0.0459). Conclusions:Heterogeneity exists among practicing radiation oncologists regarding pregnancy screening. Institutional policies should be clear and consistent. All members of the radiation oncology team should make every effort to minimise unintended radiation exposure to the embryo or foetus.

A minority of women of childbearing potential are tested for pregnancy before chemoimmunotherapy: an Australian cancer centre experience

“…Demographic data, including education level and language barriers, were not readily ascertainable from patient records, which limited the generalisability of our findings. However, our population size and results support the existing published experience that pregnancy screening is performed rarely prior to treatment 6,12–14,24 …”

“…However, our population size and results support the existing published experience that pregnancy screening is performed rarely prior to treatment. 6,[12][13][14]24…”

“…As illustrated in our study, the case of a woman presenting to the emergency department for nausea and vomiting during her fourth cycle of chemotherapy, which ultimately turned out to be a miscarriage, is a tragic result of ineffective guidelines for women's health in the context of cancer treatment. Sadly, this example is not a first, 12,24 and will not be the last, until this issue is proactively addressed through guidelines, policy and evidence‐based implementation strategies. Several oncology centres have implemented policies to improve pregnancy screening rates and reported mostly positive results 12–14 .…”

Radiation oncology department policy development for patients who may become pregnant

“…A 2021 study noted that ASTRO radiation oncologists responding to an electronic survey indicated that they would “strongly agree” or “agree” that screening for pregnancy should be done prior to delivery of radiation therapy (84.8% of respondents), but 29.7% of respondents noted that their department did not have such a screening policy in place, and 7.1% of respondents indicated that their department did not screen for pregnancy. 4 The same survey indicated that having a departmental policy in place for screening for pregnancy was strongly correlated with respondents screening for pregnancy ( p = 0.0005). These results echo those of a 2016 survey of National Comprehensive Cancer Network member institutions, which found that 30% of respondents did not have a guideline or policy in place on screening patients for pregnancy prior to treatment via radiation therapy, surgery, or chemotherapy.…”

“…However, many radiation oncology departments do not systematically or routinely verify patient pregnancy status. A 2021 study noted that ASTRO radiation oncologists responding to an electronic survey indicated that they would “strongly agree” or “agree” that screening for pregnancy should be done prior to delivery of radiation therapy (84.8% of respondents), but 29.7% of respondents noted that their department did not have such a screening policy in place, and 7.1% of respondents indicated that their department did not screen for pregnancy 4 . The same survey indicated that having a departmental policy in place for screening for pregnancy was strongly correlated with respondents screening for pregnancy ( p = 0.0005).…”