The impacts of the Dobbs ruling on US cancer care delivery

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.