Newly diagnosed breast cancer at 18 weeks — communication and planning station

Communication and planning station: a pregnant woman newly diagnosed with breast cancer. Tests the candidate's ability to convene the multidisciplinary team, communicate the prognosis evidence honestly, present the consult-series framework, address the woman's fears, and commit to a written plan. Includes assessor key and marking domains.

Prompt

A 36-year-old woman at 18 weeks' gestation is referred with core-biopsy-confirmed invasive ductal breast carcinoma, ER positive, HER2 positive, found after an eight-week delay attributed to pregnancy-related breast change. She is frightened, has been told pregnancy may have worsened her prognosis, and is considering termination. You are the obstetric registrar with the consultant 10 minutes away.

Station brief

Format. Communication and planning station, approximately 12 minutes. You are the obstetric registrar. The consultant is 10 minutes away and has been called. The woman is with her partner. The assessor plays the woman and feeds you her questions and reactions.^[1]

Candidate instruction. Communicate the diagnosis and prognosis honestly, present the consult-series framework, address her fear that pregnancy has worsened her prognosis, and commit to a written multidisciplinary plan. Verbalise your reasoning and your communication as you go.^[1]^[2]

References5Show

[1]Peccatori FA, Azim HA Jr, Orecchia R, et al. Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up Ann Oncol, 2013.PMID 23813932
[2]Loibl S, Azim HA Jr, Bachelot T, et al. ESMO Expert Consensus Statements on the management of breast cancer during pregnancy (PrBC) Ann Oncol, 2023.PMID 37572987
[3]Amant F, von Minckwitz G, Han SN, et al. Prognosis of women with primary breast cancer diagnosed during pregnancy: results from an international collaborative study J Clin Oncol, 2013.PMID 23610117
[5]Vandenbroucke T, Verheecke M, Fumagalli M, et al. Effects of cancer treatment during pregnancy on fetal and child development Lancet Child Adolesc Health, 2017.PMID 30169185
[6]Amant F, Heimovaara JH, Lok CAR, Van Calsteren K The Advisory Board on Cancer, Infertility and Pregnancy: a virtual on-demand multidisciplinary tumour board Lancet Oncol, 2022.PMID 36356601

Newly diagnosed breast cancer at 18 weeks — communication and planning station

Station brief

References5Show

[1]Peccatori FA, Azim HA Jr, Orecchia R, et al. Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up Ann Oncol, 2013.PMID 23813932
[2]Loibl S, Azim HA Jr, Bachelot T, et al. ESMO Expert Consensus Statements on the management of breast cancer during pregnancy (PrBC) Ann Oncol, 2023.PMID 37572987
[3]Amant F, von Minckwitz G, Han SN, et al. Prognosis of women with primary breast cancer diagnosed during pregnancy: results from an international collaborative study J Clin Oncol, 2013.PMID 23610117
[5]Vandenbroucke T, Verheecke M, Fumagalli M, et al. Effects of cancer treatment during pregnancy on fetal and child development Lancet Child Adolesc Health, 2017.PMID 30169185
[6]Amant F, Heimovaara JH, Lok CAR, Van Calsteren K The Advisory Board on Cancer, Infertility and Pregnancy: a virtual on-demand multidisciplinary tumour board Lancet Oncol, 2022.PMID 36356601