A Montreal obstetrician-gynecologist created a clinic dedicated to pregnant patients with cancer, when she realized how difficult it was for these women to navigate the healthcare system.
On May 15, 2024, Habalet Andrée Loblegnon learned she was pregnant for the fourth time. Two weeks later, she was diagnosed with stage three breast cancer.
She had noticed a lump under her right armpit during her third pregnancy, but her doctor had told her at the time that there was no cause for concern.
It was only during her fourth pregnancy, at the age of 41, that she received this diagnosis and immediately found herself facing an urgent question.
Her decision was made without hesitation: she would carry her pregnancy to term, even if it meant undergoing chemotherapy during her pregnancy.
When she returned home from her doctor’s appointment, to her husband and three children, she collapsed.
Loblegnon’s situation is rare — less than 0.1 per cent of pregnant women in Canada receive a cancer diagnosis — and requires a highly specialized approach to preserve the health of the mother and baby, explains Claude-Émilie Jacob, obstetrician-gynecologist at the University of Montreal Hospital Centre (CHUM).
Dr. Jacob decided to open a clinic dedicated to pregnant patients with cancer five years ago.
“We help them in both the best and worst moments of their lives,” says Dr. Jacob.
Pregnant women with cancer may find themselves going from one specialist to another, oncologists, surgeons and obstetricians, each giving them different recommendations, says Dr. Jacob.
These women then feel as if they are being given “different pieces of a puzzle without being able to see the complete picture.”
The clinic’s objective is to centralize decision-making so that patients no longer have to coordinate their own care while simultaneously dealing with cancer and pregnancy.
“We want to put the puzzle together so that the patient doesn’t have to do it,” she emphasizes.
The clinic is located in the obstetrics department of the CHUM. Each time a patient is referred to her, Dr. Jacob assembles a multidisciplinary team that may include surgeons, oncologists, pharmacists, neonatologists and specialists in high-risk pregnancies.
Together, they adapt the treatment schedule according to both the progression of the cancer and fetal development.
The clinic also began expanding its research activities over the past year, while other Quebec hospitals are increasingly turning to the CHUM team for advice regarding their own pregnant patients with cancer, according to Dr. Jacob.
After Loblegnon’s diagnosis at a hospital in Longueuil, she was immediately transferred to the CHUM. She met with Dr. Jacob and her team, who began to consider the best approach to treat her.
One of the biggest challenges is synchronizing treatment with pregnancy, explains surgical oncologist Rami Younan, who operated on Loblegnon.
Chemotherapy drugs and their dosages differ for pregnant women compared to other patients. Many cancer drugs can cause birth defects or even the loss of the fetus, explains Guy Soulières, hematologist-oncologist and spokesperson for the Canadian Cancer Society.
Because of this risk, chemotherapy is avoided during the first 13 weeks of pregnancy, when the fetus’s organs are forming, says Dr. Jacob.
Loblegnon began her treatment after 13 weeks, in July 2024; the weekly chemotherapy sessions were exhausting her. Her care required constant communication between several teams, explains Dr. Younan.
Treatment schedules, monitoring, and delivery planning all had to be carefully coordinated to protect both mother and baby.
“The coordination was perfect,” he says.
He adds that even the timing of his cesarean section had to be carefully planned. Chemotherapy weakens the immune system, increasing the risk of infection and complications during surgery, he explains.
This means that the delivery had to be scheduled at a time that would reconcile both Loblegnon’s recovery and the safety of her baby.
One month after giving birth, Loblegnon underwent a total mastectomy.
Rare cases
Because cases like Loblegnon’s are so rare, doctors lack large-scale research to guide treatment.
“When we have less than 1 per cent of cases, we cannot obtain significant numbers,” says Dr. Soulières.
Doctors say the clinic’s centralized model is especially important because pregnant women with cancer are very rare.
By concentrating patients in a specialized centre, the CHUM can develop its expertise, compare results and conduct research that could eventually help define treatment standards elsewhere.
Today, the Loblegnon’s fourth child, Théo fils, is a year and a half old and in perfect health. During the interview, he moved around the room on his own, going from his mother’s arms to the knees of the two doctors who had saved his life.
“That’s why we do our job,” Dr. Jacob reminds her, looking at Theo and his mother.
–This report by La Presse Canadienne was translated by CityNews
