Cancer during pregnancy is relatively rare. The incidence is underestimated due to the lack of international registries covering both high-income and low- and middle-income countries, and is expected to rise with increasing maternal age and increasing global adoption of cell-free DNA testing for aneuploidy. Physiological changes during pregnancy often make the diagnosis challenging and delayed. Lack of experience and knowledge about this condition may also contribute to late diagnosis, suboptimal management, and occasionally inadvertent fetal and/or maternal harm. The principles of cancer management in pregnancy for most cancer types do not differ significantly from the non-pregnant population. The impact of investigations for diagnosis and staging, risks of surgery, systemic chemotherapy, and/or radiotherapy on fetal well-being and preterm birth need to be considered for treatment and management planning, in addition to maternal wishes. Working in a multidisciplinary setting, ideally with medical and radiation oncologists, surgeons, radiologists, cancer specialist nurses, geneticists, psychologists, teratologists, and clinical pharmacologists, obstetricians, obstetric physicians, neonatologists, and experienced nursing and midwifery staff helps provide optimal care for the woman. This best practice advice aims to provide recommendations on the diagnosis and management of cancer in pregnancy, which can be adopted in all resource settings.
Jordan faces rising noncommunicable diseases (NCDs) amid protracted displacement. The 2020–2025 Integrated NCD–Humanitarian Response embedded NCD prevention and care across primary healthcare (PHC), humanitarian clinics, schools, and communities serving Jordanians and Syrian refugees. An implementation-research case study synthesized routine service and biometric data, pre/post knowledge–attitude–practice (KAP) surveys, interviews/focus groups with providers, community health workers (CHWs), teachers, youth, and beneficiaries, and site observations. Outcomes included acceptability, appropriateness, adoption, feasibility, fidelity, penetration, effectiveness, and sustainability. Interventions adapted the Healthy Community Clinic (HCC) model, Healthy Schools Program, and youth/community outreach through provider training, standardized counseling tools, culturally adapted materials, and supportive supervision. Reach: >200 PHC centers plus NGO clinics, 319 schools, 119 CHWs, 48 community health committees, and 775 youth volunteers. Interventions were highly acceptable and appropriate, with strong adoption across PHC and humanitarian clinics and good school/community penetration. In Ministry of Health facilities, mean systolic/diastolic blood pressure fell by 10.5/5.0 mmHg and fasting glucose by 39.6 mg/dL (all p < 0.001); body mass index decreased by 0.6 Kg/m². In Al-Zaatari clinics, systolic blood pressure declined by 4.1 mmHg overall, with larger reductions among hypertensive patients; fasting glucose trended downward. KAP improved (> 40-point knowledge gains), physical inactivity dropped from 58.8
