Haematological malignancies during pregnancy: a systematic review of necessary services in the Australian context

Abstract

Haematological malignancies diagnosed during pregnancy are rare, with increasing incidence, presenting unique therapeutic, social and ethical challenges for treating teams, patients and their family. There are no national guidelines regarding appropriate referral pathways, resources and services for the management of these patients. To conduct a systematic review of the literature to identify the multidisciplinary team members required for optimal care of pregnant patients with haematological malignancies. These data will be used to evaluate the capabilities of Australian health networks to provide coordinated care. A systematic review of the literature in MEDLINE and SCOPUS databases was conducted. Eligible studies focused on pregnant Australian patients with haematological malignancies, exploring care models, specialist teams and services utilised. This was then used to generate a map of Australian hospitals that can service this patient demographic. Essential team members include haematologists, maternal-fetal medicine specialists, anaesthetists, midwives, intensive care specialists, psychologists and social workers. Services utilised include haematology, maternity, intensive care, tertiary imaging, operating theatre, pharmacy and perinatal mental health services. Utilising these data, 25 hospitals can manage these patients. This study identified the necessary healthcare practitioners, services and hospitals available that can manage this patient cohort. Future research should focus on determining ideal treatment regimens, timing of therapy throughout gestation, establishing a national patient registry and implementing a cancer care plan and frameworks for best practice care. A centralised referral pathway leveraging telehealth will allow expedient, multidisciplinary action and equity in access to all women across Australia.