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Jewell TI, Petty EM. LGBTQ+ health education for medical students in the United States: a narrative literature review. MEDICAL EDUCATION ONLINE 2024; 29:2312716. [PMID: 38359164 PMCID: PMC10877666 DOI: 10.1080/10872981.2024.2312716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/26/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION People who identify as lesbian, gay, bisexual, transgender, queer/questioning, intersex, and other sexual/gender minorities (LGBTQ+) may experience discrimination when seeking healthcare. Medical students should be trained in inclusive and affirming care for LGBTQ+ patients. This narrative literature review explores the landscape of interventions and evaluations related to LGBTQ+ health content taught in medical schools in the USA and suggests strategies for further curriculum development. METHODS PubMed, ERIC, and Education Research Complete databases were systematically searched for peer-reviewed articles on LGBTQ+ health in medical student education in the USA published between 1 January 2011-6 February 2023. Articles were screened for eligibility and data was abstracted from all eligible articles. Data abstraction included the type of intervention or evaluation, sample population and size, and key outcomes. RESULTS One hundred thirty-four articles met inclusion criteria and were reviewed. This includes 6 (4.5%) that evaluate existing curriculum, 77 (57.5%) study the impact of curriculum components and interventions, 36 (26.9%) evaluate student knowledge and learning experiences, and 15 (11.2%) describe the development of broad learning objectives and curriculum. Eight studies identified student knowledge gaps related to gender identity and affirming care and these topics were covered in 34 curriculum interventions. CONCLUSION Medical student education is important to address health disparities faced by the LGBTQ+ community, and has been an increasingly studied topic in the USA. A variety of curriculum interventions at single institutions show promise in enhancing student knowledge and training in LGBTQ+ health. Despite this, multiple studies indicate that students report inadequate education on certain topics with limitations in their knowledge and preparedness to care for LGBTQ+ patients, particularly transgender and gender diverse patients. Additional integration of LGBTQ+ curriculum content in areas of perceived deficits could help better prepare future physicians to care for LGBTQ+ patients and populations.
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Affiliation(s)
- Tess I. Jewell
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Elizabeth M. Petty
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Ahrendt H, Sun H, Mishra K, Gupta S, Bukavina L. Multidisciplinary management of sexual and gender minorities with bladder cancer. Urol Oncol 2024; 42:352-360. [PMID: 38880704 DOI: 10.1016/j.urolonc.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/19/2024] [Accepted: 05/24/2024] [Indexed: 06/18/2024]
Abstract
Bladder cancer, a common urologic malignancy, has poor morbidity and mortality in sexual and gender minority (SGM) individuals, stemming from higher risk, poor access to care and lack of quality cancer care. To begin addressing this disparity, this review offers key considerations for evaluation, diagnosis and treatment of SGM individuals with bladder cancer. In addition to thorough medical and surgical history, initial evaluation should include discussion of patient goals for sexual function and organ preservation, as well as an evaluation of sexual function. Prior gender affirming surgery and patient specific sexual function goals will impact diagnosis and treatment approaches, including surgical and radiation therapy. Throughout care for SGM individuals with bladder cancer, it is critical to acknowledge the systemic discrimination that may be experienced by these individuals and approach conversations with sensitivity and humility and incorporate mental and social support as appropriate.
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Affiliation(s)
- Hannah Ahrendt
- Case Western Reserve University, School of Medicine, Cleveland, OH
| | - Helen Sun
- Case Western Reserve University, School of Medicine, Cleveland, OH; Urology Institute, University Hospitals of Cleveland, Cleveland, OH
| | - Kirtishri Mishra
- Case Western Reserve University, School of Medicine, Cleveland, OH; Urology Institute, University Hospitals of Cleveland, Cleveland, OH
| | - Shubham Gupta
- Case Western Reserve University, School of Medicine, Cleveland, OH; Urology Institute, University Hospitals of Cleveland, Cleveland, OH
| | - Laura Bukavina
- Case Western Reserve University, School of Medicine, Cleveland, OH; Urology Institute, University Hospitals of Cleveland, Cleveland, OH.
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3
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McDowell A, Rieu-Werden ML, Atlas SJ, Fields CD, Goldstein RH, Gundersen GD, Haas JS, Higashi RT, Pruitt SL, Silver MI, Tiro JA, Kamineni A. Characteristics of Clinicians Caring for Transgender Men and Nonbinary Individuals and Guideline Concordance of Clinicians' Cervical Cancer Screening Counseling for Cisgender Individuals Versus Transgender Men and Nonbinary Individuals with a Cervix. LGBT Health 2024; 11:563-569. [PMID: 38648535 DOI: 10.1089/lgbt.2023.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Purpose: We examined characteristics of clinicians caring for transgender men and nonbinary (TMNB) individuals and guideline concordance of clinicians' cervical cancer screening recommendations. Methods: Using a survey of clinicians who performed ≥10 cervical cancer screenings in 2019, we studied characteristics of clinicians who do versus do not report caring for TMNB individuals and guideline concordance of screening recommendations for TMNB individuals with a cervix versus cisgender women. Results: In our sample (N = 492), 49.2% reported caring for TMNB individuals, and 25.4% reported performing cervical cancer screening for TMNB individuals with a cervix. Differences in guideline concordance of screening recommendations for TMNB individuals with a cervix versus cisgender women (45.8% vs. 50% concordant) were not statistically significant. Conclusion: Sizable proportions of clinicians cared for and performed cervical cancer screening for TMNB individuals. Research is needed to better understand clinicians' identified knowledge deficits to develop interventions (e.g., clinician trainings) to improve gender-affirming cervical cancer prevention.
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Affiliation(s)
- Alex McDowell
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Meghan L Rieu-Werden
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Steven J Atlas
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Robert H Goldstein
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Jennifer S Haas
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robin T Higashi
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas, USA
| | - Sandi L Pruitt
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas, USA
| | - Michelle I Silver
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jasmin A Tiro
- Department of Public Health Sciences, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
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Berro T, Zayhowski K. Toward depathologizing queerness: An analysis of queer oppression in clinical genetics. J Genet Couns 2024; 33:943-951. [PMID: 37876321 DOI: 10.1002/jgc4.1819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 10/26/2023]
Abstract
Critically examining the way that the field of clinical genetics has impacted queer communities offers the field an opportunity to strengthen our commitment to inclusive high-quality care to all patients, families, and communities. This article reviews the origins of clinical genetics and genetic counseling in the eugenics movement and how this ontology promoted harmful medical practices grounded in assumptions of what is "normal." We critically examine existing clinical genetics practices and how commonly used binary frameworks for gender, sex, and sexuality perpetuate heteronormative, cisnormative, and bioessentialist assumptions. In order to move toward queer inclusivity, the genetic counseling field must first take accountability for past injustices. Restorative justice and trauma-informed approaches offer a way to engage with the queer community and to begin to rectify the history of medical harm. Through our analysis, we advocate for expanding efforts to depathologize queerness, promote bodily autonomy, and provide equitable healthcare for the queer community.
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Affiliation(s)
- Tala Berro
- Department of Genetics, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Kimberly Zayhowski
- Department of Obstetrics and Gynecology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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Koons A, Smith E, Stephens JC, McKnight NH, Barr J, Ibe IK. Disparities in Musculoskeletal Oncology. Curr Rev Musculoskelet Med 2024:10.1007/s12178-024-09925-8. [PMID: 39316352 DOI: 10.1007/s12178-024-09925-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2024] [Indexed: 09/25/2024]
Abstract
PURPOSE OF REVIEW Disparities within the healthcare system serve as barriers to care that lead to poor outcomes for patients. These healthcare disparities are present in all facets of medicine and extend to musculoskeletal oncology care. There are various tenets to health disparities with some factors being modifiable and non-modifiable. The factors play a direct role in a patient's access to care, time of presentation, poor social determinants of health, outcomes and survival. RECENT FINDINGS In musculoskeletal oncologic care, factors such as race, socioeconomic factors and insurance status are correlated to advanced disease upon presentation and poor survival for patients with a sarcoma diagnosis. These factors complicate the proper delivery of coordinated care that is required for optimizing patient outcomes. Healthcare disparities lead to suboptimal outcomes for patients who require musculoskeletal oncologic care in the short and long term. More research is required to identify ways to address the known modifiable and non-modifiable factors to improve patient outcome.
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Affiliation(s)
- Abigail Koons
- Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, 2500 N State St, Jackson, MS, 39216, USA
| | - Elyse Smith
- Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, 2500 N State St, Jackson, MS, 39216, USA
| | - Jeffrey C Stephens
- Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, 2500 N State St, Jackson, MS, 39216, USA
| | - Natilyn H McKnight
- Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, 2500 N State St, Jackson, MS, 39216, USA
| | - Jennifer Barr
- Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, 2500 N State St, Jackson, MS, 39216, USA
| | - Izuchukwu K Ibe
- Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, 2500 N State St, Jackson, MS, 39216, USA.
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Kratzer TB, Star J, Minihan AK, Bandi P, Scout NFN, Gary M, Riddle-Jones L, Giaquinto AN, Islami F, Jemal A, Siegel RL. Cancer in people who identify as lesbian, gay, bisexual, transgender, queer, or gender-nonconforming. Cancer 2024; 130:2948-2967. [PMID: 38818898 DOI: 10.1002/cncr.35355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/04/2024] [Accepted: 04/17/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Individuals who identify as lesbian, gay, bisexual, transgender, queer, intersex, or gender-nonconforming (LGBTQ+) experience discrimination and minority stress that may lead to elevated cancer risk. METHODS In the absence of population-based cancer occurrence information for this population, this article comprehensively examines contemporary, age-adjusted cancer risk factor and screening prevalence using data from the National Health Interview Survey, Behavioral Risk Factor Surveillance System, and National Youth Tobacco Survey, and provides a literature review of cancer incidence and barriers to care. RESULTS Lesbian, gay, and bisexual adults are more likely to smoke cigarettes than heterosexual adults (16% compared to 12% in 2021-2022), with the largest disparity among bisexual women. For example, 34% of bisexual women aged 40-49 years and 24% of those 50 and older smoke compared to 12% and 11%, respectively, of heterosexual women. Smoking is also elevated among youth who identify as lesbian, gay, or bisexual (4%) or transgender (5%) compared to heterosexual or cisgender (1%). Excess body weight is elevated among lesbian and bisexual women (68% vs. 61% among heterosexual women), largely due to higher obesity prevalence among bisexual women (43% vs. 38% among lesbian women and 33% among heterosexual women). Bisexual women also have a higher prevalence of no leisure-time physical activity (35% vs. 28% among heterosexual women), as do transgender individuals (30%-31% vs. 21%-25% among cisgender individuals). Heavier alcohol intake among lesbian, gay, and bisexual individuals is confined to bisexual women, with 14% consuming more than 7 drinks/week versus 6% of heterosexual women. In contrast, prevalence of cancer screening and risk reducing vaccinations in LGBTQ+ individuals is similar to or higher than their heterosexual/cisgender counterparts except for lower cervical and colorectal cancer screening among transgender men. CONCLUSIONS People within the LGBTQ+ population have a higher prevalence of smoking, obesity, and alcohol consumption compared to heterosexual and cisgender people, suggesting a higher cancer burden. Health systems have an opportunity to help inform these disparities through the routine collection of information on sexual orientation and gender identity to facilitate cancer surveillance and to mitigate them through education to increase awareness of LGBTQ+ health needs.
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Affiliation(s)
- Tyler B Kratzer
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Jessica Star
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Adair K Minihan
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Priti Bandi
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - N F N Scout
- National LGBT Cancer Network, Providence, Rhode Island, USA
| | - Monique Gary
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | | | - Angela N Giaquinto
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Farhad Islami
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Rebecca L Siegel
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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Cheng HH, Shevach JW, Castro E, Couch FJ, Domchek SM, Eeles RA, Giri VN, Hall MJ, King MC, Lin DW, Loeb S, Morgan TM, Offit K, Pritchard CC, Schaeffer EM, Szymaniak BM, Vassy JL, Katona BW, Maxwell KN. BRCA1, BRCA2, and Associated Cancer Risks and Management for Male Patients: A Review. JAMA Oncol 2024; 10:1272-1281. [PMID: 39052257 DOI: 10.1001/jamaoncol.2024.2185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Importance Half of all carriers of inherited cancer-predisposing variants in BRCA1 and BRCA2 are male, but the implications for their health are underrecognized compared to female individuals. Germline variants in BRCA1 and BRCA2 (also known as pathogenic or likely pathogenic variants, referred to here as BRCA1/2 PVs) are well known to significantly increase the risk of breast and ovarian cancers in female carriers, and knowledge of BRCA1/2 PVs informs established cancer screening and options for risk reduction. While risks to male carriers of BRCA1/2 PVs are less characterized, there is convincing evidence of increased risk for prostate cancer, pancreatic cancer, and breast cancer in males. There has also been a rapid expansion of US Food and Drug Administration-approved targeted cancer therapies, including poly ADP ribose polymerase (PARP) inhibitors, for breast, pancreatic, and prostate cancers associated with BRCA1/2 PVs. Observations This narrative review summarized the data that inform cancer risks, targeted cancer therapy options, and guidelines for early cancer detection. It also highlighted areas of emerging research and clinical trial opportunities for male BRCA1/2 PV carriers. These developments, along with the continued relevance to family cancer risk and reproductive options, have informed changes to guideline recommendations for genetic testing and strengthened the case for increased genetic testing for males. Conclusions and Relevance Despite increasing clinical actionability for male carriers of BRCA1/2 PVs, far fewer males than female individuals undergo cancer genetic testing. Oncologists, internists, and primary care clinicians should be vigilant about offering appropriate genetic testing to males. Identifying more male carriers of BRCA1/2 PVs will maximize opportunities for cancer early detection, targeted risk management, and cancer treatment for males, along with facilitating opportunities for risk reduction and prevention in their family members, thereby decreasing the burden of hereditary cancer.
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Affiliation(s)
- Heather H Cheng
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Department of Medicine (Hematology and Oncology), University of Washington, Seattle
| | - Jeffrey W Shevach
- Division of Medical Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Elena Castro
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Fergus J Couch
- Division of Experimental Pathology and Laboratory Medicine, Mayo Clinic, Rochester, New York
| | - Susan M Domchek
- Department of Medicine, Basser Center for BRCA and Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | - Rosalind A Eeles
- The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Veda N Giri
- Yale School of Medicine and Yale Cancer Center, New Haven, Connecticut
| | - Michael J Hall
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Mary-Claire King
- Department of Medicine (Medical Genetics) and Department of Genome Sciences, University of Washington, Seattle
| | - Daniel W Lin
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Department of Urology, University of Washington, Seattle
| | - Stacy Loeb
- Department of Urology and Population Health, New York University School of Medicine, New York
- Department of Surgery/Urology, Manhattan Veterans Affairs, New York, New York
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor
| | - Kenneth Offit
- Clinical Genetics Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Colin C Pritchard
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle
- Brotman Baty Institute for Precision Medicine, Seattle, Washington
| | - Edward M Schaeffer
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Brittany M Szymaniak
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jason L Vassy
- Harvard Medical School at VA Boston Healthcare System, Boston, Massachusetts
| | - Bryson W Katona
- Department of Medicine, Basser Center for BRCA and Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | - Kara N Maxwell
- Department of Medicine, Basser Center for BRCA and Abramson Cancer Center, University of Pennsylvania, Philadelphia
- Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Tinajero J, Rashid T. Urologic oncology considerations in transgender and gender diverse patients. Curr Opin Urol 2024; 34:314-322. [PMID: 38932479 DOI: 10.1097/mou.0000000000001207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
PURPOSE OF REVIEW This review delves into the pressing issue of urologic oncology considerations within the transgender and gender-diverse (TGD) community. With estimates suggesting that TGD individuals constitute 0.3 to 0.5% of adults worldwide, and this number steadily rising, our review examines the barriers that impede the delivery of excellent quality care, particularly in the context of cancer diagnosis and treatment. RECENT FINDINGS Recent findings highlight disparities in cancer screening, diagnosis, and treatment access for TGD individuals. These challenges are compounded by a dearth of research and the failure of healthcare systems to account for gender identity and its nuances in data collection. Main themes in the literature include the impact of gender-affirming hormone therapy and surgery on cancer risk, challenges in prostate cancer screening and management, and considerations pertinent to testicular and other urological cancers in TGD patients. SUMMARY The implications for clinical practice and research are profound and emphasize the need for multidisciplinary approaches that cater to the unique healthcare needs of TGD individuals. This includes comprehensive strategies for inclusive and accurate data collection, alongside the development of evidence-based guidelines for cancer screening and management tailored specifically to this population.
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Affiliation(s)
- Juan Tinajero
- Chelsea Centre for Gender Surgery, Chelsea and Westminster Hospital
| | - Tina Rashid
- Chelsea Centre for Gender Surgery, Chelsea and Westminster Hospital
- Nuffield Health Parkside Hospital, London, UK
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Di Lisa FS, Villa A, Filomeno L, Arcuri T, Chiofalo B, Sanguineti G, Pizzuti L, Krasniqi E, Barba M, Sergi D, Lombardo F, Romanelli F, Botti C, Zoccali G, Ciliberto G, Vici P. Breast and cervical cancer in transgender men: literature review and a case report. Ther Adv Med Oncol 2024; 16:17588359241259466. [PMID: 39131728 PMCID: PMC11316962 DOI: 10.1177/17588359241259466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/14/2024] [Indexed: 08/13/2024] Open
Abstract
Transgender individuals exhibit a higher prevalence of cancer-related risk factors, such as substance abuse and sexually transmitted infections. These factors, coupled with suboptimal adherence to cancer screening recommendations, may lead to a higher incidence of cancers, such as breast and cervical cancer, and contribute to delayed diagnoses in transgender patients. Herein, we report a unique case of a transgender man with a history of alcohol and drug abuse, undergoing gender-affirming exogenous testosterone therapy, who developed synchronous locally advanced breast cancer and human papilloma virus (HPV)-related cervical cancer. He underwent concurrent chemoradiation for cervical cancer and surgery followed by endocrine therapy for breast cancer. The treatments were suboptimals due to patient's comorbidities, among them liver cirrhosis leading to an early death. Additionally, we have conducted a review of existing literature, including case reports, clinical studies, and review articles investigating the role of potential risk factors specifically related to breast and cervical tumors in transgender men. Gender-affirming testosterone therapy is common among transgender men to induce gender affirmation, but its link to breast cancer risk remains ambiguous, with studies being limited and sometimes contradictory. Conversely, HPV is a well-established cause of up to 99% of cervical cancers. Despite persistent risk for cervical cancer in transgender men who retain their cervix, several studies indicate notable disparities in screening adherence, due to personal and structural barriers. Moreover, alcohol and drug use disorders, commonly encountered in transgender population, may negatively influence the adherence to screening programs. Current cancer screening guidelines for this population are somewhat unclear, and specific programs based on more robust data are urgently required along with further tailored studies.
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Affiliation(s)
| | - Alice Villa
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Lorena Filomeno
- Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome 00144, Italy
| | - Teresa Arcuri
- Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- Medical Oncology A, Policlinico Umberto I, Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Pizzuti
- Division of Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Eriseld Krasniqi
- Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Domenico Sergi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesco Lombardo
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesco Romanelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Claudio Botti
- Division of Breast Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giovanni Zoccali
- Department of Plastic and Reconstructive Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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10
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Weideman BCD, McAlpine D. State LGBTQ policy environments and the cancer burden in sexual and gender minoritized communities in the United States. Cancer Med 2024; 13:e70097. [PMID: 39140345 PMCID: PMC11322825 DOI: 10.1002/cam4.70097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 07/10/2024] [Accepted: 07/16/2024] [Indexed: 08/15/2024] Open
Abstract
PURPOSE Our objective was to assess the association between state policies related to sexual orientation and gender identity (SOGI) and cancer prevalence and survivorship indicators in a sexual and gender minoritized (SGM) population in the United States. METHODS Data from the 2017-2021 Behavioral Risk Factor Surveillance System were used to measure cancer diagnosis, physical and mental health, and substance use for SGM adult cancer survivors. A state policy Z-score, ranging from most restrictive to most protective state policies related to SOGI, was computed from data available from the Movement Advancement Project. Survey-weighted logistic regression was used to test the relationship between state policies and cancer-related outcomes for SGM people. RESULTS More protective state policies were associated with lower odds of a cancer diagnosis (adjusted odds ratio [AOR]: 0.92; 95% confidence interval [CI]: 0.87-0.97). Among SGM cancer survivors, increasing protective state policies were associated with lower odds of poor physical health (AOR: 0.83; 95% CI: 0.74-0.94), lower odds of difficulty walking or climbing stairs (AOR: 0.90; 95% CI: 0.80-1.00), and lower odds of difficulty concentrating or remembering (AOR: 0.87; 95% CI: 0.78-0.98). No significant associations were found between state policies and mental health, depression, substance use, diabetes, or cardiovascular disease among SGM cancer survivors. CONCLUSION SGM people diagnosed with cancer are more likely to live in restrictive policy states, and survivors in those states have worse physical health and cognitive disability. Additional research should investigate potential causal relationships between state policies and SGM cancer outcomes.
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Affiliation(s)
- Ben C. D. Weideman
- Division of Health Policy and ManagementSchool of Public Health, University of MinnesotaMinneapolisMinnesotaUSA
| | - Donna McAlpine
- Division of Health Policy and ManagementSchool of Public Health, University of MinnesotaMinneapolisMinnesotaUSA
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11
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Ceolin C, Papa MV, Scala A, Sergi G, Garolla A. Getting old in the desired gender: a systematic review on aging diseases in transgender people. J Endocrinol Invest 2024; 47:1851-1862. [PMID: 38904914 PMCID: PMC11266207 DOI: 10.1007/s40618-024-02353-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/28/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION The growing demographic presence of the transgender (TGD) population has sparked an increase in clinical investigations focusing on the impacts of gender-affirming hormone therapy (GAHT) in adults with gender dysphoria. Despite this surge in studies, there remains a significant gap in the literature regarding the health status of older TGD individuals. This review aims to assess prevalent pathological conditions within the TGD population, specifically concentrating on aging-related diseases investigated to date. METHODS A systematic search across Embase Ovid, Scopus, PubMed, Cochrane Library, and Web of Science databases was conducted to identify articles reporting on the aging process in TGD individuals. Methodological quality was evaluated using Newcastle-Ottawa Scale (NOS) scores. RESULTS Initial database searches yielded 12,688 studies, which were refined to 18 through elimination of duplicates and title/abstract review. Following a comprehensive appraisal, nine studies were included in the systematic review. These articles, published between 2017 and 2023, involved a total of 5403 participants. The evidence indicates a noteworthy percentage of the TGD population being at risk for cardiovascular diseases, experiencing depression or disability, and demonstrating hesitancy toward major recommended screening programs. CONCLUSIONS Limited studies on older TGD individuals highlight not only an organic risk of chronic diseases but also a cognitive/psychiatric risk that should not be underestimated. Further research is imperative to deepen our understanding of the pathophysiological mechanisms involved in the health challenges faced by older TGD individuals.
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Affiliation(s)
- C Ceolin
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, via Giustiniani 2, 35128, Padua, Italy.
- Regional Reference Center for Gender Incongruence (CRRIG), Padua, Veneto, Italy.
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Aging Research Center, Stockholm, Sweden.
| | - M V Papa
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, via Giustiniani 2, 35128, Padua, Italy
| | - A Scala
- Regional Reference Center for Gender Incongruence (CRRIG), Padua, Veneto, Italy
- Unit of Andrology and Reproductive Medicine, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - G Sergi
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, via Giustiniani 2, 35128, Padua, Italy
- Regional Reference Center for Gender Incongruence (CRRIG), Padua, Veneto, Italy
| | - A Garolla
- Regional Reference Center for Gender Incongruence (CRRIG), Padua, Veneto, Italy
- Unit of Andrology and Reproductive Medicine, Department of Medicine (DIMED), University of Padua, Padua, Italy
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12
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Hui J, Reddon H, Fairbairn N, Choi J, Milloy MJ, Socias ME. Prevalence and Correlates of Heavy Alcohol use among People Living with HIV who use Unregulated Drugs in Vancouver, Canada. AIDS Behav 2024; 28:2427-2437. [PMID: 38662276 DOI: 10.1007/s10461-024-04341-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/26/2024]
Abstract
Among people living with HIV (PLWH), heavy alcohol use is associated with many negative health consequences. However, the impacts of heavy alcohol use are not well described for PLWH who use drugs. Thus, we investigated the prevalence and correlates of heavy alcohol use among a cohort of people who use drugs (PWUD) living with HIV in Vancouver, Canada. We accessed data from an ongoing community-recruited prospective cohort of PLWH who use drugs with linked comprehensive HIV clinical monitoring data. We used generalized linear mixed-effects modeling to identify factors longitudinally associated with periods of heavy alcohol use between December 2005 and December 2019. Of the 896 participants included, 291 (32.5%) reported at least one period with heavy alcohol use. Periods of recent incarceration (Adjusted Odds Ratio [AOR] = 1.48, 95% Confidence Interval [CI]: 1.01-2.17), encounters with police (AOR = 1.87, 95% CI: 1.37-2.56), and older age (AOR = 1.05, 95% CI: 1.02-1.07) were positively associated with heavy alcohol use. Engagement in drug or alcohol treatment (AOR = 0.54, 95% CI: 0.42-0.70) and male gender (AOR = 0.46; 95% CI: 0.27-0.78) were negatively associated with heavy alcohol use. We observed that heavy alcohol use was clearly linked to involvement with the criminal justice system. These findings, together with the protective effects of substance use treatment, suggest the need to expand access for drug and alcohol treatment programs overall, and in particular through the criminal justice system to reduce alcohol-related harms among PLWH who use drugs.
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Affiliation(s)
- Jeremy Hui
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Hudson Reddon
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
| | - Nadia Fairbairn
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - JinCheol Choi
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - M-J Milloy
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Maria Eugenia Socias
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
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13
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Favazzi UM, Marconi M, Carbone P, Guerrera D, Ruocco A, Manoli M, Molinaro F, Regini FM, Vittozzi A, Mazzaccara A, Pierdominici M. Evaluating the impact of distance learning on gender-affirming healthcare competence: knowledge acquisition and satisfaction among healthcare professionals in Italy. Front Public Health 2024; 12:1393188. [PMID: 38903566 PMCID: PMC11187281 DOI: 10.3389/fpubh.2024.1393188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/24/2024] [Indexed: 06/22/2024] Open
Abstract
Background Transgender and gender diverse (TGD) individuals face significant healthcare barriers, with one of the most critical being the inadequate knowledge and skills of healthcare professionals (HCPs) in TGD health. To address this issue, we undertook a project to develop a distance learning course for all healthcare professions, encompassing a comprehensive range of topics related to TGD health issues. Objectives This study aimed to evaluate the impact of a course on gender-affirming healthcare competence, with a focus on knowledge acquisition and satisfaction levels. The hypothesis was that participating in the course would enhance the participants' knowledge on the covered topics. Methods A distance learning course, designed for all Continuing Medical Education professions, was conducted between March and September 2023. The course was structured according to the Problem-Based Learning methodology. We implemented a pre-test vs. post-test study design to evaluate the enhancement of knowledge, based on a set of Multiple Choice Questions (MCQs), and investigated users' satisfaction through the administration of a semi-structured questionnaire. We examined the pre- and post-course proportions of correct responses to questions, along with the mean score difference, categorized by learners' sex, age, and geographical area. Eventually, a Satisfaction Training Index was created. Results The maximum capacity was reached, with 29,998 out of 30,000 available spots filled. Of those enrolled, 18,282 HCPs successfully completed the training. Post-test results revealed an increase in correct answers across all MCQs, with overall mean score rising from 48.8 to 68.0 (p < 0.001). Stratified analysis indicated improvements across all participant categories. A higher average increase among female (19.87) compared to male enrollees (17.06) was detected (p < 0.001). Both "over 55" and "46-55" age groups showed the greatest score increases compared to "35-46" and "under 35" groups, despite no significant differences in pre-test scores. Course satisfaction was high, averaging 4.38 out of 5. Top-rated aspects included "learning new concepts" (4.49), "accessibility" (4.46), and "platform functionality" (4.46). Conclusion Our research hypothesis was confirmed by the significant increase in knowledge going from pre-test to post-test and by the high level of user satisfaction. The obtained results serve as a foundation for planning additional professional education in TGD health.
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Affiliation(s)
| | - Matteo Marconi
- Reference Centre for Gender Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Pietro Carbone
- Training Office, Istituto Superiore di Sanità, Rome, Italy
| | | | - Angela Ruocco
- Reference Centre for Gender Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Martina Manoli
- Reference Centre for Gender Medicine, Istituto Superiore di Sanità, Rome, Italy
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | | | | | | | | | - Marina Pierdominici
- Reference Centre for Gender Medicine, Istituto Superiore di Sanità, Rome, Italy
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14
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Ziegler E, Slotnes-O'Brien T, Peters MDJ. Cancer Screening and Prevention in the Transgender and Gender Diverse Population: Considerations and Strategies for Advanced Practice Nurses. Semin Oncol Nurs 2024; 40:151630. [PMID: 38622043 DOI: 10.1016/j.soncn.2024.151630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 03/09/2024] [Accepted: 03/15/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES This discussion paper presents recent evidence regarding cancer screening and prevention among the transgender and gender diverse (TGD) community and highlights where and how advanced practice nurses (APNs), particularly those in primary care, can better contribute to closing the gap between healthcare disparities between TGD and cisgendered populations. METHODS Relevant publications on the topic and professional guidelines and evidence have formed the basis for this discussion paper. RESULTS TGD individuals are a vulnerable population with unique needs. They remain at risk of cancer and might be at greater risk of developing some cancers compared to cisgendered people but are underscreened. Barriers to gender-affirming care need to be addressed to improve access to prevention and screening services and improve the cancer care experiences and outcomes of TGD people. CONCLUSION APNs can work in collaboration with TGD individuals and the healthcare system to improve access to culturally safe cancer screening and more effective prevention of cancer and poor cancer outcomes. IMPLICATIONS FOR NURSING PRACTICE APNs have the potential to improve access to cancer screening for TGD people by increasing their understanding of the needs of the population, providing culturally safe care, and advocating for more preventative care and cancer screening. With greater knowledge and understanding of the needs and preferences of TGD people both broadly and in relation to cancer screening and prevention, targeted interventions and care approaches can be implemented. APNs should also aim to conduct evaluations and research into cancer prevention and screening to build the currently limited evidence base and nursing knowledge in this important field.
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Affiliation(s)
- Erin Ziegler
- Associate Professor, Daphen Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada.
| | - Toni Slotnes-O'Brien
- Senior Lecture, UniSA Clinical & Health Science, University of South Australia, Adelaide, Australia
| | - Micah D J Peters
- Associate Professor, UniSA Clinical & Health Science, University of South Australia, Adelaide, Australia
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15
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Heinen CS. Medical Management of Gender Diversity. Oral Maxillofac Surg Clin North Am 2024; 36:151-159. [PMID: 38281895 DOI: 10.1016/j.coms.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
This article provides context on the experiences and medical care of individuals who experience gender dysphoria for the benefit of oral and maxillofacial surgeons. The mechanism of action, effects, and side effects of medical therapies used for gender-affirming care are reviewed. Specific guidance for anesthetic care is given. Trauma-informed tools for care of transgender and gender-diverse patients are offered.
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Affiliation(s)
- Corinne S Heinen
- Family Medicine and Internal Medicine, Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA; Harborview Medical Center, 325 9th Avenue, Box 359930, Seattle, WA 98104, USA.
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16
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Kamen CS, Gada U, Lyerly R, Scout NFN. Satisfaction with care, general health, and mental health among sexual and gender minority cancer survivors: Results of the OUT National Cancer Survey. Cancer 2024; 130:1292-1302. [PMID: 38117467 PMCID: PMC10948306 DOI: 10.1002/cncr.35164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/21/2023] [Accepted: 11/27/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Few studies have attempted to characterize the cancer care experiences and outcomes of sexual and gender minority (SGM) patients with cancer, despite indications that this population experiences disparities across the cancer continuum. The current study used descriptive and exploratory methods to assess factors related to SGM cancer patients' satisfaction with cancer care and self-reported physical and mental health. METHODS The authors designed a cross-sectional self-report online survey and recruited 3750 SGM cancer patient participants (mixed cancers; 85.6% White; 57% gay, 24% lesbian, 6.7% bisexual, and 6.2% transgender/gender nonbinary) using social media posts, partner organizations, and paid advertisements. They analyzed data using descriptive approaches and exploratory multivariate logistic regression models. RESULTS Overall, 70.6% of participants reported feeling satisfied with the cancer care they received, 70% rated their physical health as very good or excellent, and 46% reported experiencing less than 5 days of poor mental health in the last month. In models including all participants, complete cases, and Black, Indigenous, and people of color (BIPOC), satisfaction with care was consistently associated with receiving treatment in an SGM welcoming environment. Physical health was consistently associated with having strong social support after cancer. Mental health was consistently associated with feeling safe disclosing SGM identities. CONCLUSIONS SGM cancer patients treated in SGM-welcoming environments were over six times more likely to be satisfied with the care they received than those treated in nonwelcoming environments; this and other modifiable factors could be the target of further study and intervention.
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Affiliation(s)
| | - Umang Gada
- University of Rochester, Rochester, NY, United States
| | - Reece Lyerly
- National LGBT Cancer Network, Providence, RI, United States
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Boston, MA, United Stated
| | - NFN Scout
- National LGBT Cancer Network, Providence, RI, United States
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Trapani D, Murthy SS, Hammad N, Casolino R, Moreira DC, Roitberg F, Blay JY, Curigliano G, Ilbawi AM. Policy strategies for capacity building and scale up of the workforce for comprehensive cancer care: a systematic review. ESMO Open 2024; 9:102946. [PMID: 38507895 PMCID: PMC10966170 DOI: 10.1016/j.esmoop.2024.102946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Patients with cancer in low- and middle-income countries experience worse outcomes as a result of the limited capacity of health systems to deliver comprehensive cancer care. The health workforce is a key component of health systems; however, deep gaps exist in the availability and accessibility of cancer care providers. MATERIALS AND METHODS We carried out a systematic review of the literature evaluating the strategies for capacity building of the cancer workforce. We studied how the policy strategies addressed the availability, accessibility, acceptability, and quality (AAAQ) of the workforce. We used a strategic planning framework (SWOT: strengths, weaknesses, opportunities, threats) to identify actionable areas of capacity building. We contextualized our findings based on the WHO 2030 Global Strategy on Human Resources for Health, evaluating how they can ultimately be framed in a labour market approach and inform strategies to improve the capacity of the workforce (PROSPERO: CRD42020109377). RESULTS The systematic review of the literature yielded 9617 records, and we selected 45 eligible papers for data extraction. The workforce interventions identified were delivered mostly in the African and American Regions, and in two-thirds of cases, in high-income countries. Many strategies have been shown to increase the number of competent oncology providers. Optimization of the existing workforce through role delegation and digital health interventions was reported as a short- to mid-term solution to optimize cancer care, through quality-oriented, efficiency-improving, and acceptability-enforcing workforce strategies. The increased workload alone was potentially detrimental. The literature on retaining the workforce and reducing brain drain or attrition in underserved areas was commonly limited. CONCLUSIONS Workforce capacity building is not only a quantitative problem but can also be addressed through quality-oriented, organizational, and managerial solutions of human resources. The delivery of comprehensive, acceptable, and impact-oriented cancer care requires an available, accessible, and competent workforce for comprehensive cancer care. Efficiency-improving strategies may be instrumental for capacity building in resource-constrained settings.
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Affiliation(s)
- D Trapani
- Department of Oncology and Hemato-Oncology, University of Milano, Milano; European Institute of Oncology, IRCCS, Milan, Italy.
| | - S S Murthy
- Global Cancer Disparities Initiative, Division of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - N Hammad
- Michael's Hospital, University of Toronto, Toronto, Canada
| | - R Casolino
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - D C Moreira
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, USA
| | - F Roitberg
- Hospital Sírio-Libanês, São Paulo, Brazil
| | - J-Y Blay
- Department of Medical Oncology, Centre Leon Berard, Lyon, France
| | - G Curigliano
- Department of Oncology and Hemato-Oncology, University of Milano, Milano; European Institute of Oncology, IRCCS, Milan, Italy
| | - A M Ilbawi
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
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18
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Yang S, Li Y, Wheldon CW, Prosperi M, George TJ, Shenkman EA, Wang F, Bian J, Guo Y. The Burden of Cancer and Pre-cancerous Conditions Among Transgender Individuals in a Large Healthcare Network. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.24.24304777. [PMID: 38585849 PMCID: PMC10996763 DOI: 10.1101/2024.03.24.24304777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
The current study aimed to examine the prevalence of and risk factors for cancer and pre-cancerous conditions, comparing transgender and cisgender individuals, using 2012-2023 electronic health record data from a large healthcare system. We identified 2,745 transgender individuals using a previously validated computable phenotype and 54,900 matched cisgender individuals. We calculated the prevalence of cancer and pre-cancer related to human papillomavirus (HPV), human immunodeficiency virus (HIV), tobacco, alcohol, lung, breast, colorectum, and built multivariable logistic models to examine the association between gender identity and the presence of cancer or pre-cancer. Results indicated similar odds of developing cancer across gender identities, but transgender individuals exhibited significantly higher risks for pre-cancerous conditions, including alcohol-related, breast, and colorectal pre-cancers compared to cisgender women, and HPV-related, tobacco-related, alcohol-related, and colorectal pre-cancers compared to cisgender men. These findings underscore the need for tailored interventions and policies addressing cancer health disparities affecting the transgender population.
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Affiliation(s)
- Shuang Yang
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Yongqiu Li
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Christopher W. Wheldon
- Department of Social and Behavioral Sciences, Temple University, Philadelphia, Pennsylvania, USA
| | - Mattia Prosperi
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Thomas J. George
- Division of Hematology and Oncology, University of Florida, Gainesville, Florida, USA
| | - Elizabeth A. Shenkman
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Fei Wang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
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Islami F, Baeker Bispo J, Lee H, Wiese D, Yabroff KR, Bandi P, Sloan K, Patel AV, Daniels EC, Kamal AH, Guerra CE, Dahut WL, Jemal A. American Cancer Society's report on the status of cancer disparities in the United States, 2023. CA Cancer J Clin 2024; 74:136-166. [PMID: 37962495 DOI: 10.3322/caac.21812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 11/15/2023] Open
Abstract
In 2021, the American Cancer Society published its first biennial report on the status of cancer disparities in the United States. In this second report, the authors provide updated data on racial, ethnic, socioeconomic (educational attainment as a marker), and geographic (metropolitan status) disparities in cancer occurrence and outcomes and contributing factors to these disparities in the country. The authors also review programs that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. There are substantial variations in risk factors, stage at diagnosis, receipt of care, survival, and mortality for many cancers by race/ethnicity, educational attainment, and metropolitan status. During 2016 through 2020, Black and American Indian/Alaska Native people continued to bear a disproportionately higher burden of cancer deaths, both overall and from major cancers. By educational attainment, overall cancer mortality rates were about 1.6-2.8 times higher in individuals with ≤12 years of education than in those with ≥16 years of education among Black and White men and women. These disparities by educational attainment within each race were considerably larger than the Black-White disparities in overall cancer mortality within each educational attainment, ranging from 1.03 to 1.5 times higher among Black people, suggesting a major role for socioeconomic status disparities in racial disparities in cancer mortality given the disproportionally larger representation of Black people in lower socioeconomic status groups. Of note, the largest Black-White disparities in overall cancer mortality were among those who had ≥16 years of education. By area of residence, mortality from all cancer and from leading causes of cancer death were substantially higher in nonmetropolitan areas than in large metropolitan areas. For colorectal cancer, for example, mortality rates in nonmetropolitan areas versus large metropolitan areas were 23% higher among males and 21% higher among females. By age group, the racial and geographic disparities in cancer mortality were greater among individuals younger than 65 years than among those aged 65 years and older. Many of the observed racial, socioeconomic, and geographic disparities in cancer mortality align with disparities in exposure to risk factors and access to cancer prevention, early detection, and treatment, which are largely rooted in fundamental inequities in social determinants of health. Equitable policies at all levels of government, broad interdisciplinary engagement to address these inequities, and equitable implementation of evidence-based interventions, such as increasing health insurance coverage, are needed to reduce cancer disparities.
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Affiliation(s)
| | | | | | | | | | - Priti Bandi
- American Cancer Society, Atlanta, Georgia, USA
| | | | | | | | | | - Carmen E Guerra
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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20
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D’Angelo A, Portaluri A, Caprini F, Sofia C, Ferrara F, Condorelli E, Iaccarino L, Catanzariti F, Mancino M, Trombadori CML, Belli P, Marino MA. Male Breast: A Review of the Literature and Current State of the Art of Diagnostic Imaging Work-Up. Diagnostics (Basel) 2023; 13:3620. [PMID: 38132204 PMCID: PMC10743117 DOI: 10.3390/diagnostics13243620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/21/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
Pathological conditions affecting the male breast (MB) share some similarities with those found in women, while others are specific to men. The first part of this review provides an overview of MB disorders, exploring the most common types of MB diseases. The second part then emphasizes the state-of-the-art approaches proposed in the literature for screening and follow-up with MB cancer patients, which highlights the importance of tailored strategies for diagnosis, follow-up, and identifying high-risk populations. Considering the increasing attention in recent years on the topic, transgender individuals are also included in this review. Together with the MB, it is an understudied category thus far. This review aims to raise awareness among radiologists that MBs should be approached differently from female breasts, contributing to the advancement of medical knowledge, improving patient outcomes, and promoting early detection of MB disorders. The review also provides an update on breast cancer and screening in the transgender population.
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Affiliation(s)
- Anna D’Angelo
- Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.C.); (F.F.); (L.I.); (M.M.); (C.M.L.T.); (P.B.)
| | - Antonio Portaluri
- Department of Biomedical Sciences and Morphologic and Functional Imaging, AOU G. Martino, University of Messina, 98100 Messina, Italy; (A.P.); (C.S.); (E.C.); (F.C.); (M.A.M.)
| | - Flavia Caprini
- Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.C.); (F.F.); (L.I.); (M.M.); (C.M.L.T.); (P.B.)
| | - Carmelo Sofia
- Department of Biomedical Sciences and Morphologic and Functional Imaging, AOU G. Martino, University of Messina, 98100 Messina, Italy; (A.P.); (C.S.); (E.C.); (F.C.); (M.A.M.)
| | - Francesca Ferrara
- Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.C.); (F.F.); (L.I.); (M.M.); (C.M.L.T.); (P.B.)
| | - Elvira Condorelli
- Department of Biomedical Sciences and Morphologic and Functional Imaging, AOU G. Martino, University of Messina, 98100 Messina, Italy; (A.P.); (C.S.); (E.C.); (F.C.); (M.A.M.)
| | - Ludovica Iaccarino
- Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.C.); (F.F.); (L.I.); (M.M.); (C.M.L.T.); (P.B.)
| | - Francesca Catanzariti
- Department of Biomedical Sciences and Morphologic and Functional Imaging, AOU G. Martino, University of Messina, 98100 Messina, Italy; (A.P.); (C.S.); (E.C.); (F.C.); (M.A.M.)
| | - Matteo Mancino
- Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.C.); (F.F.); (L.I.); (M.M.); (C.M.L.T.); (P.B.)
| | - Charlotte M. L. Trombadori
- Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.C.); (F.F.); (L.I.); (M.M.); (C.M.L.T.); (P.B.)
| | - Paolo Belli
- Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.C.); (F.F.); (L.I.); (M.M.); (C.M.L.T.); (P.B.)
| | - Maria Adele Marino
- Department of Biomedical Sciences and Morphologic and Functional Imaging, AOU G. Martino, University of Messina, 98100 Messina, Italy; (A.P.); (C.S.); (E.C.); (F.C.); (M.A.M.)
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Ginsburg O, Vanderpuye V, Beddoe AM, Bhoo-Pathy N, Bray F, Caduff C, Florez N, Fadhil I, Hammad N, Heidari S, Kataria I, Kumar S, Liebermann E, Moodley J, Mutebi M, Mukherji D, Nugent R, So WKW, Soto-Perez-de-Celis E, Unger-Saldaña K, Allman G, Bhimani J, Bourlon MT, Eala MAB, Hovmand PS, Kong YC, Menon S, Taylor CD, Soerjomataram I. Women, power, and cancer: a Lancet Commission. Lancet 2023; 402:2113-2166. [PMID: 37774725 DOI: 10.1016/s0140-6736(23)01701-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/27/2023] [Accepted: 08/11/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Ophira Ginsburg
- Centre for Global Health, US National Cancer Institute, Rockville, MD, USA.
| | | | | | | | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Carlo Caduff
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Narjust Florez
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Nazik Hammad
- Department of Medicine, Division of Hematology-Oncology, St. Michael's Hospital, University of Toronto, Canada; Department of Oncology, Queens University, Kingston, Canada
| | - Shirin Heidari
- GENDRO, Geneva, Switzerland; Gender Centre, Geneva Graduate Institute, Geneva, Switzerland
| | - Ishu Kataria
- Center for Global Noncommunicable Diseases, RTI International, New Delhi, India
| | - Somesh Kumar
- Jhpiego India, Johns Hopkins University Affiliate, Baltimore, MD, USA
| | - Erica Liebermann
- University of Rhode Island College of Nursing, Providence, RI, USA
| | - Jennifer Moodley
- Cancer Research Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, and SAMRC Gynaecology Cancer Research Centre, University of Cape Town, Cape Town, South Africa
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - Deborah Mukherji
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Clemenceau Medical Center Dubai, Dubai, United Arab Emirates
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Winnie K W So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong Special Administrative Region, China
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | | | - Gavin Allman
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA
| | - Jenna Bhimani
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - María T Bourlon
- Department of Hemato-Oncology, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Michelle A B Eala
- College of Medicine, University of the Philippines, Manila, Philippines; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Yek-Ching Kong
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sonia Menon
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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22
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Leone AG, Casolino R, Trapani D, Miceli R, Massagrande M, Morano F, La Verde N, Dalu D, Berardi R, Marsoni S, Lambertini M, Iula B, Carieri E, Converti M, Di Maio M, Beretta GD, Perrone F, Pietrantonio F, Cinieri S. Position paper of the Italian association of medical oncology on health disparities among transgender and gender-diverse people: the Assisi recommendations. EClinicalMedicine 2023; 65:102277. [PMID: 37877000 PMCID: PMC10590834 DOI: 10.1016/j.eclinm.2023.102277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 10/26/2023] Open
Abstract
Transgender and gender-diverse individuals experience substantial health disparities across the cancer care continuum. Despite well recognized unique healthcare needs, there are barriers in accessing cancer prevention and treatment services, influenced by disadvantages in key social-economic determinants of health which result in worse clinical outcomes, as compared to the general population. The Italian Association of Medical Oncology (AIOM) acknowledges the critical relevance of this issue. The "Assisi Recommendations" here summarize the outcomes of the "AIOM Oncology Ethics Day" dedicated to gender differences in oncology and cancer care of transgender and gender-diverse people. The recommendations generated during a 2-day multidisciplinary discussion address the various aspects of cancer care experience of transgender and gender-diverse people. The promotion of research in this field, through the generation of new evidence and the collection of prospective data, has been identified as a priority action to mitigate these disparities. By acknowledging the challenges of cancer care in transgender and gender-diverse people and recognizing the need for dedicated policy and clinical recommendations, AIOM demonstrates its commitment to improving the health and well-being of all patients with cancer, regardless of their gender identity or any other personal or social circumstances, as part of health-for-all societal vision.
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Affiliation(s)
- Alberto Giovanni Leone
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan 21033, Italy
| | - Raffaella Casolino
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Dario Trapani
- European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Oncology and Hemato-oncology (DIPO), University of Milan, Milan, Italy
| | - Rosalba Miceli
- Department of Biostatistics for Clinical Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan 21033, Italy
| | | | - Federica Morano
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan 21033, Italy
| | - Nicla La Verde
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Davide Dalu
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| | - Silvia Marsoni
- IFOM - the FIRC Institute of Molecular Oncology, Milan, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Bianca Iula
- ACET - Associazione per la Cultura e l’etica Transgenere (Association for Transgender Culture and Ethics), Milan, Italy Degree: N/A
| | | | - Manlio Converti
- AMIGAY Aps - Associazione Italiana Medici e Personale Sanitario, LGBTQIA+ e Friendly (Italian Association of LGBTQIA+ Medical care Providers), Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
- National Secretary of the Italian Association of Medical Oncology (AIOM), Italy
| | - Giordano Domenico Beretta
- UOC Oncologia Medica, ASL Pescara P.O., Pescara, Italy
- National President of the Italian Foundation of Medical Oncology (Fondazione AIOM), Italy
| | - Francesco Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
- President-elect of the Italian Association of Medical Oncology (AIOM), Italy
| | - Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan 21033, Italy
| | - Saverio Cinieri
- Medical Oncology Unit, Ospedale di Summa A. Perrino, Brindisi, Italy
- National President of the Italian Association of Medical Oncology (AIOM), Italy
| | - the Italian Foundation of Medical Oncology (Fondazione AIOM)
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan 21033, Italy
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Oncology and Hemato-oncology (DIPO), University of Milan, Milan, Italy
- Department of Biostatistics for Clinical Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan 21033, Italy
- ELMA Research, Milan, Italy
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
- Oncology Clinic, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
- IFOM - the FIRC Institute of Molecular Oncology, Milan, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- ACET - Associazione per la Cultura e l’etica Transgenere (Association for Transgender Culture and Ethics), Milan, Italy Degree: N/A
- Independent Researcher, Italy Degree: N/A
- AMIGAY Aps - Associazione Italiana Medici e Personale Sanitario, LGBTQIA+ e Friendly (Italian Association of LGBTQIA+ Medical care Providers), Italy
- Department of Oncology, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
- National Secretary of the Italian Association of Medical Oncology (AIOM), Italy
- UOC Oncologia Medica, ASL Pescara P.O., Pescara, Italy
- National President of the Italian Foundation of Medical Oncology (Fondazione AIOM), Italy
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
- President-elect of the Italian Association of Medical Oncology (AIOM), Italy
- Medical Oncology Unit, Ospedale di Summa A. Perrino, Brindisi, Italy
- National President of the Italian Association of Medical Oncology (AIOM), Italy
| | - Italian Association of Medical Oncology (AIOM)
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan 21033, Italy
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Oncology and Hemato-oncology (DIPO), University of Milan, Milan, Italy
- Department of Biostatistics for Clinical Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan 21033, Italy
- ELMA Research, Milan, Italy
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
- Oncology Clinic, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
- IFOM - the FIRC Institute of Molecular Oncology, Milan, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- ACET - Associazione per la Cultura e l’etica Transgenere (Association for Transgender Culture and Ethics), Milan, Italy Degree: N/A
- Independent Researcher, Italy Degree: N/A
- AMIGAY Aps - Associazione Italiana Medici e Personale Sanitario, LGBTQIA+ e Friendly (Italian Association of LGBTQIA+ Medical care Providers), Italy
- Department of Oncology, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
- National Secretary of the Italian Association of Medical Oncology (AIOM), Italy
- UOC Oncologia Medica, ASL Pescara P.O., Pescara, Italy
- National President of the Italian Foundation of Medical Oncology (Fondazione AIOM), Italy
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
- President-elect of the Italian Association of Medical Oncology (AIOM), Italy
- Medical Oncology Unit, Ospedale di Summa A. Perrino, Brindisi, Italy
- National President of the Italian Association of Medical Oncology (AIOM), Italy
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23
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Arevalo MVPN, Maslog EAS, Manlongat KD, Ornos EDB, Chitapanarux I, Eala MAB, Dee EC. Social determinants of sex disparities in cancer in Southeast Asia. iScience 2023; 26:107110. [PMID: 37456827 PMCID: PMC10339016 DOI: 10.1016/j.isci.2023.107110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Sex disparities in cancer exist along the cancer spectrum, ranging from genomic predisposition and behavioral risk factors to access to screening, diagnostics, treatment, and survivorship care. A growing body of research is studying the biological underpinnings of these differences, from cancer risk to tumor biology to treatment response. It is well known, however, that the social determinants of health play a large role across the cancer disease continuum, which encompasses risk, prevention, diagnosis, treatment, survivorship, rehabilitation, and palliative care. Less literature focuses on the gendered disparities that are epidemiologic in nature, especially in Southeast Asia (SEA), a diverse region that is home to nearly 670 million people, where most are lower middle income countries, and where socioeconomic and cultural factors increase cancer risk for women. In this review, we highlight the social drivers of gendered disparities, namely the geographic, environmental, sociocultural, economic, and political forces that contribute to the increased mortality and poorer health outcomes in the region.
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Affiliation(s)
| | | | | | - Eric David B. Ornos
- College of Medicine, University of the Philippines, 1000 Manila, Philippines
| | - Imjai Chitapanarux
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Michelle Ann B. Eala
- College of Medicine, University of the Philippines, 1000 Manila, Philippines
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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24
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Leone AG, Miceli R, Trapani D, Massagrande M, Morano F, Marsoni S, La Verde N, Berardi R, Casolino R, Lambertini M, Dalu D, Di Maio M, Beretta GD, Perrone F, Cinieri S, Pietrantonio F. Cancer care in transgender and gender-diverse persons: results from two national surveys among providers and health service users by the Italian Association of Medical Oncology. ESMO Open 2023; 8:101578. [PMID: 37270870 DOI: 10.1016/j.esmoop.2023.101578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/23/2023] [Accepted: 04/29/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Transgender and gender-diverse (TGD) population represents an underserved group across the cancer care continuum. To assess the perspective of both oncology health care providers (OHPs) and TGD individuals in Italy, we conducted two national surveys: one among 2407 OHPs about their attitudes, knowledge and behavior toward TGD patients, and one among TGD persons about their health needs, experiences and barriers encountered in the use of health services across the cancer continuum. MATERIALS AND METHODS The surveys were self-compiled web-based computer-aided web interview, conducted in Italy within the 'OncoGender-Promoting Inclusion in Oncology' project, led by the Italian national cancer society [Associazione Italiana di Oncologia Medica (AIOM)]-associated researchers. All members of AIOM were invited by e-mail to participate in the OHP survey. TGD persons were reached through advocacy groups and consumers' panel. The recruitment was completed on a voluntary basis. Survey data were collected and managed using an online platform managed by ELMA Research, an independent pharmaceutical marketing agency. RESULTS A total of 305 OHPs (13% of AIOM members) and 190 TGD individuals participated in the surveys. Only 19% of OHPs felt competent in providing care to TGD patients and 21% declared not to feel comfortable in treating TGD patients. Seventy-one percent of TGD persons reported that they had never joined any cancer screening program; 32% reported one or more acts of discrimination by health care providers. Seventy-two percent of OHPs recognized the lack of specific education on cancer care for TGD patients and deemed it necessary to receive adequate training. CONCLUSIONS A general lack of knowledge among OHPs about TGD health issues seems to be the main driver of difficulties in providing assistance and of discriminatory attitudes against TGD individuals. Ultimately, this whole issue generates access barriers and contributes to lack of trust in health care services. Educational interventions and an implementation of person-centric cancer policies are urgently needed.
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Affiliation(s)
- A G Leone
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - R Miceli
- Department of Biostatistics for Clinical Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - D Trapani
- European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy; Department of Oncology and Hematology (DIPO), University of Milan, Milan, Italy
| | | | - F Morano
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - S Marsoni
- IFOM-The FIRC Institute of Molecular Oncology, Milan, Italy
| | - N La Verde
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - R Berardi
- Oncology Clinic, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| | - R Casolino
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy; Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - D Dalu
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - M Di Maio
- Department of Oncology, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
| | - G D Beretta
- UOC Oncologia Medica, ASL Pescara P.O., Pescara, Italy
| | - F Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - S Cinieri
- Medical Oncology Unit, Ospedale di Summa A. Perrino, Brindisi, Italy
| | - F Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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