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The impacts of the Dobbs ruling on US cancer care delivery
Margaret Katana Ogongo1, Nicole Huberfeld2, Karen Basen Engquist3
1Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, United States.
Abstract:
The US Supreme Court's ruling on Dobbs v Jackson Women's Health Organization (Dobbs) in 2022 eliminated federal constitutional protection for abortion access. Dobbs has clinical and practical implications throughout the cancer control continuum. In abortion access-restrictive states, providers and patients with cancer who are pregnant will need to consider less efficacious cancer treatments, criminal or civil penalties for providers, and/or travel to abortion access-protective states. Provider shortages as well as closures of clinics that offer abortion services and cancer screening will likely contribute to screening declines. Limited access to and delays in reproductive health-care services, including fertility preservation, will likely widen existing gaps in cancer care and outcomes, disproportionately affecting marginalized populations and further perpetuating health inequities. In 2023, the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine conducted a webinar series to examine the implications of Dobbs on cancer care delivery. This commentary summarizes presentations and discussions related to (1) cancer treatment in pregnant persons and all people of reproductive age, (2) the cancer care workforce and care delivery, and (3) access to fertility preservation. Where relevant, we discuss how abortion restrictions affect patients with cancer and cancer care delivery; describe how Dobbs affects the health system and workforce; and discuss the ethical, legal, and social implications of overturning Roe v Wade. We also make recommendations for patients, health-care workforce, cancer centers, payers, professional societies, and data and for mitigating the impact of the evolving patchwork of state laws and restrictions for cancer care and outcomes.
Insights
The Dobbs ruling eliminated abortion access, impacting cancer care. Pregnant patients and providers face treatment challenges, workforce shortages, and fertility preservation delays, worsening health inequities.
Area of Science:
- Oncology
- Public Health
- Reproductive Health
Background:
- The 2022 Dobbs v Jackson Women's Health Organization ruling removed federal abortion protections.
- This decision has significant implications for cancer care delivery across the continuum.
- Abortion restrictions create complex challenges for patients with cancer and healthcare providers.
Purpose of the Study:
- To examine the implications of the Dobbs ruling on cancer care delivery.
- To summarize discussions on cancer treatment, workforce, and fertility preservation post-Dobbs.
- To identify recommendations for mitigating the impact of abortion restrictions on cancer patients.
Main Methods:
- Analysis of presentations and discussions from a National Cancer Policy Forum webinar series in 2023.
- Review of clinical, practical, ethical, legal, and social implications of the Dobbs decision on cancer care.
- Synthesis of expert perspectives on challenges and potential solutions.
Main Results:
- Abortion restrictions necessitate consideration of less effective cancer treatments and potential legal penalties for providers.
- Provider shortages and clinic closures may lead to decreased cancer screening rates.
- Limited access to reproductive health services, including fertility preservation, exacerbates existing cancer care disparities.
Conclusions:
- The Dobbs ruling creates substantial barriers to comprehensive cancer care, particularly for marginalized populations.
- Addressing the impact requires a multi-faceted approach involving patients, healthcare providers, institutions, and policymakers.
- Recommendations focus on adapting cancer care delivery, supporting the workforce, and ensuring access to essential reproductive services.
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