Cancer doctors are debating how new state laws will affect their discussions with pregnant patients about what treatment choices they can offer as abortion prohibitions take effect across a contiguous stretch of the South.
Roughly 1 in 1,000 pregnancies are accompanied by cancer, the most common types being breast, melanoma, cervical, lymphoma, and leukaemia. However, some drugs and medical procedures can harm the developing embryo or result in birth abnormalities. In some situations, pregnancy-induced hormone surges feed the growth of the malignancy, increasing the patient’s risk.
Cancer doctors view the legal terminology as vague, despite the fact that new abortion regulations sometimes provide exceptions based on a “medical emergency” or a “life-threatening physical condition.” They worry about misinterpreting the law and being abandoned.
For instance, if pregnancy may prevent or delay surgery, radiation, or other therapy, brain cancer patients have traditionally been given the choice of abortion, according to Dr Edjah Nduom, a brain cancer surgeon at Emory University‘s Winship Cancer Institute in Atlanta.
Is the need for abortion due to a medical emergency? Nduom questioned, seeking to understand the new Georgia law’s medical emergency provision, “I don’t know. Then, he continued, “you find yourself in a circumstance where an overly aggressive prosecution is asking, ‘Hey, this patient had a medical abortion; why did you need to do that?'”
According to a research analysis, published in 2020 in Current Oncology Reports, pregnant women with cancer should be treated similarly to non-pregnant patients wherever possible, while occasionally alterations are made in the timing of surgery and other care.
According to the study, early surgery could be used to treat breast cancer patients, delaying chemotherapy till later in the pregnancy. Radiation therapy throughout pregnancy and the majority of chemotherapy medications during the first trimester are normally discouraged by cancer specialists.
Dr Gwen Nichols, chief medical officer of the Leukemia & Lymphoma Society, stated that time is not on the side of the patient with some diseases, such as acute leukaemia, because the recommended medications have recognised harmful dangers to the foetus.
You urgently need treatment, she added. “A pregnancy cannot be carried out over the course of three or six months.”
According to Dr Debra Patt, an oncologist in Austin, Texas, who estimates she has treated more than two dozen pregnant patients with breast cancer, another potentially fatal scenario involves a patient who has been diagnosed with breast cancer early in her pregnancy and it is spreading. Tests reveal that the growth of the cancer is accelerated by the hormone oestrogen.
“A state of having higher oestrogen levels is pregnancy. Actually, it actively contributes to the growth of the disease every single instant. Therefore, I would classify that as an emergency, said Patt, who also serves as Texas Oncology’s executive vice president for policy and strategic initiatives. Texas Oncology is a statewide organisation with more than 500 doctors.
According to Dr Miriam Atkins, an oncologist in Augusta, Georgia, one issue that arises when cancer affects people of childbearing age is that malignancies frequently have a higher level of aggressiveness. Another is that it’s unclear how some of the more recent cancer medications will affect the foetus, according to her.
Micah Hester, a specialist in ethics committees and chair of the department of medical humanities and bioethics at the University of Arkansas for Medical Sciences College of Medicine in Little Rock, said that while hospital ethics committees may be consulted regarding a particular treatment dilemma, the facility’s legal interpretation of a state’s abortion law is likely to prevail.
Let’s be truthful, he said. In many states, the legal system imposes fairly strict restrictions on what you can and cannot do.
In places with almost complete abortion bans, it might be challenging to determine how doctors intend to approach such conundrums and dialogues. When contacted by many sizable medical facilities for this story, they stated that their doctors were either unavailable or not interested in speaking on the subject.
The discussions they have with patients about the best course of treatment, the potential effects of pregnancy, and if abortion is an option will not be affected by the new rules, according to other doctors like Nduom and Atkins.
Atkins declared, “I’m going to always be honest with patients. Oncology medications can be harmful. Some medications can be administered to cancer patients who are pregnant, while many others cannot.
Some argue that when cancer threatens someone’s life, termination is still an important and legal component of care.
According to Dr Joseph Biggio Jr., chair of maternal-fetal medicine at Ochsner Health System in New Orleans, patients “are educated on the best treatment options for them, and the potential consequences on their pregnancy and future fertility.” “Pregnancy termination is permitted by state law when necessary to preserve the mother’s life.”
Similar to this, Patt stated that doctors in Texas can advise cancer patients who are pregnant about the procedure if, for example, therapies have known risks of birth abnormalities. Therefore, she said, doctors can offer abortions even though they cannot recommend them.
In my opinion, there is no controversy at all, Patt stated. Unchecked cancer poses significant risks to life.
Patt has been informing the Texas Oncology doctors on the new state law and has shared an editorial from JAMA Internal Medicine that discusses abortion care resources. She remarked, “I believe knowledge is power quite strongly.
Joanna Grossman, a professor at the SMU Dedman School of Law, stated that despite this, the Texas statute’s ambiguous phrasing makes it difficult for doctors to establish what medical treatment is acceptable under the law. Nothing in the law, according to her, specifies to a physician “how much risk there needs to be before we name something legally ‘life-threatening,'” she said.
And according to Hester, the medical ethicist, a woman has “sad options” if she is unable to get an abortion through legal channels. She’ll have to decide whether it’s ideal for her to receive cancer treatment on the timeline advised by doctors or to postpone it in order to maximise the health benefits to the foetus, he said.
Patients with little financial resources, no other child care, or who share a car with an extended family may not be able to travel outside of Georgia to get an abortion, according to Atkins. “Many of my patients barely have the means to go to receive their chemotherapy,”
Dr Charles Brown, an Austin specialist in maternal-fetal medicine who resigned this year, claimed he has greater freedom of speech than his former colleagues. According to Brown, who has provided care for pregnant cancer patients, the possible outcomes and associated unsolved concerns are nearly too numerous to count.
Consider another scenario, he suggested, in a state like Georgia where the law recognises “foetal personhood.” Brown questioned what would happen if a cancer patient couldn’t get an abortion and the medication had known side effects.
Brown posed the question, “What if she answers, ‘Well, I don’t want to delay my treatment—give me the medicine regardless. The foetus can be harmed by a medication, as we are aware. Is the foetus now a person, making me responsible for any damage it sustains?
Doctors have traditionally attempted to cure the patient’s cancer while preserving the pregnancy, according to Brown. He claimed that “these are gut-wrenching trade-offs that these pregnant women have to make” when those objectives clash. “You’ve removed one of the alternatives to manage her sickness” if termination is not a possibility.
