Authors: Usha Periyanayagam, MD, MPH, Vice President, Research & Analytics; Lyuba Popadic, Senior Analytics Services Associate; Francesca Devine, Senior Research Consulting Manager; Yuqin Wei, Director, Research 

Komodo Team Presents Poster at ASCO This Week

Though cancer diagnoses during pregnancy are rare, occurring in approximately 1 in 1,000 pregnant patients, the number of these cases is on the rise. This is largely attributable to the increasing average maternal age in the U.S, as cancer incidence generally increases with age. According to the Centers for Disease Control and Prevention, the average age of first-time mothers in the U.S. was 26.9 years in 2021, up from 24.9 years in 2000.

The intersection of pregnancy and cancer presents unique challenges for both patients and their providers. The typical exclusion of pregnant patients from clinical trials, largely due to complexities of risk assessment, ethics, and liabilities, has resulted in limited evidence to inform clinical approaches and decision-making.

Shedding Light on Pregnancy Outcomes in Women With Cancer
This year's ASCO conference focused strongly on the intersection of precision medicine and AI, which is expected to enhance outcomes and equity in cancer care, especially in diverse healthcare settings. There is a growing need for research into AI technologies to ensure that personalized treatment approaches reach patients in rural and community-based settings. Additionally, disparities in diagnosis and care for pregnant women remain underresearched, presenting an opportunity for deeper exploration, particularly in light of the Biden administration’s women’s health initiative. Advances in real-world data will be crucial to better quantifying and studying populations previously underserved by healthcare.

In alignment with this year’s ASCO focus, Komodo presented findings from its retrospective cohort study of demographic characteristics and outcomes among pregnant patients diagnosed with cancer. The analysis utilized data from the Komodo Research Dataset, which includes closed claims from January 2016 through August 2023 and is specifically designed for real-world evidence (RWE) and health economics and outcomes research (HEOR) studies. The cohort included patients with one year of continuous medical and pharmacy enrollment after their pregnancy began. These dates were calculated using the earliest gestational age claim and were used as the index point for analysis. Patients were categorized based on their cancer status — indicated by any cancer diagnosis within the year prior to the index date — and further subgroup analyses were conducted to differentiate outcomes between live births and pregnancy losses. 

Pregnancy loss more common than live birth for Black patients and those on Medicaid

Among 1,921,866 eligible patients, 12,723 (0.7%) had a cancer diagnosis in the year prior to pregnancy. Pregnancy loss (stillbirth/IUFD, elective termination, miscarriage, or other loss) was 5.8% more common among patients with cancer than those without cancer (31.6% vs. 25.8%), while live birth was 7.4% less common (59.7% vs. 67.1%).

While a higher proportion of White patients and commercially insured patients experienced live birth compared to pregnancy loss, the opposite was true for Black patients and patients on Medicaid. This difference applied to both cohorts of pregnant women, with and without cancer:

Among patients with cancer:

• 18.8% of those with pregnancy loss were Black, vs. 15.2% of those with live births
• 35.5% of those with pregnancy loss were enrolled in Medicaid, vs. 27.5% of those with live births
• 63.1% of those with pregnancy loss were White, vs. 68.2% of those with live births 
• 61.1% of those with pregnancy loss were enrolled in commercial insurance, vs. 71.1% of those with live births

Among patients without cancer:

• 29.4% of those with pregnancy loss were Black, vs. 24.1% of those with live births
• 45.7% of those with pregnancy loss were enrolled in Medicaid, vs. 38.7% of those live births
• 52.9% of those with pregnancy loss were White, vs. 60.6% of those with live births
• 53.6% of those with pregnancy loss were enrolled in commercial insurance, vs. 60.9% of those with live births

This study highlights the greater incidence of pregnancy loss among cancer patients compared to those without cancer and underscores the additional disparities faced by Black and Medicaid-insured pregnant women. Our findings add to the small body of research on the intersection of pregnancy and oncology and to the plethora of evidence on the significantly increased risks associated with being Black and pregnant in the U.S. Future research should aim to expand on patients with cancer during pregnancy and identify and address the factors driving disparities. 

This study also highlights the importance and potential of applying new tools to improve research among certain patient populations. AI's role in oncology has seen significant progress but remains underutilized. Greater investment in AI can help fill gaps in research while enhancing precision medicine. In providing RWE to this underserved space, Komodo aims to help fill these gaps, ultimately improving both maternal and fetal health outcomes.

Read more of our coverage of ASCO 2024 and check out the full poster here.