Women who receive a breast cancer diagnosis while pregnant are faced with a myriad of emotions and challenging treatment decisions. A time that normally signifies joy and anticipation for a woman and her family is now mingled with uncertainty and fear. Pregnancy-associated breast cancer (PABC) is becoming more common as more women are waiting to bear children. It is important for women to have complete and accurate information about the treatment options available to them while pregnant. Nurses are uniquely positioned to help patients with PABC navigate complex health care decisions and choose what makes the most sense for them and their families. Nurses can assist patients in communicating fully with the health care team during the course of cancer treatment, obstetric care, and beyond, so care is a transparent and collaborative process. Patients can be encouraged to engage their support network and access all available resources. There are certain psychosocial challenges that nurses should keep in mind when treating patients with PABC.
Normal breast changes caused by fluctuating pregnancy hormone levels may mask breast cancer symptoms, rendering the cancer difficult to detect. Screening may be delayed, leading to diagnosis at a later stage and fewer effective treatment options. Women should be counseled about the safety of screening and treatment during pregnancy. Often, it is imperative to begin cancer treatment quickly, when the fetus is not to term and delivery is not yet possible.
Treatment for PABC is designed to ensure that the mother has the best possible outcome, with the fetus’ safety also a priority. However, at times these two interests may conflict. In my clinical experience, patients invariably have concerns about this balance and need support along the way. Most likely they are just getting used to the experience of pregnancy and impending motherhood, only to be thrust into the world of cancer. They may worry about whether they should terminate the pregnancy, what (if any) lasting impact screening and treatment will have on their growing fetus, what to expect in terms of side effects, and about their ability to be there for their child over the long-term.
I always encourage my clients to have an open, honest conversation with their health care team about their concerns. They can start by writing down a list of their top five most pressing questions that they need to have addressed. This will help the patient’s health care team identify any barriers to treatment in order to create the best possible plan for mother and child.
Breast cancer diagnosed at a young age is especially disruptive. Women in their 20s through early 40s are progressing in their careers, building their own families, and juggling various life demands. They may be the family’s primary breadwinner, or the main caretaker for children or parents. The diagnosis impacts the whole person and the entire social system. Nurses and other health care providers will find it helpful to assess the patient’s individual needs and possible obstacles to treatment adherence, along with their available supports. Are grandparents living locally able to offer childcare for young children in the home? Can a woman’s partner or friends help drive her to and from treatment? Does she belong to a church, synagogue, or mosque that may be able to provide meals or other assistance? Is the woman’s workplace understanding and flexible? You can assist the patient in drawing on her available strengths and supports as she moves through the phases of treatment.