‘See the symptom, not the pregnancy’- a look at cancer diagnosis during pregnancy

Today, we’re speaking to Dr Afrodita Marcu, a Research Fellow in Cancer Care at the University of Surrey.Title of paper: Symptom appraisal and help- seeking before a cancer diagnosis during pregnancy: a qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2024.0208There is a gap in current understanding about the experiences of women diagnosed with cancer during or around pregnancy including how they appraise and seek help for cancer-related symptoms. This qualitative study found that women and healthcare professionals often interpreted symptoms through the lens of pregnancy, particularly when symptoms were vague. Health professionals need to ensure full assessment of symptoms, timely referral, and effective safety-netting for these women.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.040 - 00:01:04.650Hello and welcome to BJJP Interviews. I'm Nada Khan and I'm one of the associate editors of the bjgp. Thanks for listening to this podcast today. In today's episode, we're speaking to Dr.Aphrodite Marcoux, a research fellow in Cancer care at the University of Surrey.We're here to talk about a paper she's recently published here in the bjgp, which is titled Symptom Appraisal and Help Seeking Before a Cancer Diagnosis during Pregnancy, A Qualitative Study. So it's really lovely to meet you, Aphrodita, to talk about your research.And I think this is a really important area and I wanted to get your thoughts on just why this area is so important to research.But I think that most people will probably appreciate that during pregnancy, women's bodies are going through lots of changes, so it can sometimes be difficult to know what's normal and what's not. But talk us through why you wanted to do this study.What are the challenges faced by patients and by doctors around cancer diagnosis in women who are pregnant?Speaker B00:01:05.050 - 00:02:32.190It's an important area to research because the symptoms of pregnancy, the bodily changes that naturally occur during pregnancy, can mask the symptoms of cancer, both for the women experiencing them, but also for the healthcare professionals with whom they come into contact and with whom they share the symptoms.So it's an important area to research from that point of view in terms of understanding the potential causes for delay in receiving a cancer diagnosis.And one of the areas which we discovered was less researched was early diagnosis or timeliness of diagnosis of cancer diagnosis in the context of pregnancy.So we conducted this research because there was a lack of research, especially in the uk, on women's pathway or other pathways to a cancer diagnosis and pregnancy.And we wanted to get a more detailed understanding knowledge of how women make sense of their symptoms during pregnancy, how they seek help and why to whom they present, midwife, gp, other healthcare professionals and how they receive a diagnosis. What is the pathway to a cancer diagnosis and pregnancy?We wanted to get more clarity about that, more detail, and we were also interested to find out whether delays characterize this pathway to a cancer diagnosis in pregnancy, be they patient related delays or healthcare system related delays.Speaker A00:02:32.830 - 00:02:44.750And I guess you've touched on this. So does do we know if there are delays in cancer diagnosis amongst women who are pregnant?So do they tend to have a later diagnosis than women who aren't pregnant?Speaker B00:02:45.540 - 00:03:15.770International research suggests so. For example, in relation to breast cancer, which is the most frequent cancer diagnosed during pregnancy?Women are typically diagnosed later or later stage breast cancer than women who are not pregnant of similar age groups.So there is some indication that in the body of literature around cancer in pregnancy that women might receive a later diagnosis compared to women who are not pregnant.Speaker A00:03:16.570 - 00:03:56.710And this was a qualitative research study. So your team talked to women diagnosed with cancer during or soon after pregnancy and you talked to 20 women.And I really wanted to focus on what you found here. And you used an interesting model here.So you map the findings of your research onto a commonly used framework in cancer diagnosis, the models of pathway to treatment. So you've talked about sort of these pathways that women experience during their cancer diagnosis journey during pregnant.And I wanted to just talk through some of the findings. So when women were pregnant, how did they interpret their symptoms that may or may not have been related to cancer?Speaker B00:03:58.390 - 00:06:22.420Well, they interpreted these symptoms in various ways and that depended on the type of cancer they had, but also the type of symptom or symptoms that they experienced.So, for example, we had a couple of women with colon cancer, bowel cancer, one of them had abdominal pain and bloatedness, bloating, whilst the other one had blood in the stool. So obviously the symptoms were interpreted differently by the two women.The one with blood in the stool saw this as incongruent with pregnancy because it's very unusual to have blood in stool during pregnancy, and looked up her symptoms online, did some reading and decided that these symptoms warrant medical attention. So she contacted her GP fairly promptly.The other lady with more diffuse symptoms with abdominal pain and bloating repeatedly mentioned these symptoms to her midwife, but these were put down to pregnancy. And she always, when she actually engaged in information seeking online, she always added in pregnancy.So she saw these symptoms as being part of the pregnancy, was her first child, and thought it's normal to have abdominal pain or to feel bloated during pregnancy. So she was actually diagnosed quite late with stage 4 colon cancer.Of course, we are not drawing cause effect conclusions because this was a qualitative study, but we do find that the symptoms, which are vague, are more likely to be interpreted as being signs or symptoms of pregnancy, as being pregnancy related bodily changes.So it depends on the type of symptom that people symptoms that people experience, but also depends on the type of cancer they have, because some cancers, such as breast cancer, are more people are more familiar with breast cancer, let's say, than with lymphoma or other types of cancer, and they're more likely to see breast lumps which are typical symptom of breast cancer as being indicative or being suggestive of breast cancer, and it makes them more worried and more inclined, speak to a healthcare professional to see their GP promptly. So for women who experience breast lumps, the pathway was in a sense clearer.They knew who to contact and also the healthcare professional in question, the GP was more likely to make referrals to tests and secondary care, refer them to the breast clinic.Speaker A00:06:22.980 - 00:06:30.180I think it was interesting in the paper you described this as people viewing their symptoms through the lens of pregnancy.Speaker B00:06:30.620 - 00:07:20.420Yes.So the pregnancy offered for the women sort of heuristic and also in competitive lens, they understood their symptoms in the context of the pregnancy.Of course, people, women expected their bodies to change during pregnancy, such as breasts becoming larger or various lumps appearing, perhaps being related to milk ducts and things like that. So they always thought of pregnancy as being the reason for their bodily changes rather than cancer.So again, we have different patient histories, different types of symptoms, and this leads to different ways or different pathways to cancer.Diagnosis in pregnancy for some people can be a very straightforward pathway, for others, it's more prolonged, one more complicated one because of the types of symptoms they experience.Speaker A00:07:21.380 - 00:07:36.880And I guess the flip side to this is what the healthcare professionals did with women coming to them with symptoms during their pregnancy.And this is all from the perspective of the women you talked to in the study, but what did they feel that the healthcare professionals thought of their symptoms when they presented to them?Speaker B00:07:37.120 - 00:09:06.970Well, I suppose it varied from individual to individual.In some cases, the healthcare professionals thought that the symptoms were due to pregnancy, saying it's hormonal, just hormonal changes, nothing to worry about.In some cases they thought that the baby was lying on a nerve, which explained why people had symptoms such as back pain or breathlessness or other symptoms, in some cases, the gps thought it is hormonal change, it's probably due to pregnancy, but I will refer the patient to a breast clinic because the system is there in place, it's better