This course covers cancer care for patients diagnosed with breast cancer during pregnancy. The topics for these 9 concise mini modules were identified by ambulatory oncology nurses who requested this resource. This course would prepare the healthcare professional about to care for a pregnant patient who is newly diagnosed with breast cancer and will need a diagnostic work up – including genetic considerations, obstetrical and neonatal monitoring, surgery, systemic therapy including supportive drugs, psychosocial support, and lactation support.

Course Syllabus

By the end of this course, you will be able to:

Module 1- Introduction

• Identify the three most common cancers diagnosed during pregnancy
• Define pregnancy associated with breast cancer (PABC), incidence, stage, and prognosis
• Explain why a breast mass in a pregnant patient persisting longer than 2 to 4 weeks should be taken seriously and the assessment that should be carried out
• Recognize the importance of precise communication between the oncologist/oncology team and high-risk obstetrician/ obstetrical team in collaboration with a larger multidisciplinary team

Module 2 – Medical Imaging

• List the diagnostic procedures in imaging and biopsy recommended during pregnancy
• Describe the general principles of assessing the amount of fetal radiation exposure 

Module 3- Genetic Considerations

• Describe the percent of breast cancers that are hereditary
• Explain the importance of assessing family history and other risk factors that may warrant a genetic referral
• Describe how a positive genetic result may impact screening and follow up management after childbirth

Module 4 – Surgical Care

• Identify the timing and safety of each breast cancer surgery procedure (including reconstruction) during pregnancy
• Describe the option of sentinel lymph node biopsy (SLNB) and axillary lymph nodes dissection during surgery and list any restrictions
• List the risks associated with anesthesia during the surgery and the drugs and techniques that are safe for both mother and baby

Module 5 – Psychosocial Support

• Recognize symptoms of distress commonly experienced by patients and their loved ones who are diagnosed with breast cancer during pregnancy
• Identify emotional and physical challenges of managing parental responsibilities while under cancer treatment
• Illustrate psychological impact on the patient including body image, future health, anticipatory grief and loss, and worry about the future of the child
• Identify community supports resources specific to pregnant patients and their families

Module 6 – Obstetrical Monitoring

• Explain the importance of timely referral a pregnant woman with breast cancer to a high-risk obstetrical healthcare provider
• Describe specific assessments of the mother and fetus that should be carried out during diagnosis and before the initiation of any oncological treatment assessments
• Identify the types of prenatal monitoring during pregnancy in collaboration with the oncology team

Module 7– Neonatal and Pediatric Monitoring

• Describe assessments specific to neonates exposed to chemotherapy in utero
• Identify follow up assessments to measure physicals and assess physical, neurological, and psychological development in young children who were exposed to chemotherapy in utero

Module 8 – Systemic Therapy

• State the specific timing for chemotherapy in relation to gestational stage, and fetal safety
• Identify the preferred breast cancer regime to date, and when endocrine and anti-HER 2 and endocrine therapy should be given
• Describe general principles when delivering chemotherapy during pregnancy and the role of supportive drug agents.

Module 9 – Lactation Support

• Explain why breast imaging during lactation is difficult, and what types of counselling should be given to patients before an imaging procedure.
• Describe the relationship between breast or chest feeding, surgery, radiation, and chemotherapy and why breastfeeding is not recommended during chemotherapy.
• Recognize why a lactation consultant/expert should be part of the multidisciplinary team.

Course Requirement

To receive a certificate, participants are required to complete:

1. Complete a pre-course evaluation
2. Complete all eLearning modules
3. Complete the post-course evaluation

Time Commitment: 5 hours

Course Syllabus: To view the course syllabus, please click HERE

Eligibility

Available to all regulated health care professionals working along the cancer care continuum.