Perceived impact of abortion access on quality of cancer care and on future practice location decisions among oncology fellow physicians: An ASCO State of Cancer Care in America study.
Authors: Kirkwood M. Kelsey , Levit Laura A. , Spence Rebecca , Accordino Melissa Kate , Patel Manali I. , Peppercorn Jeffrey M. , Polite Blase N. , Subbiah Ishwaria M. , Waterhouse David Michael , Yabroff Robin 
Published: September 2024

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Background:
The Supreme Court decision in Dobbs v. Jackson Women’s Health Organization (2022) allows states to ban or limit abortion without health exceptions for pregnant persons. Notably, about 1 out of every 1000 pregnant persons has cancer and abortion is utilized in up to 28% of pregnant patients with cancer. To investigate the impact of this court decision on oncology practice, we studied perceptions among oncology fellows of the effect of abortion restrictions on quality care and whether they anticipate care implications to influence their decisions on future practice location.
Methods:
Fellows who took the 2024 ASCO Medical Oncology In-Training Exam (ITE) were invited to take an optional post-ITE survey assessing perceived (1) effect of abortion policies on ability to provide 9 key aspects of quality cancer care, including care access and delays, trust, and professional well-being and (2) impact of abortion restrictions on quality care in decisions of future practice location. Agreement (Agree, Strongly Agree) and impact on future practice location (Somewhat likely, Very likely) were compared by respondent gender and abortion policies (banned/under legal contention vs legal) in their own or neighboring state using chi-squared analysis.
Results:
Of 1884 US medical oncology fellows who took the ITE, 1254 (67%, inc. 49% male, 46% female) participated in this survey; 34% trained in states with bans, 44% in states adjacent to states with bans, and 22% in and adjacent to states where abortion is legal. Overall, 33% of fellows report that abortion restrictions affected their ability to deliver at least one aspect of quality care, including 22% reporting limited availability/delays of drugs and 28% reporting poorer job satisfaction. For all 9 aspect of quality care, agreement was strongly associated with local abortion status (p<0.001). For example, 37% of fellows in abortion-restricted states report reduced patient trust and relationship quality vs. 20% among those in states adjacent to bans vs. 18% among those in and adjacent to legal states (p<0.001). Over half (51%) of fellows report that they are likely to consider the impact of local abortion policies on quality care when deciding future practice location (28% were neutral, 21% unlikely to consider). More fellows training in states where abortion is legal report being likely to consider the impact of local abortion policies on care in future practice location decisions (55%) than those training in abortion-restricted states (45%) (p<0.001). More women (58%) than men (45%) report being likely to consider the impact of local abortion policies on quality care in future practice location (p<0.001).
Conclusions:
Findings provide early insights into the impact of abortion restrictions both on key aspects of quality care as well as the geographic distribution of future oncologists.