Lack of Access to Abortion Has Had a Negative Impact on Cancer Care

Help for Clinicians and Patients

“On an individual level, oncologists must be able to counsel pregnant patients on all of their options, regardless of geographic location, and we must support our colleagues in states with abortion bans who face challenges in how they can treat pregnant patients with cancer,” Dr Teplinsky said. 

“One of the ways we can do this as an oncology community is to provide guidance on clinical situations that are life-threatening and should be free from legal prosecution — such as a pregnant patient with newly diagnosed leukemia, for example.” 

Dr Teplinsky said one resource that can help guide treatment in these cases is the Advisory Board on Cancer, Infertility and Pregnancy, an international board that provides expert advice to doctors treating pregnant patients with cancer.¹⁵

Another resource is ASCO’s guidance for navigating cancer care in states with abortion restrictions.¹⁶ The guidance includes recommendations for oncologists and their institutions. For example, the guidance recommends that oncologists:

• Inform patients about the benefits and risks of all treatment options available within the United States and do not omit medically and scientifically accurate information
• Ensure patient safety and privacy, being sensitive to patients who can’t legally access abortion in their state and are unable to travel.

The guidance also recommends that institutions “protect clinicians who appropriately inform their patients about all standard treatment options for their disease” and “establish safe and rapid mechanisms for referral and transfer of patients who require abortion care related to cancer treatment.”

Such mechanisms could help meet the transportation needs of patients seeking abortions outside of their home state, but whether patients can afford that transportation, or whether their insurance will cover it, is another consideration.

“Transportation barriers are especially high for those patients not covered under private insurance, since Medicaid patients and patients treated on insurance plans provided by the ACA exchange may be limited to their in-state providers,” said Sunita D. Nasta, MD, professor of clinical medicine at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.  

“Because federal law only allows the use of federal funds for abortion in cases of rape, incest, or life endangerment of the pregnant person, in most states, Medicaid coverage for abortion is limited to these circumstances,” Dr Nasta added. “However, 16 states do go beyond this limit and use state funds to cover other abortions for people enrolled in Medicaid.”¹⁷

To address these challenges, there is a need to enact “legislation permitting travel for abortion services, or the current restrictions on abortion care in the states limiting abortion need to be loosened for management of cancer patients,” Dr Nasta said.

“In terms of advocacy, I think we need to make sure that our policy makers understand the potentially devastating consequences of denying a pregnant woman the oncologic care that she requires,” Dr Van Loon said. 

Dr Gralow said ASCO is committed to ensuring timely access to high-quality, equitable, evidence-based care for cancer patients who are pregnant or may become pregnant during treatment, regardless of where they live, as well as advocating for policies that allow the provision of such care. 

“No court decision, regulation, or legislation should deprive patients of potentially life-saving, life-extending, or palliative treatment,” Dr Gralow said. “Furthermore, no oncologist should have to choose between their professional duties and ethical commitments to patients, obeying the law, and their individual conscience or fear criminal prosecution for providing evidence-based, high-quality care to their patients.”

Disclosures: The clinicians interviewed for this article reported that they have no relevant disclosures.

References

1. Abortion in the United States dashboard. KFF. Updated April 14, 2023. Accessed May 3, 2023.

2. State policies protecting or restricting legal status of abortion. KFF. Updated July 27, 2022. Accessed May 3, 2023.

3. Luthra S. State abortion bans are preventing cancer patients from getting chemotherapy. The 19th. Published October 7, 2022. Accessed May 3, 2023.

4. Grey H. How strict abortion laws are delaying cancer treatment. HealthLine. Published October 27, 2022. Accessed May 3, 2023.

5. Ungar L and Hollingsworth H. Despite dangerous pregnancy complications, abortions denied. Associated Press. Published November 20, 2022. Accessed May 3, 2023.

6. Hanna TP, King WD, Thibodeau S, et al. Mortality due to cancer treatment delay: systematic review and meta-analysis. BMJ. 2020;371:m4087. doi:10.1136/bmj.m4087

7. Abortion in Louisiana. June Medical Services v. Russo. Center for Reproductive Rights. Accessed May 3, 2023.

8. Status of State Abortion Bans, as of April 6, 2023, Louisiana. State Profiles for Women’s Health. KFF. Accessed May 3, 2023.

9. Human Life Protection Act. RS 40:1061. Chapter 5. Health Provisions: Abortion. Louisiana State Legislature. Accessed May 3, 2023.

10. Maternal deaths and mortality rates per 100,000 live births. KFF. Accessed May 3, 2023.

11. Cancer mortality by state. US Centers for Disease Control and Prevention. Updated February 28, 2022. Accessed May 3, 2023.

12. Silverstein J and Van Loon K. The implications of the Supreme Court decision to overturn Roe v Wade for women with pregnancy-associated cancers. JAMA Oncol. 2022;8(10):1394-1395. doi:10.1001/jamaoncol.2022.3785

13. Mittal K, Sheen M, Wheelden M, Faramand R, Teplinsky E, Joshi M. Dobbs v Jackson– rewriting women’s autonomy in cancer care. JCO Oncol Pract. Published online January 18, 2023. doi:10.1200/OP.22.00610

14. Harris LH. Navigating loss of abortion services – a large academic medical center prepares for the overturn of Roe v. Wade. N Engl J Med. 2022;386(22):2061-2064. doi:10.1056/NEJMp2206246

15. Advisory Board on Cancer, Infertility and Pregnancy. Ask for Advice. https://www.ab-cip.org/ask-for-advice

16. Spence RA, Hinyard LJ, Jagsi R, et al. ASCO ethical guidance for the US oncology community where reproductive health care is limited by law. J Clin Oncol. Published online March 29, 2023. doi:10.1200/JCO.23.00174

17. State funding of abortions under Medicaid. KFF. Updated May 1, 2022. Accessed May 3, 2023.

This article originally appeared on Cancer Therapy Advisor