In 10 seconds? Cancer care for pregnant patients is impacted by abortion limiting legislation in some US states–making patient-centered shared decision-making about cancer treatments less attainable.
Is it common for cancer patients to be pregnant? More so than you might have suspected! Pregnancy occurs most frequently among breast cancer patients. About 4% of breast cancer patients under 45 are diagnosed during pregnancy. That’s 27,000 patients in the US alone, and that number is rising each year.
Got it. And what exactly is the ‘shared decision-making process’ you mentioned? These days, there are many options for those seeking medical care. Each individual has their own preferences, dreams, and healthcare goals. Shared decision-making, as the name implies, is a best practice of medical care where healthcare decisions are made collaboratively between patients and their healthcare providers with an emphasis on the patient's goals and preferences. Shared decision-making is meant to replace models of care where healthcare providers unilaterally make healthcare decisions for their patients.
Makes sense. Patients should have a say in their healthcare. But how exactly is cancer care impacted by abortion restrictions? Alongside patient input (listening to patients’ concerns about their care), cancer treatment regimens (AKA any combination of treatments or surgeries) are recommended based on tumor-specific features (for example HER2+ or HER2-, which are subtypes of breast cancer) and the stage of cancer. An additional slew of complexities arises for pregnant cancer patients because many cancer treatments are unsafe for developing embryos. Depending on the stage of the tumor and trimester of pregnancy, some cancer patients may choose (and, indeed, may be encouraged by their oncologists) to terminate their pregnancy to undergo the cancer treatment option that is most likely to cure their cancer.
Got it. But can you give me some examples? Right away. Billions of US federal dollars have been poured into research to develop a slew of targeted cancer treatments for breast cancer. For example, tamoxifen, a drug used to treat the most common subtype of breast cancer (HER+) is known to cause fetal abnormalities. That means that in states with limited abortion access, many pregnant patients can only be safely administered chemotherapy, even though it doesn’t treat cancer as well and is associated with worse side effects.
That is very tough to hear... does that mean an abortion should not be excluded as an option? I know. As weighty (and frequently tragic) as these scenarios are, abortion may be a cancer patient’s best bet of survival. Some oncologists have raised concerns that these laws make evidence-based shared decision making with their patients unfeasible, lowering the quality of care they can provide and – let’s call a spade a spade –subsequently endangering cancer patients’ lives. Be that as it may, it's in the hands of state governments now to take these facts into consideration and decide what is the most ethical role for the government to play in dictating cancer treatment for pregnant patients. The predominant opinion of oncologists, however, is that it’s most ethical to leave healthcare decisions between doctors and patients.
What about cancer immunotherapy during pregnancy?
Treatments that boost the immune system to kill cancer, or immunotherapies, have revolutionized cancer care in the last decade. Since these treatments are so new, there’s no solid evidence showing if they negatively impact pregnancy outcomes.
Of note, however, immunotherapies intentionally disrupt multiple pathways in cancer that are also key to maintaining the complex maternal-fetal immune relationship. Much more research needs to be done to determine if and when immunotherapies are safe to use in pregnant cancer patients.
Dr. Talia Henkle has distilled 4 papers saving you 14 hours of reading time.
The Science Integrity Check of this 3-min Science Digest was performed by Flávia Oliveira Geraldes