By Melinda Young
Discussions about access to abortion care sometimes overlook a segment of pregnancy-capable people who face roadblocks to obtaining health- or life-preserving medical care because of abortion bans in their states. The U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization to allow states to ban abortion care has a broader impact than many physicians initially assumed. It can create barriers to women receiving many different types of medical care, including treatment for cancer.1
Oncologists and other people who work with cancer patients need to know how they and their patients could be affected by state laws that ban or limit abortion care. Patients who are pregnant may have been warned several years ago that their cancer treatment could affect their pregnancy and they need to decide how they want to proceed. Now, some of those patients may not have a choice in their home state. The states with the most restrictive bans may create a legal risk for physicians who provide cancer treatment or who even suggest a patient could obtain an abortion before starting treatment. Doctors often do not want to provide medical treatment to patients when it could result in a miscarriage or lead a patient to seek an abortion.
“They are afraid to take a chance for good reason,” says Georgia Robins Sadler, BSN, MBA, PhD, FAACE, a professor in the department of surgery at the University of California San Diego (UCSD) School of Medicine in La Jolla, CA. Sadler is the senior author of a paper on how abortion bans affect cancer patients.1 Physicians face arrest and loss of their license if they provide treatment that a state or local prosecutor defines as an abortion, and this could happen to almost any physician — not just OB/GYNs.
“We need physicians who are the most deeply impacted by the Dobbs decision to work together with [their colleagues], and we should not ask every physician to make his or her own decision,” Sadler says. This potential collaboration in finding a way to provide pregnancy-capable patients with the best care, while avoiding legal risk, is why Sadler and her co-author wrote the paper and attended a national meeting of cancer providers.
“We went to a cancer meeting that the American Association for Cancer Education puts on every year, and our idea was to educate our colleagues,” Sadler says. “We expected people to roll their eyeballs and say, ‘Of course we knew that!’ But most of our colleagues had no idea about the ripple effect of abortion bans.”
When the U.S. Supreme Court decided to overturn Roe v. Wade in June 2022, it shocked many young women who had grown up with mothers and grandmothers who had the protection of Roe throughout their reproductive lives.
“From a student’s perspective, my passions have aligned more in women’s health; in 2022, it left me quite confused about how the world would change, and I was very concerned about how everyday care of women’s health would be impacted,” says Emily Smith, an undergraduate and pre-med student in public health at the University of California San Diego in La Jolla. Smith also is a scholar of the National Cancer Institute Program at UCSD, and she is the first author on the paper about how abortion bans impact cancer patients.1
“I wondered about all the implications of the Dobbs decision and how it would affect access to care for women,” Smith says. “I pitched this issue to Dr. Sadler, and she led me through this amazing conversation about Dobbs and cancer care.” That conversation led to the “Abortion” paper and discussion with clinicians at the cancer meeting.
“I met a lot of people in the field from physicians to nurses to patient advocates, and the big thing I heard from them was they always knew there was a little bit of a connection between abortion and cancer, but they had never put the two together in the context of the Dobbs decision,” Smith says.
“I talked with them about whether they understood the regulations in their states, and their answers were disheartening,” she adds. “All the providers understood this was an issue and saw the impact.” But they did not know what their resources were and how to handle liability issues.
“The mindset we adopted was despite how frustrated — and at times — concerned we are, we have to acknowledge this is our current reality and without adapting and [knowing] our current landscape of care, our freedom, and our liability, it’s the patients who suffer the consequences,” Smith explains.
Cancer clinicians need to understand precisely how various cancer treatments could affect an embryo or fetus and obtain legal information about whether their state’s abortion ban could limit their ability to provide that treatment to pregnant patients. Some cancer treatments can result in the end of a pregnancy, for instance.
“There have been a landslide of decisions made by people who do not understand all the issues,” Sadler says.
Soon after the Dobbs decision, some clinicians referred cancer patients to an out-of-state clinic to obtain an abortion before they started cancer treatment. But even these referrals pose some risk in states that have tried to limit information about abortion care, as well as the actual care.
“If someone reports you, you can lose your license in some states, so what your options are depends on the state you are in,” Sadler says. “We are public health people, trying to educate the public about the implications of the Dobbs decision in the event that someone they love has cancer during their reproductive years,” she adds. “We’re in the very early stage of figuring this out. It’s a kick in the head — every time we turned another stone over, we had new information.”
The public, cancer patients, and all physicians need to know more about abortion bans and the effect on healthcare for patients capable of pregnancy. “We’re suggesting medical schools and residency programs address it and bring more awareness toward the issue,” Smith says. “What we’re hoping is there’s a way to move forward in a united manner.”
Physicians need one voice. Every state should have a group of physicians and lawyers and politicians who get together to really understand the implications of the Dobbs decision and what the definitions are for a life-threatening illness, Sadler says. “If we all put our heads together, we can come up with many solutions,” she adds. “The goal of our paper was to stimulate people to think about what we need to do to make this new ruling work for people with cancer.”
Reference
- Smith ER, Sadler GR. Cancer care in post-Roe America: How do we move forward? J Cancer Educ. 2024;Oct 8. doi: 10.1007/s13187-024-02512-y. [Online ahead of print].
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
