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Prenatal cancer treatment, how are the children doing?

Cancer during pregnancy is diagnosed in approximately 200 pregnant women per year in the Netherlands. In collaboration with the Advisory Group on Cancer and Pregnancy (AKZ) Netherlands, the CIP (Cancer In Pregnancy) team at the Princess Máxima Center provides optimal care for families that are affected. Prof. Marry van den Heuvel-Eibrink: ‘knowledge of oncology in adults and in children is required to pursue this effort. The CIP team of the Máxima Center is investigating, in an international context, the direct and long-term consequences for the children.’

Together with centers in Belgium, Italy, the Czech Republic, Spain, Denmark and the United States, children are followed longitudinally. This unique so-called INCIP (international CIP), lead prof. F.C. Amant of the Netherlands Cancer Institute (NKI), collaboration aims to gather knowledge about the children concerned as quickly as possible. Marry van den Heuvel-Eibrink: ‘In recent years, more knowledge  has become available at an international level about the possibilities of treatment during pregnancy and its effect on the outcomes for mother and child. This resulted in the fact that immediate termination of pregnancy, which  was common practice in the past, is no longer necessary.’


(Late) effects
Pediatric oncologists Marry van den Heuvel and Martine van Grotel participate in the Dutch advisory group specifically for feedback on the (late) effects of these treatments in children: 'For example, we recently discussed a case of a young mother with cancer, 26 weeks pregnant. Can chemotherapy be started or is it better to wait, and is birth at 34 weeks of pregnancy better than postponing until 37 weeks, and which cytotoxic compounds can be safely applied for mother and child, are then obvious questions. These decisions needs to involvement of  experts with knowledge of oncology both in adults and in children!’


Centralized care for families
Currently more than 150 children of mothers who were diagnosed and treated for cancer during pregnancy have been seen one or more times at the Máxima's CIP clinic. Martine van Grotel: ‘We follow the children at fixed times in a multidisciplinary setting, from birth to 18 years. A pediatric physiotherapist, neuropsychologist and remedial education expert conduct the neuromotor and neurocognitive examination. In addition, based on exposure to specific compounds during pregnancy, specific tests such as audiological testing and cardiac ultrasound are performed. Cancer during pregnancy comes with many concerns. The CIP outpatient clinic is a place where parents can discuss these concerns and questions and be reassured about the health and development of their child. If necessary, they can count on a timely referral.


Mathilde van Gerwen and Evangeline Huis in 't Veld are involved in the CIP consultation hours as PhD candidates. Their research projects involve the long-term development of children exposed to cancer treatment before birth. These projects are carried out in an international setting. Mathilde: ‘We already know from previous research that the neurocognitive development of these children is more influenced by prematurity than by cancer treatment. An important goal nowadays is therefore to maintain the pregnancy for at least 37 weeks. Current research also focuses on the development of motor skills and hearing damage. The knowledge we are currently gathering will inform future parents, helps to reassure families and will help develop (evidence-based) guidelines for the best care for this group of patients.’


CIP team
The Princess Máxima Center's CIP team consists of dr. M. van Grotel, pediatric oncologist, drs. M. van Gerwen, neuropsychologist, drs. E. Huis in ’t Veld, remedial educationalist, prof. dr. M.M. van den Heuvel-Eibrink, pediatric oncologist and principal investigator, and drs. E. Verwaaijen, pediatric physiotherapist, epidemiologist and PhD student. They team is also involved in the Advisory Group on Cancer and Pregnancy (AKZ) Netherlands, which works closely with the International Network on Cancer, Infertility and Pregnancy (INCIP).

The CIP team is a permanent team that has weekly consultation hours on Wednesdays. Parents and children experience the after care in the Máxima as pleasant. In consultation with the CIP team, they united themselves last year in the STER(k) Foundation, with the aim of peer contact, information and education. Depending on the type of cancer and the administered treatment/procedures during pregnancy, patients receive a consultation (medical history and physical examination) and, if necessary, an additional investigations, such as  audiological and cardiac screening, an examination of motor skills and a neuropsychological examination. For more information and contact: cip@prinsesmaximacentrum.nl.