Introduction:

Cytotoxic chemotherapy is commonly used in cancer patients, including women of childbearing age. Chemotherapy can potentially cause birth defects and miscarriages when it is administered to women during pregnancy and the risk is especially high in the first trimester. A policy was introduced in the Southern Adelaide Local Health Network in July 2013 to give guidance on the pregnancy screening process using serum beta-Human Chorionic Gonadotrophin (ß-HCG) levels. However, adherence to this policy by the treating health professionals has not been evaluated since its introduction.

Methods:

A retrospective chart review was performed to look at the compliance with this policy in the outpatient setting for patients who attended the oncology clinic at Flinders Medical Centre in 2014. All female patients aged between 18 and 55 years, who received chemotherapy in the year 2014 were included for this audit.

Results:

A total of 109 patients met the inclusion criteria; 78 of them were deemed to have childbearing potential based on their gynaecological history, e.g. regular menses, intact uterus and ovaries. The median age of the included patients was 47 years and breast cancer accounted for 60% of all cancers. Of the 78 women with childbearing potential, only 16 were screened with ß-HCG testing before their chemotherapy, making the compliance rate 20.5%. Of the 62 patients who were not screened, 6 patients had ß-HCG testing before their previous cycles of chemotherapy. The medical records did not specify the reasons for not performing the pregnancy screening tests.

Conclusion:

Pregnancy screening prior to chemotherapy was performed only for 20.5% of women with childbearing potential at our centre. Efforts to improve compliance, e.g. education on the policy, additional checks by the pharmacists and nurses prior to the start of chemotherapy are being considered.