08 Nov 2012

Childbearing, cancer, and chemotherapy

3 Comments

One of the amazing changes I have witnessed in my career has to do with women, childbearing, and cancer. When I was a nursing student, if a woman got cancer, she was lucky to survive; much less, get pregnant, carry her baby to term, and breastfeed. Cancer during pregnancy was a death sentence for mother, and often, her baby.

For years, the Centers for Disease Control have said that receiving chemotherapy is an absolute contraindication to breastfeeding. My friend LInda, whose story is described in a guest blog on the Best for Babes site (http://www.bestforbabes.org/milk-train-brings-healing-to-baby-and-mom) was able to give her milk to her premature baby just once, before starting chemotherapy in 1990.

Now, in the 21st century, the boundaries for cancer chemotherapy in pregnancy and lactation are expanding. Medical journals report that certain chemotherapy agents can be used in in the second and third trimesters, with good outcomes for mother and baby. In May 2004, the medical journal Lancet Oncology published a review of cancer treatments during pregnancy, with recommendations about specific drugs, timing of dosing, and encouragement to others to publish cases.

A case report of a mother being treated for papillary thyroid cancer who pumped and dumped during treatment with carboplatin and paclitaxil is in the November 2012 issue of the Journal of Human Lactation. Her milk was analyzed for drug levels; the authors conclude that the potential adverse effects of infant exposure to the drugs via breast milk would be “unlikely, following exposure to the levels of carboplatin and paclitaxel” that were measured. The evidence about specific cancer chemotherapy during breastfeeding is expanding with other journal reports of drug levels in milk.

Unfortunately, my friend Linda died of inflammatory breast cancer (IBC) which even today carries a dreadful prognosis, although she might have  had a longer life with today’s newer drugs. What is new about IBC is that those working in the fields of breastfeeding medicine and lactation management now know more than they did 20 years ago.  A breastfeeding woman with symptoms of mastitis that do not resolve after 2 or 3 weeks of antibiotic therapy should receive an ultrasound examination and biopsy, because the symptoms of IBC and mastitis are initially identical.

Other types of cancer have happier outcomes if a nursing mother is treated.  For example, check out this story (http://babygooroo.com/2010/09/pumping-through-chemotherapy/) about a nursing mother who was treated 3 times for Hodgkin’s lymphoma while she was nursing her toddler. Each time, she bargained with her toddler to stop breastfeeding during the treatment, and pumped and dumped to keep up production. She even drank her own milk as an additional cancer treatment, figuring it wouldn’t hurt.  This story has a happy ending; may there be many, many more!

 

 

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3 Responses to Childbearing, cancer, and chemotherapy
  1. […] In 1990, my friend Linda, 28 weeks pregnant with her second baby, was diagnosed with breast cancer. I remember sitting in the back of a car, being driven to a music festival, and hearing the driver say those terrible words; I promptly burst into tears. I didn’t want to face the possibility of Linda’s death but my experience as a nurse wouldn’t give me a break from the truth. Getting cancer while pregnant had a grim prognosis in those days. (Nowdays, things are different. http://www.nikkileehealth.com/nikkiweb/childbearing-cancer-and-chemotherapy/)* […]

  2. Here’s a similar story about a woman with cancer drinking human milk; she’d lived in Australia for a number of years and wanted to return home, to the US, to die. Drinking human milk helped her get home.

    “Ruth goes home: an adult’s use of human milk.”
    Breastfeeding Review November 2012; 20(3)
    written by Elizabeth McGuire

    ‘Ruth goes home’ is the account of a woman with terminal bowel cancer who found that donated breastmilk helped her gain the strength to travel home. Ruth’s experience raises questions about how human milk might have been beneficial. Those questions are addressed later in the paper but first, Helen Gardner tells Ruth’s story in an extract from the book Snapshots from our lives.

    “I met Ruth through the B’nai B’rith* Environment Group (BBEG). She was an
    American who came here [Melbourne, Australia] with her husband and had been here
    for about 6 years when we first met. I first learned that she had cancer in late
    2002 when I picked her up to go to a meeting. I thought she looked very thin and
    drawn. When I asked her just as a routine question how she was, she made some
    remark about feeling the cold very badly because of the chemotherapy. She wanted
    to go home.”

    (snip)

    Before Ruth began drinking breastmilk she was receiving fluids in an intravenous
    drip. Obviously Ruth needed hydration and nutrition, but eating was painful.
    After a few days of taking breastmilk, she was able to have her intravenous line
    removed and to eat small amounts of semi-solid food. She must have been well
    enough hydrated and nourished to manage without parenteral nutrition. Ruth
    attributed her improvement to the breastmilk. How could breastmilk achieve that,
    if other foods did not? There have been no controlled studies of human milk’s
    effects in adults with cancer, but breastmilk is well known to affect infant
    health. Breastmilk has anti-inflammatory and antioxidant properties as well as
    providing species-appropriate nutrition. Some breastmilk components have been
    identified as being able to kill cancer cells without affecting healthy cells.
    Perhaps some of these properties might be useful to cancer patients, as well as
    to infants?

  3. A colleague from Australia (thank you Sylvia Ann Ellison) mentioned The Grapes of Wrath, where the book ends with this powerful scene: ” Rose of Sharon delivers a stillborn child that Uncle John sends in a box down the creek. The family eventually reaches higher ground and finds a barn for shelter. Inside the barn is a starving man and his young son. Steinbeck ends the novel with Rose of Sharon, barely recovered from the delivery, breastfeeding the dying man to nurse him back to health.” < http://www.gradesaver.com/the-grapes-of-wrath/study-guide/short-summary/>

    There is a collection of paintings featuring a young woman nursing her father, who is starving and in jail. The theme of these painting is Charity. < http://milkydreams.com/roman_charity/paintings-roman-charity-daughter-breastfeeding-her-father-starving-prison>

    Human milk is as much of a life-giving liquid as water.


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