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Cancer and Pregnancy: Elyce Cardonick
79 Plays5 months ago
Dr. Elyce Cardonick is a cancer and pregnancy specialist at Cooper University Hospital in Camden, NJ. Listen to Elyce discuss the founding of the Cancer and Pregnancy Registry in 1997, the Hope for Two support network and common misconceptions regarding medical treatment during pregnancy.
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Transcript
Introduction and Guest Overview
00:00:09
Speaker
You're listening to The Wound Dresser, a podcast that uncovers the human side of healthcare. I'm your host, Jon Neary.
00:00:21
Speaker
My guest today is Dr. Elise Cardonic. Dr. Cardonic is a high-risk obstetrician at Cooper University Healthcare care in Camden, New Jersey. In this role, she specializes in the care of women who receive a cancer diagnosis during pregnancy.
Cancer and Pregnancy Registry
00:00:35
Speaker
She also directs the Cancer and Pregnancy Registry, which seeks to gather data to improve treatment for pregnant women with cancer. Dr. Elise Cardonic, welcome to the show. Thank you for having me. Thank you so much. So before we get into talking about the registry, can you just give our listeners and an idea of how frequently ah cancer happens during pregnancy?
00:00:56
Speaker
It's about one in a thousand pregnancies. um When I was a fellow or actually a resident four years of OBGYN, I didn't see a single patient during my four-year training that was pregnant with cancer. And that's probably because in the 90s when I did my training, most women were having children in their 20s. And I think that I saw more when I was in ah my fellowship and we're seeing more now because women are delaying their childbearing to older ages and a delayed first pregnancy in and of itself might be a risk for breast cancer. So I think we're seeing this now consistently one in a thousand pregnancies because of later pregnancies in someone's reproductive life. ah You mentioned breast cancer, but what are some of the most diagnosed cancers you see during pregnancy?
00:01:44
Speaker
So breast cancer is probably about 50% of all the cases we see. ah The next most frequently diagnosed is probably Hodgkin's lymphoma, non-Hodgkin's lymphoma, but we also see patients with colon cancer, melanoma, acute leukemia, cervical cancer, not as much as you would think because we're screening women with their pap smears and also ovarian cancer can happen. but Luckily in pregnancy, because we're doing fetal ultrasounds, we tend to be able to diagnose those at early stages compared to non-pregnant patients. So it would be not as often as we see the other cancers.
Tracking Long-term Outcomes
00:02:22
Speaker
And so now, yeah, can you tell our listeners about what the the cancer and pregnancy registry is? Sure. So um when I was a fellow, as I said, during my training, I never met a pregnant patient who had cancer.
00:02:35
Speaker
and Within six months of my high-risk fellowship at Jefferson, I met a patient who had, the first one was um melanoma. She was early in pregnancy and surgeons were reluctant to go back in after the biopsy and do an extensive groin dissection and look at the lymph nodes in her leg and really see if this melanoma from her thigh had spread. And she was being encouraged to terminate the pregnancy.
00:03:03
Speaker
And we worked with nuclear medicine to see kind of what dose would go to the inguinal groin lymph nodes and be near the fetus if she had the tumor injected with a radioactive material to kind of see what lymph nodes there were that were involved. And the radiation was far less than the five rads that we like to stay under in pregnancy.
00:03:24
Speaker
So we were able to work with the surgeon and the patient and have her go through this procedure and continue the pregnancy because there was no data saying that termination of the pregnancy would improve her prognosis from melanoma, just kind of made that the treatment a little more complicated. So after she decided to continue the pregnancy, underwent the surgery, delivered her child, I thought, well, that was very interesting. I take care of women with all different medical conditions um during pregnancy, high You know, that's what high risk is, diabetes, hypertension, malaria, sickle cell disease, whatever it may be. And this was one case of melanoma. And then within two, three months, there was a patient who was diagnosed with Hodgkin's lymphoma 10 weeks, who was also encouraged to terminate her pregnancy. And the literature didn't show that pregnant women who have Hodgkin's lymphoma
00:04:16
Speaker
If you compare them to a non-pregnant patient who's the same age and stage as the pregnant patient, there was no difference in five-year survival. So I couldn't tell her that termination of the pregnancy would improve her prognosis. But because Hodgkin's lymphoma is a very curable cancer, I also didn't want her to go from 10 weeks to term and not be treated for a curable cancer. She had other children that I wanted her to be ah around four. And obviously, we want to treat the mom as well as we can. So we started looking into the literature of chemotherapy in pregnancy. And the literature at that time showed you that if you start chemotherapy after the fetal organs are developed, so if you wait after 12 weeks, that the babies appear fine at birth. But as an OBGYN, I knew that although the organs are done developing, most of them in the first 12 weeks, you still have further development of the brain throughout pregnancy. So I was concerned
00:05:13
Speaker
What happened after birth? you show You tell me that the baby's born with no birth defects and the baby did well, but I want to know how that baby's doing at 18 months of age and two years of age and three years of age so that I can tell this patient, you know you can get through the pregnancy but without harming the fetus as best we can tell at delivery, but I want to be able to tell you what the long-term risks are. And there was one study at the time in Mexico where they did just that. They brought these children back when they were older and did developmental testing for them and showed that they were performing just as well as their siblings who were not born from a complicated pregnancy needing chemotherapy and from other children that were in the community that were matched for their age. But that was the only study. So the way that the um registry was developed is that with this one couple, I said, I'll follow your child after birth to make sure that
00:06:12
Speaker
he continues to develop normally. And we had to present her case to the ethics board of the hospital because the oncologist was not comfortable giving chemotherapy, understandably, really was risk management of the hospital, radiation. I mean, nuclear medicine in the hospital and the oncologists were all feeling more comfortable termination. And someone around the ethics board said, well, what happens to the fetal gonads? Is the sperm or egg of a fetus going to be at risk for infertility the same way an adult is at risk for infertility. And that was the other reason to follow this child in the registry because I wanted to to follow the child at least through puberty to show that that should not be the case. that The egg and sperm of a fetus is dormant. It should not be sensitive to the chemotherapy. And some of the babies in the Mexican study were in their teens and developing normally. So the second reason
00:07:08
Speaker
was not only to see the development of this child would be okay, but to follow that child through puberty. And now I follow that child till he's in his 20s. So at the end of this one case, you know the oncologist said to me, well, you know this will never happen again. Thank you for your help. And you know it's gonna be so rare. And then three months later, someone with breast cancer came. So now I was like, okay, we need to really not just record this for this one patient, but to collect cases from everywhere because each oncologist is only gonna have a few patients who are pregnant and each OBGYN is only going to have a few patients that have cancer. So we need to collect these cases from all over the United States into one place so we can look at patterns and see the best way to treat cancer during pregnancy and make sure these babies and moms are okay. and wait What year did this start, by the way? Ninety-seven. Ninety-seven. um how How many patients have you enrolled in the registry? Six hundred and three.
00:08:04
Speaker
Wow. And do you kind of break it down by different types of cancer? Or are are most of those folks like lumped together, ah regardless of their diagnosis? So everybody, any cancer can enroll any cancer diagnosed between six weeks before conception through delivery. As long as you know, there's exposure of the fetus to a cancer, they're included, in and it's any cancer type, we have some cancers that we only have one or two cases of like multiple myeloma.
00:08:34
Speaker
And we have some cases like breast cancer. We have 300 cases. So your cancer type doesn't matter. It's if you're pregnant and you have an ah invasive cancer. So we actually don't follow pre-invasive. Like we don't follow um DCIS, for example, with breast cancer. But if it's invasive brain breast cancer, yes. If it's invasive cervical cancer as opposed to just CIN1, then we would follow you. So cancer type doesn't matter. but if We put everybody in that database, but if an oncologist called and said, I need help with a case of lymphoma, we certainly can search the database for the 35 patients with that particular ly lymphoma and help that oncologist know without, we never give anyone's name or confidential information, but we can say of the 30 people with Hodgkin's lymphoma, all but one had the bleomycin in their ABBD regimen and the babies were fine. So some doctors like to,
00:09:31
Speaker
um change up that the typical chemotherapy regime the regimen that a non-pregnant patient would have. And if we have the evidence that the standard of care chemotherapy is tolerable by the fetus, we want the mom to be treated with the standard of care. So we can separate it by cancer type. We can we can separate it by chemotherapy type for all different cancer types. um We can search the database in a lot of different ways.
00:09:59
Speaker
Listening to you describe the study, it feels like it would be really hard to to follow patients for that long, right? You said you were you were starting basically during a pregnancy and following the child you know all the way ah through to adulthood. So can you talk a little bit more about your data collection process and how you ah you know ah get all the data you need to for the registry?
00:10:21
Speaker
Even though we can tell pregnant patients that call that we have 602 other women besides her that have cancer and pregnancy, each woman still feels like, I've never heard of this, like how can I possibly get cancer treatment when I'm pregnant? I have to be the only one that this has ever happened to. So because of that feeling,
00:10:38
Speaker
These women are so motivated to contribute to research to help the next person that gets diagnosed that I actually don't have a hard time um having these women um agree to participate because they really want to help the next woman down the road feel like they're not the only one going through this. So two things happen. One is um I refer them or they've found them first and refer them to me to a support group in Buffalo called Hope for Two and they can call that hotline and say, I have breast cancer. I'm 14 weeks. It's triple negative. I don't know what to do with my pregnancy. And they will say to her, I'm going to match you with another woman who was triple negative and continued her pregnancy. And you could bond together and she'll be your support person. She already had her baby. So Hope for Two is a place where these women can check in also. And they will say, if you'd like to be in the cancer and pregnancy registry, please contact Dr. Cardonic. We work together. I'm on their board. I've fallen to Buffalo.
00:11:35
Speaker
a few times to meet with these women, and they kind of started their support group at the same time I started the registry. So now when the patient enrolls in the registry, she signs not only consent to be in the registry, but she lets me know who the child's pediatrician is going to be and signs a release form for the pediatrician, the oncologist, and the obstetrician. does The patients don't have to be delivered at Cooper. In fact, there's plenty of patients in the registry from California.
00:12:02
Speaker
So I get there, wherever they're being treated, wherever they're comfortable being treated, whatever's close to home and convenient for the patient to not increase stress and have to travel, they sign for their record release. So now when the baby's, I know when the baby's delivered, when the baby's born, I send a letter to the patient congratulating her, asking how everything went and to the obstetrician. And then on the birthday month, so if that baby was born in October, every October I send a letter to the,
00:12:29
Speaker
pediatrician asking age-related specific questions. Is the baby meeting milestone? What is their height and weight? Are they being treated for any um medical issues? Do they see a specialist for for speech or motor or any other issues? So it's an annual contact with that pediatrician. It's not just a survey from you know parents or anything like that. it's a It's an annual contact with the pediatrician. It's a lot of work to to do that. um But that's the most valuable piece because you know people have to know what the long-term implications are. And from following these children long-term, we have learned a couple of things, such as children when they go to school, ah maybe by first grade, the children who've been exposed to chemotherapy have a higher risk to need glasses. So now we can inform patients, you know don't wait to your child, can't see that the school board, you know have the child's vision checked a little bit earlier than you would if you haven't had chemotherapy. so
00:13:25
Speaker
um I think the moms are comforted knowing that we're going to keep a close eye on these babies.
Balancing Treatment and Fetal Health
00:13:31
Speaker
But if someone moves away, you're absolutely right, they move away, change doctors, and they don't inform us, it's very hard to get that follow up. You mentioned um like you just mentioned the need for for glasses for, say, ah young children um who who were kind of exposed to chemotherapy. ah Are there other ah you know common themes or patterns you've seen with the 600 or so patients you've enrolled?
00:13:55
Speaker
So of the 600, we've enrolled 417 had chemo. So remember, there's some patients who just had melanoma and they need extensive surgery or central node biopsy, something like that. So not all 600 had chemo, but a good number did, 417. The needing the glasses was one. um We are looking at um development now of 12-year-old children. So we did three, six, and nine. and at age three, age six, and age nine. When we did developmental testing on these children, they performed just as well as children of the same age from uncomplicated pregnancies or from pregnancies in which there was cancer, such as melanoma, but the patient didn't need chemo. Joglasses was the one thing. If you have cervical cancer
00:14:48
Speaker
um or a need for cisplatin, with those agents, there is a higher risk for ototoxicity or hearing loss. So we inform the oncologists, if for this type of tumor, you can treat the mom with carboplatin instead of cisplatin, we would prefer that because the risk of hearing loss is less.
00:15:11
Speaker
And also, if you can, and that tumor really responds to cisplatin and or you're getting carboplatin, we would have the delivering physician aware or the pediatrician aware that you can't just do a um simple auditory test in the nursery. You have to really do a, what's called a bear test. You have to do the more in-depth hearing test for the sensory neuro hearing loss.
00:15:36
Speaker
so While we can try to change the medication to decrease the risk of ototoxicity, we we also modify the way you screen for it after delivery. And we would let the pediatricians know if a baby was exposed to cisplatin or to carboplatin to not use gentamicin, for example, or other medications that might be also damaging to the ear. So you you have to just be aware of that risk.
00:16:03
Speaker
as far as um anthracyclines, which in moms can be cardiotoxic, right? So you're your carries a lifelong risk for cardiac arrhythmias and and issues. We have not found that the fetal heart is susceptible to um cardiotoxic risks of the anthracycline, so we can reassure moms about that.
00:16:27
Speaker
I'd like to hear more about the, you know, the experience patients have, uh, you know, when they have cancer during pregnancy. I think, you know, as we've said, that can be, you know, pregnancy is kind of daunting enough, but then to detect like a cancer diagnosis on top of that, um, can probably feel super overwhelming, uh, super hard. So like what, what, when you first kind of encounter these patients, um, who are potentially joining the registry, what are, how did they kind of present, um, in terms of, of just their experience they're having?
00:16:58
Speaker
I think that when you can can tell a patient that who wants the pregnancy, that termination is not going to improve their prognosis and and is not necessarily um continuing the pregnancy is necessarily going to harm the fetus. There's such a relief there that they don't kind of have to choose their life over the fetus's life. um For example, we have patients in regular high-risk OB who have high blood pressure who come in without their blood pressure medications, and they think that no exposure to the fetus of any medicine is better. And we have to explain that, listen, if you have such high blood pressure that you have a stroke, that's not good for the baby, and you have to be on blood pressure medications. And there are different ones that are safer than others you know to keep you safe. If you're on seizure medications, you know you have a seizure, your oxygen's low, that affects the baby. So continue your seizure medicines, antidepressants,
00:17:56
Speaker
diabetic medication. So cancer and chemo is just another high risk situation, but that you have to compare not, I want to expose the fetus to medicine or I don't, but I'm going to have to expose the fetus to this medication because if I don't, untreated cancer is worse for me and the baby. And especially, for example, with acute leukemia, there have been cases where the patient was refused chemotherapy because they thought it would be harmful to the fetus and then both mom and baby died you know from acute leukemia before she even got to viability. So I think when you can present for some cases that there is a safe option where you can both treat the mom and not harm the baby, there's a little bit of a relief that at least the choice of termination is now the patient's and not her only option.
00:18:49
Speaker
and If you have, you know, most moms would avoid any treatment if they think it's better for the baby and sacrifice themselves, but that's not the point. The point is we want you to be healthy so that when this baby is born, they have a mom. So, you know, being sacrificing your own health to think you're going to help the baby deliver, maybe at nine months, the baby will be tad healthier because it had no chemo exposure, but at 18 months when the mom is gone, now it's going to have a lifetime of issues from losing their mother.
00:19:20
Speaker
um potentially. So we have to kind of talk to the patient about looking not just at the short-term exposure and the pregnancy, but the whole lifetime of this baby is going to be improved if we can safely treat mom. And if there's unfortunately a rare cancer where we don't have safety data, that could be an entirely different discussion. um and We don't have chemotherapy data on this cancer and and maybe termination is unfortunately a way that we can aggressively treat mom and we don't know what the repercussions are for the fetus and that may be the decision that has to be made. But I think for most women, when you tell them they have options as opposed to only one option, um it's helpful for them not to feel like guilty that they had to treat their own health as a sacrifice of the fetal health. As far as the scariness of having chemo during pregnancy, only another patient going through chemo when they're pregnant can really understand that. And that's the great thing about the Hope for Two support group is these women
00:20:18
Speaker
um really can tell what it's like to have the chemo and talk to them and how their baby is doing. and And they always match them with someone who's delivered their baby, not who's going through it at the same time. um So they really are a good ah support system. And I've had patients who've met other patients and then stayed friends and and did play dates and everything when the babies were born afterwards.
00:20:42
Speaker
What do you think contributes to that perception that all sort of medicines are harmful to a baby? Is it kind of just like these almost like semi-traumatic, you know, past incidents like thalidomide and stuff like that is that? Is that kind of what paints a picture for patients that like all medicines are bad?
00:21:02
Speaker
I think it's not just patients. I think it's non obstetricians as well. I mean, we do have patients that you know were advised to stop all their medications once they had a positive pregnancy test and and don't really take into account what's the repercussions of either not weaning off of a medication and stopping a cold turkey and and what are the repercussions of not treating your disease. So it's not just patients. I think people don't feel comfortable um exposing a pregnant patient, even though logically they know there's small incidence of fetal risks, whether it's medical, legal, or emotional, it's very common, not just for cancer, but for any medical um issue for either the pregnant patient or their non-OB position sometimes to just feel more comfortable not exposing the pregnant patient
Medication Risks and Ethical Issues
00:21:49
Speaker
period. They just think no exposure is better than and any exposure. and
00:21:53
Speaker
that's only true if the disease is controlled. So if I have a patient who's been seizure free for three years and was planning on coming off of a her seizure medication and and happened to get pregnant and then went off of that, I'm going to be much more comfortable than someone who's had a seizure up until the time of conception and is just going off of it to not have any exposure. um So it's the untreated disease versus the exposure that you have to take into account. But I think that And it's funny because there's signs everywhere about alcohol. there's you know Pregnant women are told, you know take the least amount of medication you need. And Tylenol is the only pain reliever you can take in pregnancy, even though we've used narcotics for trauma and really severe pain. But but you know there's danger from cigarettes. So then you have people that are having you know smoking cigarettes, but not taking their hypertension medication. So it's just it's just you really have to educate the untreated disease
00:22:53
Speaker
is also at risk as well as the exposure. um We've mentioned a lot sort of like decisions the mother might have to make like during her ah pregnancy if she has cancer or you know termination. Are there a lot of just ethical issues arise that arise in in in this practice in your maternal feed and fetal medicine practice? And ah do you find yourself frequently ah consulting an ethics committee to kind of you know find a way forward with the patient?
00:23:20
Speaker
um In the beginning we did that because there was really not much data in the and the US s that went beyond ah the birth and the and the risk management of the hospital and the oncologists were uncomfortable treating the patient. I would hear from patients all over the country in the 90s and early 2000s saying, my doctor wants me to terminate and I don't know what to do. But now I get called from patients that say, I just want to make sure your You like my treatment plan because my oncologist has never treated a pregnant patient before, but they've read the literature and they know it's possible and they're comfortable with the plan. So the the ethical dilemmas are far less than they were when we first started because there's more information out there. As women delay their they're um childbearing and we have more cases that we can report and publish on safe chemotherapy and pregnancy and safe so cancer surgery and pregnancy.
00:24:17
Speaker
the ethical dilemmas are being less and less. It's really when you have a rare cancer or an early diagnosis in the first trimester when people start to get nervous about, you know, trying to delay treatment to get to the second trimester, depending on what that treatment is, or having an issue with the cancer that's that's pretty rare, then the ethical ah situations come up. And and also with the um The termination issue in different states that's you know coming up, there was a patient in Florida who had to make a decision by six weeks of pregnancy. If she was going to do a termination, she had breast cancer and she got the biopsy at like five weeks and two days. So you know we really had to to move quickly to figure out if her lymph nodes are positive and and type of breast cancer she had so she could make an informed decision. But it put a lot of pressure on um to do it in a very quick way. quick fashion. Do you think ah our healthcare care system in general should be encouraging, uh, folks to have, uh, like, like children earlier because that they would run into the less complications or is that kind of just outside the scope of healthcare? And that's, that's up to like everybody kind of to decide on their own. I mean, you know, we're taught in medical school, if you have, you know, early first pregnancy and late first period.
00:25:41
Speaker
decreases your risk for breast cancer. But if it's not the right time for you to be you know to have a baby when you're 25, the risk is slightly higher. But it's not not everybody over 30 with their first baby is going to get breast cancer. I think just as a society, people are getting married later. People are pursuing their careers. People are doing other things before they have their family. So you know we have a lot of patients in our practice who are 40 having their first baby. um So I think we just have to, during our our annual GYN visits, you know, ask patients what their what their plans are, and if their plans are to have children later, you know, just just remind them, like, you know, of their screening, you know, do your colonoscopy, do your mammogram, excuse me. um Make sure you're up on your pap, you know, make sure you do your screening. um We kind of, when I was a resident, everyone was getting pregnant before those risks increased.
Challenges and Rewards in Treatment
00:26:37
Speaker
It's not zero. We have 25-year-olds in the registry of breast cancer. you know It depends on your family history also. Yeah, I want to wrap up by hearing more about just your experience treating um you know pregnant patients with cancer. What are some of the the gifts and challenges that you find in this work? Well, all the gifts are the baby's pictures. I mean, ah healthy moms, healthy babies, that's the gift.
00:27:02
Speaker
um For sure. I think you know even some moms who've elected to end the pregnancy still felt like they would were able to go through a decision process that they felt comfortable with as opposed to just being told, you have no options, this is what you need to do. um So I think it's just um empowering women to learn more about their own options. you know Even patients, we had one patient who was treated in another country
00:27:34
Speaker
and came home ah to finish her chemo to be closer to where she was delivering. And when we looked at the doses of chemotherapy she was getting, you know they gave her the doses in another country that was far less than what she should have received. so We want pregnant women you know to be treated based on their actual body weight, not their pre-pregnancy weight, not their ideal body weight. so To be able to talk to that patient and that oncologist and make sure she got the right treatment for all the future cycles, that was you know rewarding because we knew we made we we probably made a difference in her treatment.
00:28:05
Speaker
um so just you know I would say healthy moms, healthy babies, um and help even for the you know the moms determining their pregnancies for them to get the best cancer care um that they can and and be healthy. That's the reward. Do you find anything like particularly challenging about ah you know working with um pregnant women who are diagnosed with cancer? I mean, the challenge is that ah you know I'm a high risk doctor, not an oncologist. So I try very hard not to make the oncologic decisions.
00:28:43
Speaker
um But sometimes patients really, really want me to help them to pick the best thing. So it's just really, you know, going back to have your oncologist give me option one, two, three in order of what their preference is for how to treat you. And I can see not only in my registry, but I work with a group in Europe who's looking at this as well.
00:29:06
Speaker
um we can see what is the most experienced in pregnancy and what's the safest from the perspective of the baby while it's not inferior, you know, to your treatment. So I think the challenges are when I get asked like very oncologic based questions and I really want to um work with the oncologist, each and every oncologist to do the best for the
Immunotherapy and Multidisciplinary Approach
00:29:28
Speaker
patient. And I think the other challenge is that the big challenge for my future is that a lot of cancers now are being treated with immunotherapy And there's very limited experience in pregnancy. And as you know you know, the mom's immune system is dampened to protect the presence of a foreign fetus in her body. So that's that's the next challenge. And for lung cancer and for melanoma, um there really are good strides in the non-pregnant patients with this immunotherapy. and And when that happens in pregnancy, it's going to be the the next challenge.
00:30:03
Speaker
Have you actively enrolled anybody who's undergone immunotherapy p in your registry or is that kind of, like you said, just uncharted water since there's not much safety data on that? So we have enrolled three patients, very little, um but none of them, well, actually I shouldn't say that. Two of them, it's recurrent cancer, not primary cancer. So at least, you know, for the majority of patients with a primary cancer, we have other options to give.
00:30:29
Speaker
um for for many of the cancers, but for a patient with recurrent Hodgkin's lymphoma that had not responded to prior chemo, we had to look into immunotherapy for her. Melanoma, there's really not much else you can offer. The chemotherapy doesn't really work, so so that has come up once or twice in my ah European colleagues group. And lung cancer, we have. So we have two people in the registry with lung cancer and one with recurrent lymphoma that's got immunotherapy. But it's going to happen more and more, and we're just going to have to. So so the risk with immunotherapy and the pregnancy is not that the baby will birth defects, but maybe they're going to have thyroiditis, gastroenteritis. They're going to have you know antibodies that can affect their other and organs that are affected by the immune system. But what's so interesting with immunotherapy is that
00:31:24
Speaker
For chemotherapy, we avoid any exposure in the first trimester, and after you finish organogenesis 12 to 14 weeks, you can safely start chemo if you need to. Whereas with immunotherapy, it's the opposite. Antibodies don't cross the human placentals after 14 weeks, so if someone conceives You know, a cancer survivor is on their maintenance immunotherapy or on their maintenance or septin and they get pregnant. Everybody used to get really nervous and say, oh, you had first trimester exposure during a gynecogenesis shift to terminate. But no, if it's an IgG antibody, there is no way across prior to 14 weeks. So you can reassure the patient. You may not be able to continue it forward, but that exposure that you had before you realized you were pregnant is not going to be harmful.
00:32:12
Speaker
With all these different moving parts in this process, how do you think ah you can effectively create an effective care team for a patient when you have you know high-risk obstetrician in the picture, an oncologist in the picture, and perhaps other medical professionals? How can you create like a good um sort of team structure so that the patient can get the best treatment possible? Yeah, that's such a great question. Because every publication that we do, we say care of the pregnant patient with cancer requires a multidisciplinary team.
00:32:41
Speaker
You know, the oncologist puts what they think the best treatment would be. The pediatrician tries to have us avoid a preterm birth. The OB-GYN, you know, monitors the weight gain of the mom and the anemia of the mom because certain, and the white blood cell count of the mom with the oncologist. And then the high-risk doctor could talk about, you know, different different medications and whether you can, you know, how you time certain things and follow the growth of the fetus. So no one person can can he handle it.
00:33:11
Speaker
It has to be a multidisciplinary team and actually behavioral medicine, psychiatry, psychology is another piece because as you can imagine, it's a very stressful process. um And there's a lot of support that pregnant women need you know going through this and postpartum. Especially postpartum, if patients have not completed their chemo during pregnancy, we do pause it around 34-35 weeks so that the mom's counts can increase before she may go into spontaneous labor from 37 weeks on. So not everybody has an opportunity to finish all the planned cycles before delivery. So now, during the pregnancy, you
00:33:49
Speaker
You came, you had your own time, you can rest, let's say it's your first pregnancy and you're getting your chemo and you're resting in between, but now you have to finish your chemo and you have a newborn. So um you're getting less sleep, you know you're not feeling great, you're not gonna recover from your chemo the same as you did during pregnancy and you need support.
Personal Insights from Dr. Cardonic
00:34:09
Speaker
With that, it's time for a lightning round, a series of fast-paced questions that tell us more about you. Okay. um So what's your go-to wellness practice?
00:34:18
Speaker
Kickboxing. Arms, legs, cardio, love it. The whole whole body. Yeah. ah What's your favorite winter activity? Reading a book by a fire, not being outside. Not shoveling snow, right? No, no. Favorite comfort food? Popcorn and chocolate. What's an unchecked item on your bucket list?
00:34:44
Speaker
I'm going to check it in January. I want to see gorillas in the wild. Oh, wow. Where's that going to be at? Uganda. Good for you. That's awesome. And ah lastly, what's one change you'd like to see in healthcare?
00:35:00
Speaker
ah Reproductive choice for women, not being comforted by different states and whatnot. Dr. Elise Cardonic, thank you so much for joining the show.
00:35:14
Speaker
Thank you. Thank you. Thank you for having me. Appreciate it.
00:35:27
Speaker
Thanks for listening to The Wound Dresser. Until next time, I'm your host, John Neery. Be well.