Cancer doctors are debating how new state laws will affect their talks with pregnant patients about what treatment choices they may give as abortion prohibitions take effect throughout a contiguous stretch of the South.
Roughly 1 in 1,000 pregnancies are accompanied with cancer, the most common types being breast, melanoma, cervical, lymphoma, and leukaemia. However, certain drugs and medical procedures may harm the developing embryo or result in birth abnormalities. In certain situations, pregnancy-induced hormone surges feed the development 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 a pregnancy may prevent or delay surgery, radiation, or other therapy, brain cancer patients have typically 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 the abortion due to a medical emergency? I’m not sure,” Nim inquired, attempting to understand the new Georgia law’s medical emergency provision. Then, he said, “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 study analysis, which was published in 2020 in Current Oncology Reports, pregnant women with cancer should, wherever possible, be treated identically to non-pregnant patients, however sometimes alterations are made in the scheduling of surgery and other therapy.
According to the study, early surgery might be used to treat breast cancer patients, delaying chemotherapy till later in the pregnancy. Radiation treatment during 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, said that time is not on the side of the patient with certain diseases, such as acute leukaemia, since the prescribed medications have recognised harmful dangers to the baby.
You desperately need therapy, 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.
“Increased oestrogen levels are a characteristic of pregnancy. Actually, it actively contributes to the growth of the disease every single instant. Therefore, I would classify it as an emergency “Patt, who also serves as Texas Oncology’s executive vice president for policy and strategic initiatives and is one of the organization’s more than 500 doctors, said.
According to Dr. Miriam Atkins, an oncologist in Augusta, Georgia, one issue that arises when cancer affects people of childbearing age is that malignancies often have a higher level of aggressiveness. Another is that it’s unclear how some of the more recent cancer medications may affect the baby, 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 places, the legal system imposes rather strict restrictions on what you may and cannot do.
In places with almost complete abortion prohibitions, it might be difficult to determine how doctors intend to approach such conundrums and dialogues. When approached by many large medical facilities for this story, they said that their doctors were either unavailable or not interested in speaking on the issue.
The talks they have with patients about the best course of treatment, the possible 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 said, “I’m going to always be honest with patients. “Oncology medications may be harmful. Some medications may be administered to [pregnant] cancer patients; many others cannot.”
Some argue that when cancer threatens someone’s life, termination is still an important and legal component of treatment.
According to Dr. Joseph Biggio Jr., head of maternal-fetal medicine at Ochsner Health System in New Orleans, patients “are educated on the best treatment choices for them, and the possible 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 said that doctors in Texas may advise cancer patients who are pregnant about the procedure if, for example, therapies have known risks of birth abnormalities. Therefore, she added, doctors may provide abortions even if they cannot advocate for them.
In my opinion, there is no controversy at all, Patt stated. Unchecked cancer poses significant dangers 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 said, “I believe knowledge is power quite strongly.
Joanna Grossman, a professor at the SMU Dedman School of Legislation, 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 danger there has to be before we name something legally ‘life-threatening,'” she added.
And according to Hester, the medical ethicist, a woman has “sad alternatives” if she is unable to have an abortion via legal channels. She’ll have to decide whether it’s ideal for her to have cancer treatment on the timeline advised by doctors or to postpone it in order to optimise the health advantages to the foetus, he added.
Patients with little financial resources, no other child care, or who share a vehicle with an extended family may not be able to travel outside of Georgia to have an abortion, according to Atkins. “Many of my patients barely have the means to go to get their treatment,”
Dr. Charles Brown, an Austin specialist in maternal-fetal medicine who resigned this year, said he had greater freedom of speech than his former colleagues. According to Brown, who has provided treatment for pregnant cancer patients, the possible outcomes and associated unsolved concerns are nearly too many to list.
Consider another scenario, he said, 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 postpone my treatment—give me the drug regardless. “Additionally, we are aware that some medications may be harmful to an unborn child. Are my obligations to the foetus changed now that it is a person?”
Doctors have traditionally attempted to cure the patient’s cancer while preserving the pregnancy, according to Brown. He said that “these are gut-wrenching trade-offs that these pregnant women have to make” when those objectives clash. “You’ve eliminated one of the alternatives to manage her sickness” if termination is not a possibility.