With the entry into force of the abortion ban Across a contiguous patch to the southCancer doctors are grappling with how new state laws will affect their discussions with pregnant patients about the treatment options they can offer.
Cancer coincides with 1 in 1,000 pregnancies, most often breast cancer. skin cancercervical cancer, lymphoma, and leukemia. But medications and other treatments can be toxic to a developing fetus or cause birth defects. In some cases, the hormones shipped during pregnancy fuel the growth of cancer, putting the patient at greater risk.
Although new abortion restrictions often allow exceptions on the grounds of a “medical emergency” or a “life-threatening physical condition,” cancer doctors describe legal terminology as opaque. They are afraid of misinterpreting the laws and of leaving them in trouble.
For example, brain cancer patients are traditionally offered the option of having an abortion if the pregnancy would limit or delay surgery, radiation or other treatment, said Dr.
“Is this a medical emergency that warrants an abortion? I don’t know,” Nadom asked, trying to analyze the medical emergency exception. In the new Georgia law. He said, “Then you end up in a situation where an overzealous prosecutor would say, ‘Hey, this patient had a medical abortion, so why did you need to do that?’ ‘.
Pregnant patients with cancer should be treated similarly to non-pregnant patients when possible, although adjustments are sometimes made in the timing of surgery and other care, according to the Search overviewpublished in 2020 in Current Oncology Reports.
For breast cancer patients, surgery can be done earlier as part of treatment, and to push chemotherapy into later in pregnancy, according to research. Cancer experts usually recommend avoiding radiation therapy throughout pregnancy, and avoiding most chemotherapy drugs during the first trimester.
But with some cancers, such as acute leukemia, the recommended medications have known toxic risks to the fetus, and time is not on the patient’s side, said Dr. Gwen Nichols, chief medical officer 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 female patient early in her pregnancy He was diagnosed with breast cancer This is spreading, and tests show that cancer growth is stimulated by estrogen, said Dr. Debra Butt, an oncologist in Austin, Texas, and she has estimated she has cared for more than two dozen pregnant patients with breast cancer.
said Pat, who is also the executive vice president for policy and strategic initiatives at Texas Oncology, a statewide practice with more than 500 physicians.
When cancer affects individuals of reproductive age, one of the challenges is that malignancies tend to be more aggressive, said Dr. Miriam Atkins, an oncologist in Augusta, Georgia. Another reason, she said, is that it is not known whether some of the new cancer drugs will affect the fetus.
said Micah Hester, an expert on ethics committees who heads the Department of Medical Humanities and Bioethics at the University of Arkansas for Medical Sciences Little Rock School of Medicine.
He said, “Let’s be honest.” “The legal landscape sets very strong standards in many states about what you can and cannot do.”
It is difficult to fully assess how physicians plan to deal with such dilemmas and debates in states that ban near-complete abortion. Many of the large medical centers contacted for this article said that their doctors were not interested or available to talk about it.
Other doctors, including Nduom and Atkins, said the new laws won’t change 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. “Oncology drugs are dangerous, and there are some that you can give them [pregnant] cancer patients; There’s a lot you can’t.”
The bottom line, some say, is that termination remains an important and legal part of care when cancer threatens someone’s life.
“Patients are counseled about the best treatment options for them, and the potential effects on their future pregnancies and fertility,” wrote Dr. Joseph Biggio Jr., chief of maternal and fetal medicine at Ochsner Health System in New Orleans, in an email. “Under state laws, it is legal to terminate a pregnancy to save the mother’s life.”
Likewise, Pat said doctors in Texas can advise pregnant patients with cancer about the procedure if the treatments, for example, have a documented risk of birth defects. Therefore, doctors cannot recommend it, and an abortion can be offered, she said.
“I don’t think it’s controversial in any way,” Pat said. “Cancer that is left unabated can pose serious risks to life.”
Pat educates doctors at the University of Texas Oncology New state lawplus an editorial post for JAMA Internal Medicine Provides details about abortion care resources. “I feel so strong about this,” she said, “that knowledge is power.”
However, the vague terminology of Texas law complicates physicians’ ability to determine what care is legally permissible, said Joanna Grossman, a professor at SMU Dedman School of Law. She didn’t say anything in law telling a doctor “how much danger there must be before we call this law a ‘life threat’.”
And if a woman can’t obtain an abortion through legal means, she has “bleak choices,” according to Hester, a medical ethicist. She would have to sort out questions like, “Is it better for her to get cancer treatment in the time range recommended by medicine,” he said, or delay cancer treatment in order to maximize the health benefits of the fetus? “
Atkins said that performing an abortion outside of Georgia may not be possible for patients who have limited cash, who do not have backup child care, or who share a single car with an extended family. “I have many patients who can barely travel to get chemotherapy.”
Dr. Charles Brown, a maternal-fetal physician in Austin who retired this year, said he can speak more freely than fellow practitioners. Brown, who has cared for pregnant women with cancer, said the scenarios and related unanswered questions are almost endless.
And, take another example, he said, a possible situation in a country that includes “fetal personality” in its law, such as Georgia. Brown asked, what if a cancer patient could not abort, and the treatment had toxic effects?
“What if she said, ‘Well, I don’t want to delay my treatment – give me the medicine anyway,'” Brown said. “And we know the medicine can harm the fetus. So am I now responsible for harming the fetus because it is human?”
Whenever possible, Brown said, doctors have always sought to treat a patient’s cancer and preserve the pregnancy. When these goals conflict, he said, “these are painful trade-offs that these pregnant women have to make.” If termination is not off the table, she “has removed one of the options for managing her disease.”
This article was reprinted from khn.org Courtesy of the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization not affiliated with Kaiser Permanente.