Psycho-oncological care for young women facing cancer and pregnancy

Women who are diagnosed with cancer during pregnancy have to deal with two critical life events at the same time: pregnancy and cancer. More importantly, these two events lie at the opposite ends of the life continuum. With pregnancy a new life begins, while the word cancer is still associated for most people with the end of life and dying. From a medical standpoint there are several complicating factors in this situation: diagnosis is often delayed, because the focus of the physician (and the mother) is on pregnancy. Information giving is limited by the fact that there is still a paucity of statistical data on outcome and impact of treatment options. Also, several disciplines are forced to work together very closely and the collaboration of oncology, obstetric and psychological experts with family physicians is both very important yet sometimes challenging. The task of supporting a pregnant cancer patient can also mean a psychological burden for the caregivers and special attention needs to be paid to personal resources and as well as to each person's individual limits. The important issues for a pregnant cancer patient are as follows: giving life and being in a life-threatening situation at the same time; experiencing overwhelming emotions while coping resources may be limited; feeling a responsibility to take care of the fetus/the child and at the same time needing to be cared for herself; choosing between treatment options that can only be second-best as there is no perfect solution (the loss incurred by terminating a pregnancy or the danger in risking its continuation); ambivalence towards chemotherapy (a poison); changes in body image caused by both the pregnancy and the effects of cancer treatment. In the post-partum period other issues arise: the joy of childbirth is hampered and breast-feeding may not be possible because of on-going chemotherapy; any other children will need minding during particularly heavy cancer treatment; both mother and child may need care, if the baby is premature; paternal ambivalence: joy about the child/sorrow about the mother, with the predominant issue being the constant fear of losing the mother. In this context, the patient and her partner need regular visits (obstetric and oncological) and psycho-oncological support from an experienced team. If the pregnancy is continued, the couple will need help in bonding with the child, both before and after the birth. If the pregnancy is terminated, the patient needs to be supported in her mourning process while at the same time helped in activating the resources needed to go through the treatment process. Integration of the partner is very important: cancer threatens the whole family with separation and loss. Such threats can seriously alter the course of family life, particularly in the case of cancer in a first pregnancy, when the family system is only just developing. Ideally, the partner will play an active part in the decision-making process, but this is a very difficult situation to be in: the woman is bearing a child that he may badly want to see born, but he also wants the best possible outcome for his partner and above all does not want her to die. This conflict is not easy to communicate. A role-change within the couple can be an additional burden. The woman, who until now was pregnant and healthy, is now pregnant and ill, while her partner is neither pregnant nor ill. He may well be feeling the pressure of such responsibility, but again, in the present situation this might not be something he feels he can talk about.