A journey through cancer treatment can be grueling, unforgiving, and treacherous for both patient and physician. But what happens when a pregnancy complicates the treatment?
With the Supreme Court’s recent overturning of Roe v. Wade and Planned Parenthood v. Casey, unplanned pregnancy during cancer treatment will significantly impact the access and timeliness of adequate care for patients, create a confounding landscape of legal and ethical dilemmas for physicians, and result in consequences that may irreparably alter the landscape of medicine in this country.
The American Cancer Society has reiterated the importance of local clinics and early screening and detection of cancer, stating that they are in opposition to “any action that results in limiting the number of institutions or clinics where people can receive access to affordable screening and early diagnosis.”
Public clinics like Planned Parenthood have long been accessible locations for early cancer screening and diagnosis of breast and reproductive cancers in women.
In states with restrictive abortion laws, family planning clinics have already begun to shut down, limiting access. Beyond the devastating consequences affecting pregnant persons with cancer, the loss of family planning clinics will decrease access to early cancer detection.
Early diagnosis of breast and reproductive cancers is essential for the best shot at survival.
U.S. cancer centers, advocacy groups, professional societies, and medical journals have been very direct in their concerns (The Cancer Letter, July 1, 2022).
Approximately one in 1,000 patients—or 6,400 people—are diagnosed with cancer while pregnant each year. The ability to provide cancer treatments like imatinib, which is associated with spontaneous abortions, will be affected by the recent SCOTUS decision. The ruling also threatens the doctor-patient relationship and informed decision-making in medical treatment (The Cancer Letter, July 1, 2022).
Physicians will no longer be able to provide a patient with all medically viable options; instead, the physician will be limited to methods which are in compliance with their state’s legislation. According to some health law experts, it is unclear whether a physician may even discuss abortion or treatments that may have abortifacient effects with a patient without being liable for criminal charges in some states (The Cancer Letter, July 1, 2022).
Jack Resneck Jr., president of the American Medical Association, stated that the Roe decision represents a “direct attack on the practice of medicine and the patient-physician relationship” for this very reason. The hallmark of patient-centered care, including informed decision-making on evidence-based practices, is undermined and in many ways impossible.
Instead, patients have less agency, and physicians in restrictive states are left with three exceedingly uncomfortable options: remain in practice where they are and risk losing licensure or even criminal prosecution; remain and watch their patients risk increased mortality without access to certain evidence-based options for treatment; or, leave those restrictive states and practice where it is safer to do so.
A recent University of California San Francisco study illustrates that physicians are very likely to leave their restrictive states to practice elsewhere. The authors of the study wrote, “In 2020, 92% of obstetrics and gynecology residents reported having access to some level of abortion training […] We predict that, if Roe v. Wade is overturned, this would plummet to at most 56%.” The authors went on to note that their numbers likely underestimate the effect of the Roe overruling, as they did not incorporate “family medicine or other similar specialties where residents receive abortion training.”
The Association of American Medical Colleges reiterated the impact of the Roe decision on the legality of abortion training in tandem with abortion care. Bloomberg Law, a news service, tracked pre-Roe abortion legislations, dating to the 19th century, which are currently being revisited. While the ramifications of such legislation coming back is not yet fully known, it is clear that opportunities for medical students and residents to learn life-saving procedures are being struck down.
OB/GYN residents are required by the Accreditation Council for Graduate Medical Education to have access to abortion training. However, new trigger bans and modified curriculums in several restrictive states are making that access extremely difficult. It seems reasonable that future residents will not desire to be placed in such states in which the necessary training for their specialty will not be provided.
Residents put in that position would either be unable to fulfill their accreditation requirements, or—as has already become the case in Texas—they would be forced to leave their residency to do abortion training in another state. Either option is clearly undesirable.
As Theresa Rohr-Kirchgraber stated in an earlier interview with The Cancer Letter, medical students with any desire to train in the OB/GYN specialty are left to pursue placements where they are able to fulfill the requirements of their specialty.
According to the AAMC, 54.2% of residents maintain practice in the state they did their residency in—and, further, there is a correlation between restrictive states and lack of comprehensive abortion training in medical schools. If there is less training in these states, and residencies in them will not fulfill the requirements to become a certified OB/GYN, it follows that patients may have reduced access to OB/GYN care in restrictive states.
Abortion care affects all medical specialities. It may not just be the obstetrics and gynecology fields that lose physicians in certain states; other specialties could follow suit. For example, if an oncology resident or physician wishes to protect their physician-patient relationships or ensure that all treatment options remain available to their patients, practicing in a restrictive state may put them at legal and moral risk. In order to protect themselves, physicians will likely move to a state in which they are safe to practice to the fullest extent of their Hippocratic Oath.
Thus begins the great dive into deeper healthcare disparity in this country, all thanks to the overruling of Roe v. Wade.
Legislatures have the power to avoid this public health crisis, however. If state governments so chose, they could bypass the devastating consequences of restrictive abortion laws by simply not enacting them.
States should seek to maintain reasonable legislation which—at the very least—protects the right to medically necessary abortions and abortions for circumstances of grave emotional or physical harm to the birthing person.
