Dobbs decision may limit access to fertility services for patients with cancer

The overturning of Roe v. Wade earlier this year may limit or prevent access altogether to fertility preservation for more than 32,000 adolescents and young adults who were newly diagnosed with cancer.

“The recent Supreme Court decision [in Dobbs v. Jackson Women’s Health Organization] might create a lot of legal uncertainty on assisted reproductive technology,” Changchuan Jiang, MD, MPH, a third-year medical oncology fellow in the department of medicine at Roswell Park Comprehensive Cancer Center in Buffalo, New York, told Healio. “In the oncology world, fertility preservation care is an essential but underutilized service for cancer patients. There has been much concern about the future of oncofertility care among clinicians in the field.”

Data collection

Jiang and colleagues used 2018 data from the population-based North American Association of Central Cancer Registries to identify 123,591 patients aged 15 to 44 years who were newly diagnosed with cancer who required fertility care. Because of the common use of chemotherapy, radiotherapy or other gonadotoxic treatments for certain cancers, the researchers considered patients as needing fertility care if they had diagnoses of:

• lymphoma;
• leukemia;
• bone, joint or soft tissue sarcoma;
• testicular cancer;
• female breast, ovarian, uterine or cervical cancer; or
• any regional or distant cancer.

They compared patients who were from 22 states where abortion is banned or likely to be banned as of Aug. 6 with those from the 28 states where abortion remained legal at that time.

Characteristics of patients impacted by bans

In total, 85,085 (68.8%) patients who were newly diagnosed with cancer in 2018 would require fertility preservation, with 32,008 (25.9%) patients living in states where abortion was banned or likely to be banned in 2022. Most patients living in states where abortion was banned or likely to be banned were girls or women (n = 20,834; 65.1%) and lived in counties with high levels of poverty (n = 26,936; 84.2%).

The largest numbers of patients impacted by an abortion ban or likely ban lived in Texas (24.4%), Ohio (9.4%) and Georgia (9.1%).

Compared with states where abortion remained legal, states that had abortion bans or were likely to implement them had greater proportions of patients who:

• were non-Hispanic white (56.5% vs. 62.7%) and non-Hispanic Black (11.4% vs. 15.6%);
• lived in non-metropolitan areas (8.2% vs. 18.9%) and in the poorest counties — 68.7% vs. 84.2% of patients lived in counties with at least 10% of their population living in poverty; and
• were diagnosed with ovarian, uterine or cervical cancers (11.8% vs. 14.2%).

Changchuan Jiang

“Oncologists and other physicians should be aware of the adolescent and young adult (AYA) cancer patients’ fertility need and advocate for this unique vulnerable group,” Jiang said. “Fertility needs should be screened and addressed for AYA cancer patients on the regular basis, as fertility preservation care is an essential cancer care for AYA patients.”

References:

• Continued access to fertility preservation critical for adolescent and young adult cancer patients, following SCOTUS decision. https://www.eurekalert.org/news-releases/965971. Published Sept. 26, 2022. Accessed Oct. 3, 2022.
• Jiang C, et al. Lancet Oncol. 2022;doi:10.1016/S1470-2045(22)00562-9.