Objectives
  • To be able to diagnose, stage, treat and counsel pregnant patients with cancer and to assess and counsel patients with pregnancies occurring after cancer

Awareness
  • Awareness of the epidemiology of main cancer types occurring during pregnancy

  • Awareness of the existence of diagnostic pitfalls of cancer during pregnancy due to the pregnant status

  • Awareness of the availability of diagnostic and staging procedures which are safe for the pregnant mother and her fetus

  • Awareness of the existence of specific treatment strategies for each tumour type

  • Appreciation of the importance of multidisciplinarity in treating cancer during pregnancy

  • Appreciation of the principles of surgery, radiation therapy and systemic treatment during pregnancy

  • Recognition of the importance of referral to specialised centres

  • Awareness of the existence of the special psychological and social support needs of the pregnant mother with cancer and her family

  • Appreciation of the safety and feasibility of pregnancy following cancer treatment

Knowledge
  • Familiarity with the implications of the different types of cancer diagnosed during pregnancy and their impact on maternal and fetal prognosis

  • Familiarity with the peculiarities and implications associated with cancer diagnosed at different gestational ages

  • Understanding of the situations where abortion might be considered and prioritise shared decision-making with the mother and her partner

  • Familiarity with the available diagnostic means, including needle biopsy and surgery, and with the fetal effects of local and general anaesthesia with the mother

  • Familiarity with the importance of correct staging also during pregnancy and of the available diagnostic means

  • Familiarity with the indications and the value of surgery, radiation therapy, chemotherapy, immunotherapy, targeted therapy and supportive and palliative care for cancer diagnosed during pregnancy and their effects on the pregnant mother and her embryo or fetus

  • Understanding of the importance of sensitive and empathic counselling

  • Familiarity with the impact of previous treatments on pregnancy after cancer, including maternal effects (eg, drug-induced infertility, cardiomyopathy, radiation-induced breast fibrosis) and fetal effects (eg, genotoxicity of recent chemotherapy or endocrine treatment)

  • Familiarity with the importance and the feasibility of contraception during and after cancer treatment

  • Familiarity with the feasibility of fertility preservation during cancer treatment

  • Understanding of the pharmacokinetics of drugs administered during pregnancy and of the importance of correct dosing according to actual weight and height

  • Familiarity with conditions (such as rapidly deteriorating maternal performance status due to cancer spread) that are important for considering early delivery

  • Familiarity with the potential adverse effects and neonatal risks of very early delivery

  • Understanding of the long-term safety of children exposed to maternal chemotherapy during gestation

Skills
  • Ability to contribute actively to the multidisciplinary management of the pregnant mother with cancer, sharing the appropriate oncological treatment with the surgeon, the radiation therapist, the obstetrician and the perinatologist

  • Ability to perform a history and physical examination acknowledging the pregnant status of the patient

  • Ability to explore the availability of social support and the patient's attitude regarding the ongoing pregnancy

  • Ability to discuss critically the treatment options/recommendations of each tumour type diagnosed during pregnancy including prognostic considerations

  • Ability to discuss with the mother the effects of local and general anaesthesia on the fetus

  • Ability to recognise the effects of various therapeutic agents and their potential fetal toxicity according to the gestational age and mechanism of action

  • Ability to counsel young patients with cancer about contraception during oncological treatments and about the feasibility and safety of subsequent pregnancies, when appropriate

  • Ability to refer the patient to a centre with experience in treating cancer during pregnancy and to include the data into international registries after permission

  • Ability to be compassionate, empathic, non-judgemental and to learn the art of listening and shared decision-making