Symptom appraisal and help-seeking before a cancer diagnosis during pregnancy: a qualitative study.

Abstract

Background Estimated incidence of cancer diagnosis during or shortly after pregnancy is 1 in 1,000 women. Pregnancy can impact symptom appraisal and help-seeking for symptoms subsequently diagnosed as cancer. Little is known about the pathway to cancer diagnosis in pregnancy or delays that women can encounter. Aim To explore symptom appraisal, help-seeking decisions, and experience of receiving a cancer diagnosis during pregnancy. Design and setting Semi-structured interviews with women diagnosed with cancer during or shortly after pregnancy in the previous four years, recruited between January and May 2022 via the charity Mummy's Star. Method Reflexive Thematic Analysis of 20 interviews. Analysis was largely inductive, and the themes generated were mapped onto the intervals of the Model of Pathways to Treatment. Results Symptoms were often interpreted through the lens of pregnancy by both participants and most of the healthcare professionals from whom they sought help. Participants who found breast lumps were likely to suspect cancer and be referred promptly for tests in secondary care. While most participants sought timely help for their symptoms, some subsequently encountered health system delays, partly due to both the vague nature of their symptoms and the COVID-19 pandemic. Conclusion Health services need to better support women presenting with possible cancer symptoms during pregnancy to ensure timely diagnosis. Recommendations include prioritising symptoms over attributing them solely to pregnancy, ensuring timely referrals to rule out serious conditions, and emphasising clear communication alongside robust safety-netting practices. A full assessment is essential before dismissing symptoms as pregnancy related.