Capturing the lived experiences of women with lymphoma in pregnancy: a qualitative study

Abstract

Lymphoma in pregnancy is a rare and challenging diagnosis that complicates ∼1:6000 pregnancies; posing a series of unique therapeutic, social, and ethical challenges to the patient, her family, and the medical professionals involved. These difficulties are compounded by the paucity of real-world data on the management of LIP, and a lack of relevant support systems for women in this setting. We conducted a retrospective multicenter qualitative study, interviewing women aged ≥18 years of age diagnosed with Hodgkin (HL) or non-Hodgkin lymphoma (NHL) during pregnancy or within 12 months postpartum, between 1 January 2009 and 31 December 2020 from 13 Australasian sites. Semi-structured telephone interviews were conducted, recorded, and analyzed using QSR Int NVivo 12 Pro (March 2020, USA) to quantify salient themes. Of the 32 women interviewed, 20 (63%) were diagnosed during pregnancy (16, 34, and 13% in the 1st, 2nd, and 3rd trimesters, respectively), while 12 (37%) were diagnosed post-partum. Women recalled that their chief concerns at diagnosis were the welfare of their child (n = 13, 41%) and a fear of dying (n = 9, 28%). Perceived diagnostic delay attributed to pregnancy was reported by 41% of participants. Other key themes were communication, educational materials, psychosocial supports, and oncofertility issues. To our knowledge this is the first report capturing the lived experiences of survivors of lymphoma during pregnancy, affording a unique opportunity to consider the management, psychosocial supports, and delivery of care to meet the needs of these women.

• What is the NEW aspect of your work? To our knowledge, this is the first report capturing and analyzing the healthcare experiences of survivors of Lymphoma in Pregnancy (LIP).

• What is the CENTRAL finding of your work? Women valued clear and empathic communication, provision of tailored educational materials, access to psychosocial supports (particularly childcare and financial supports), and timely oncofertility management in their healthcare journey.

• What is (or could be) the SPECIFIC clinical relevance of your work? Women’s personal accounts of positive and negative experiences of LIP care provide insights into their specific concerns and needs which can shape healthcare policy and development of a specific framework for managing and supporting patients with LIP (and other cancers).

Keywords:

• Lymphoma and Hodgkin disease
• chemotherapeutic approaches
• lymphocytes

Acknowledgments

We would like to acknowledge all the women who donated their time and consented to be interviewed. We would also like to acknowledge the Delta Goodrem Foundation which supports the St Vincent’s Hospital Lymphoma Fellow which facilitated the conduct of this study.

Author contributions

P.D.C. and N.H. designed the research and concept. G.M., V.C., M.S., J.L., K.M., C.T., and P.D.C. coordinated and/or conducted interviews. G.M., N.H., and V.C. coded the transcripts and analyzed the data. G.M. wrote the manuscript. G.M., N.H., K.M., B.C., M.S., K.M., C.Y., S.G., G.K.-G., X.B., M.G., R.E., and V.C. edited the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).