Diagnostic and treatment delay in women with cancer in pregnancy: a case-based study

PURPOSE: More advanced stages at diagnosis and lower survival rates are seen in women diagnosed with cancer during pregnancy compared to non-pregnant women with similar cancers. This study aims to investigate diagnostic and treatment delays, cancer stage, and survival in Danish pregnant cancer patients. METHODS: Patients from the Danish cancer in pregnancy database were included. Cancer diagnosis, treatment, and obstetrical data were collected from the database. Time to treatment was compared to national cancer patient pathways. Cancer stages at diagnosis were compared to epidemiological studies identified through a systematic literature search. Survival was compared to data from NORDCAN, a Nordic cancer statistics database. RESULTS: The study included 74 patients diagnosed with cancer in pregnancy. The median total delay was 43.5 days (IQR 27.75-94.75) with a patient delay of three days (IQR 0-31), a diagnostic delay of 15 days (IQR 8-35), and a treatment delay of 9.5 days (IQR 0-19). Time from cancer suspicion to start of treatment fell within recommended national cancer patient pathway intervals in 80.0% of cases. Breast cancer and melanoma in pregnancy tended to have more advanced stages at diagnosis compared to non-pregnant patients. The 1- and 5-year mortality rates were 5.4% and 17.6%, respectively. CONCLUSION: Our findings suggest that pregnant cancer patients presented with advanced stages at diagnosis and lower survival rates compared to non-pregnant patients with similar cancers. Our results indicate that the main contributor to the delay in cancer in pregnancy in Denmark is delayed suspicion of cancer.