New abortion laws undermine cancer treatment for pregnant patients

As abortion ban come into force along a contiguous southern strip Cancer doctors are struggling with how new state laws will influence t...


As abortion ban come into force along a contiguous southern stripCancer doctors are struggling with how new state laws will influence their discussions with pregnant patients about what treatment options they might offer.

Cancer occurs in about 1 in 1,000 pregnancies, most often breast cancer, melanoma, cervical cancer, lymphomas and leukemias. But medications and other treatments can be toxic to the developing fetus or cause birth defects. In some cases, hormones that are overloaded during pregnancy fuel the cancer’s growth, putting the patient at greater risk.

While the new abortion restrictions generally allow exceptions based on “medical emergency” or “life-threatening physical condition,” medical oncologists describe the legal terms as unclear. They fear misinterpreting the laws and being let down.

For example, brain cancer patients have traditionally been offered the option of abortion if the pregnancy might limit or delay surgery, radiation or other treatment, said Dr. Edjah Nduom, a brain cancer surgeon at the Winship Cancer Institute at Emory University in Atlanta.

“Is this a medical emergency that requires an abortion? I don’t know,” Nduom asked, trying to analyze the medical emergency exception. in Georgia’s new law. “So you end up in a situation where you have an overzealous prosecutor who’s saying, ‘Hey, this patient had a medical abortion; why would you need to do that?'” he said.

Pregnant cancer patients should be treated the same as non-pregnant patients when possible, although adjustments are sometimes made to the timing of surgery and other care, according to an overview of the searchpublished in 2020 in Current Oncology Reports.

With breast cancer patients, surgery may be performed early as part of treatment, deferring chemotherapy until later in the pregnancy, according to the research. Cancer experts generally recommend avoiding radiation therapy during pregnancy and most chemotherapy drugs during the first trimester.

But with some cancers, such as acute leukemia, the recommended drugs have known toxic risks to the fetus, and time is not on the patient’s side, said Dr. Gwen Nichols, medical director of the Leukemia & Lymphoma Society.

“You need treatment urgently,” she said. “You can’t wait three months or six months to complete a pregnancy.”

Another life-threatening scenario involves a patient early in her pregnancy who has been diagnosed with breast cancer that is spreading, and tests show that the cancer’s growth is stimulated by the hormone estrogen, said Dr. Debra Patt, an oncologist from Austin, Texas, who estimated that she has cared for more than two dozen pregnant breast cancer patients.

“Pregnancy is a state where you increase estrogen levels. In fact, you’re actively making the cancer grow bigger all the time. So I would consider this an emergency,” said Patt, who is also executive vice president. policy and strategic initiatives from Texas Oncology, a statewide practice with more than 500 physicians.

When cancer strikes individuals of childbearing age, a challenge is that malignancies tend to be more aggressive, said Dr. Miriam Atkins, an oncologist in Augusta, Georgia. Another is that it is not known whether some of the new cancer drugs will affect the fetus, she said.

While hospital ethics committees may be consulted on a specific treatment dilemma, it is the legal interpretation of a state’s abortion law installation that is likely to prevail, said Micah Hester, an ethics committee expert who chairs the medical humanities department. and bioethics from the University of Arkansas to the School of Medicine of Medical Sciences in Little Rock.

“Let’s be honest,” he said. “The legal landscape sets pretty strong parameters in many states about what you can and cannot do.”

It is difficult to fully appreciate how doctors plan to handle these dilemmas and discussions in states with near-total abortion bans. Several major medical centers contacted for this article said their doctors were not interested or available to talk about it.

Other doctors, including Nduom and Atkins, said the new laws will not alter their discussions with patients about the best treatment approach, the potential impact of pregnancy or whether abortion is an option.

“I will always be honest with patients,” Atkins said. “Cancer drugs are dangerous. There are some drugs you can give [pregnant] Cancer patients; there are many you cannot.”

The bottom line, some argue, is that termination remains a critical and legal part of care when cancer threatens someone’s life.

Patients “are advised on the best treatment options for them and the possible impacts on their pregnancies and future fertility,” wrote Dr. Joseph Biggio Jr., president of maternal-fetal medicine at the Ochsner Health System in New Orleans, via email. “Under state law, termination of pregnancy to save the mother’s life is legal.”

Likewise, Patt said doctors in Texas can advise pregnant cancer patients about the procedure if, for example, the treatments carry documented risks of birth defects. So doctors can’t recommend them, and abortion can be offered, she said.

“I don’t think it’s controversial at all,” Patt said. “Cancer not abated can pose serious risks to life.”

Patt has been teaching doctors at Texas Oncology about the new state lawas well as sharing a JAMA Internal Medicine editorial that provides details on abortion care resources. “I feel very strongly about that, that knowledge is power,” she said.

Still, the vague terminology of Texas law complicates doctors’ ability to determine what is legally permissible treatment, said Joanna Grossman, a professor at the SMU Dedman School of Law. She said nothing in the statute tells a doctor “how much risk there must be before we legally label this ‘life threatening.

And if a woman can’t obtain an abortion through legal means, she has “dark options,” according to Hester, a medical ethicist. She will have to resolve questions such as, “Is it better for her to have cancer treatment on the medically recommended time scale,” he said, “or delay cancer treatment to maximize the health benefits of the fetus??”

Having an abortion outside of Georgia may not be possible for patients with limited money or no child care or who share a car with an extended family, Atkins said. “I have a lot of patients who can barely travel for chemotherapy.”

Dr. Charles Brown, a maternal-fetal medicine doctor in Austin who retired this year, said he can speak more freely than fellow practitioners. The scenarios and related unanswered questions are almost too numerous to count, said Brown, who has cared for pregnant women with cancer.

Take as another example, he said, a potential situation in a state that incorporates “fetal personality” into its law, such as Georgia. What if a cancer patient can’t get an abortion, asked Brown, and the treatment has known toxic effects?

“What if she says, ‘Well, I don’t want to delay my treatment – give me the medicine anyway,'” Brown said. “And we know that medicine can harm the fetus. Am I now responsible for harm to the fetus because I am a person?”

Whenever possible, doctors have always strived to treat a patient’s cancer and preserve the pregnancy, Brown said. When those goals conflict, he said, “these are painful tradeoffs that these pregnant women have to make.” If termination is off the table, “you removed one of the options to control her illness.”


KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with Policy Analysis and Research, KHN is one of the three main operational programs of the KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides information on health issues to the nation.

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Newsrust - US Top News: New abortion laws undermine cancer treatment for pregnant patients
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