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Gorman JR, Corey SL, Ginavan I, Garcia J. "Just for pregnant women, not for you": a qualitative evaluation of the sexual and reproductive healthcare experiences of transgender and gender diverse cancer survivors. J Cancer Surviv 2024:10.1007/s11764-024-01633-z. [PMID: 38980652 DOI: 10.1007/s11764-024-01633-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/17/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE To identify opportunities to improve sexual and reproductive health (SRH) care for transgender and gender diverse (TGD) cancer survivors by describing (1) challenges experienced when navigating SRH care and (2) strategies to help overcome these challenges. METHODS We enrolled a purposive sample of 17 adult TGD cancer survivors and 5 co-survivors. We aimed for a diverse sample across cancer experience, age, racial/ethnic background, sexual orientation, and gender identity. We conducted 90-min individual interviews via videoconference and used reflexive thematic analysis, guided by a focus on three social determinants of health. RESULTS Themes describing challenges were as follows: (1) Cancer treatment's impact on sexual health was insufficiently addressed by cancer care providers; (2) fertility-related information and conversations were complicated by gendered expectations and ultimately did not meet survivors' needs; (3) feeling excluded and uncared-for in healthcare settings due to gendered language and lack of supportive services that met their needs; and (4) TGD survivors commonly reported high financial burden, negatively impacting their access to care. Strategies to overcome these challenges were (1) a solid social support network that can be integrated into the care team to meet the unique SRH needs of TGD survivors and (2) gender-affirming healthcare providers and environments to address SRH care needs and concerns. CONCLUSIONS TGD survivors and co-survivors desire improved access to gender-affirming SRH care in cancer survivorship. IMPLICATIONS FOR CANCER SURVIVORS Key opportunities to improve gender-affirming SRH care in cancer survivorship include fostering and engaging TGD survivors' support networks and implementing system-level changes in cancer care settings.
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Affiliation(s)
- Jessica R Gorman
- Health Promotion and Health Behavior Program, College of Health, Oregon State University, 2250 SW Jefferson Way, 160 SW 26thStreet, Corvallis, OR, 97331, USA.
| | - Stephanie L Corey
- Health Promotion and Health Behavior Program, College of Health, Oregon State University, 2250 SW Jefferson Way, 160 SW 26thStreet, Corvallis, OR, 97331, USA
| | - Isabelle Ginavan
- Health Promotion and Health Behavior Program, College of Health, Oregon State University, 2250 SW Jefferson Way, 160 SW 26thStreet, Corvallis, OR, 97331, USA
| | - Jonathan Garcia
- Health Promotion and Health Behavior Program, College of Health, Oregon State University, 2250 SW Jefferson Way, 160 SW 26thStreet, Corvallis, OR, 97331, USA
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2
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Cathcart-Rake EJ, Ruddy KJ, Tevaarwerk AJ, Jatoi A. Breast cancer and gender-affirming hormone therapy for transgender and gender-diverse (TGD) individuals. Maturitas 2024; 181:107913. [PMID: 38262089 PMCID: PMC10872221 DOI: 10.1016/j.maturitas.2024.107913] [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: 09/08/2023] [Revised: 12/01/2023] [Accepted: 01/06/2024] [Indexed: 01/25/2024]
Abstract
Transgender and gender-diverse (TGD) individuals are at risk for breast cancer, but are less likely to undergo screening mammograms and appear to suffer poorer cancer-related outcomes than cisgender women. Gender-affirming hormone therapy (GAHT) may be lifesaving for TGD individuals from the perspective of affirming their core identities; however, the effects of GAHT on cancer development, progression, and outcomes are poorly understood.
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Affiliation(s)
| | - Kathryn J Ruddy
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States of America
| | - Amye J Tevaarwerk
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States of America
| | - Aminah Jatoi
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States of America
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3
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Mullins MA, Reber L, Washington A, Stasenko M, Rankin A, Friese CR, Cooley ME, Hudson MF, Wallner LP. Barriers, facilitators, and recommendations for sexual orientation and gender identity data collection in community oncology practices. Cancer Med 2023; 12:19203-19214. [PMID: 37732470 PMCID: PMC10557876 DOI: 10.1002/cam4.6517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Sexual orientation and gender identity (SOGI) data collection in community oncology practices is critical to identify and address cancer inequities, but less than 20% of NCI Community Oncology Research Program (NCORP)-affiliated practices regularly collect SOGI data despite widespread recommendations. We evaluated multilevel barriers and facilitators for SOGI data collection at NCORP practices. METHODS We conducted 14 semi-structured interviews at seven purposefully sampled NCORP oncology practices. We interviewed one clinician (oncologist, advanced practice provider) and one clinic staff member per practice. Thematic analysis informed by the Consolidated Framework for Implementation Research (CFIR) was conducted to identify barriers and facilitators. RESULTS Thematic saturation occurred after interviews at six practices and was confirmed with interviews at an additional practice. Participants highlighted multilevel barriers including low levels of understanding, information technology infrastructure, and perceived low relative priority. Not understanding the role of SOGI data in oncology care contributed to cis-heteronormative culture. At the clinic level, this culture coincided with a lack of processes and policies for collecting SOGI from all patients. At the care team level, perceived irrelevance to oncology care was related to discomfort asking SOGI, fear of patient discomfort, and limited awareness of SOGI in electronic health records. Suggested solutions included: normalizing asking SOGI questions, giving patients privacy to complete SOGI, and clarifying clinical relevance. CONCLUSIONS SOGI data collection barriers stemmed from perceptions that SOGI disclosure does not influence care quality. Oncology teams may benefit from training on culturally sensitive SOGI collection, education on SOGI data relevance to oncology practices, and support for implementing SOGI data collection policies.
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Affiliation(s)
- Megan A. Mullins
- Peter O'Donnell Jr. School of Public HealthUT Southwestern Medical CenterDallasTexasUSA
- Harold C. Simmons Comprehensive Cancer CenterUT Southwestern Medical CenterDallasTexasUSA
| | - Lisa Reber
- Peter O'Donnell Jr. School of Public HealthUT Southwestern Medical CenterDallasTexasUSA
| | - Ariel Washington
- Karmanos Cancer Institute, Department of OncologyWayne State University School of MedicineDetroitMichiganUSA
| | - Marina Stasenko
- Division of Gynecologic Oncology, Department of Obstetrics and GynecologyNYU Langone HealthNew YorkNew YorkUSA
| | - Aaron Rankin
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Christopher R. Friese
- Center for Improving Patient and Population HealthUniversity of MichiganAnn ArborMichiganUSA
- Rogel Cancer CenterUniversity of MichiganAnn ArborMichiganUSA
| | - Mary E. Cooley
- Phyllis F. Cantor Center, Research in Nursing and Patient Care ServicesDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - Matthew F. Hudson
- Prisma Health Cancer Institute Greenville South CarolinaGreenvilleSouth CarolinaUSA
| | - Lauren P. Wallner
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
- Rogel Cancer CenterUniversity of MichiganAnn ArborMichiganUSA
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4
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Cheung CK, Lee H, Levin NJ, Choi E, Ross VA, Geng Y, Thomas BN, Roth ME. Disparities in cancer care among sexual and gender minority adolescent and young adult patients: A scoping review. Cancer Med 2023; 12:14674-14693. [PMID: 37245227 PMCID: PMC10358240 DOI: 10.1002/cam4.6090] [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] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/08/2023] [Accepted: 05/04/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Adolescent and young adult cancer patients (AYAs) who are sexual and gender minorities (SGM) are a rapidly increasing population that experiences unmet cancer-related needs. Despite emerging awareness, little is known about cancer care and outcomes for this vulnerable population. The purpose of this scoping review was to explore current knowledge and gaps in the literature on cancer care and outcomes for AYAs who identify as SGM. METHODS We reviewed empirical knowledge on SGM AYAs by identifying, describing, and critically appraising the literature to date. We conducted a comprehensive search on OVID MEDLINE, PsycINFO, and CINAHL in February 2022. Additionally, we developed and piloted a conceptual framework for appraising SGM AYA research. RESULTS A total of 37 articles were included in the final review. Most studies focused exclusively on SGM-related outcomes as the primary aim of the study (81.1%, n = 30), whereas others included some focus on SGM-related outcomes (18.9%, n = 7). The majority of studies included AYAs as part of a broader age range (86.0%, n = 32), and only a few studies examined exclusively AYA samples (14.0%, n = 5). Gaps in scientific evidence on SGM AYAs were seen across the cancer care continuum. CONCLUSION Numerous gaps in knowledge of cancer care and outcomes exist for SGM AYAs diagnosed with cancer. Future efforts should fill this void with high-quality empirical studies that reveal unknown disparities in care and outcomes and are inclusive of the intersectionality of SGM AYAs with other minoritized experiences, thereby advancing health equity in meaningful ways.
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Affiliation(s)
| | - Haelim Lee
- University of Maryland School of Social WorkBaltimoreMarylandUSA
| | - Nina Jackson Levin
- University of Michigan School of Social Work and Department of AnthropologyMichiganAnn ArborUSA
| | - Eunju Choi
- Department of Nursing and MD Anderson Cancer CenterUniversity of TexasHoustonTexasUSA
| | | | - Yimin Geng
- Research Medical LibraryUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Bria N. Thomas
- Geisinger Commonwealth School of MedicineScrantonPennsylvaniaUSA
| | - Michael E. Roth
- University of Texas MD Anderson Cancer CenterHoustonTexasUSA
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5
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Chan ASW, Leung LM, Wong FKC, Ho JMC, Tam HL, Tang PMK, Yan E. Needs and experiences of cancer care in patients' perspectives among the lesbian, gay, bisexual, transgender and queer community: a systematic review. SOCIAL WORK IN HEALTH CARE 2023; 62:263-279. [PMID: 37338823 DOI: 10.1080/00981389.2023.2226182] [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: 03/02/2023] [Accepted: 06/08/2023] [Indexed: 06/21/2023]
Abstract
Individuals within the Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) community who are diagnosed with cancer experience inequitable treatment in healthcare systems worldwide, resulting in dissatisfaction, communication challenges with healthcare providers, and a deep sense of disappointment. Stigma, discrimination, and perceived homophobia further heighten the risk of psychological and attitudinal disorders, including depression and suicidal tendencies, among LGBTQ cancer patients. To comprehensively assess the discrimination faced by LGBTQ cancer patients and gain deeper insights into their needs and experiences, we conducted a systematic review following PRISMA guidelines. We searched for relevant articles using specific keywords in reputable databases such as PubMed, Google Scholar, and PsycINFO. We rigorously evaluated article quality using the CASP (Critical Appraisal Skills Programme) checklist. From a total of 75 eligible studies, we carefully selected 14 studies, specifically examining LGBTQ cancer patients who were currently undergoing or had previously undergone cancer treatment. The studies revealed various factors, including unmet needs related to anxiety and depression, instances of discrimination, disparities in care, and inadequate support systems. A majority of patients expressed dissatisfaction with their cancer care and continued to encounter discrimination and disparities throughout their treatment journeys. Consequently, this led to heightened levels of anxiety, stress, depression, and negative perceptions of healthcare providers. Based on these findings, we recommend providing specialized training to social workers and healthcare providers. This training will equip them with the necessary skills and knowledge to deliver culturally sensitive care tailored to the unique needs of LGBTQ cancer patients. By addressing discrimination, reducing disparities, and fostering an inclusive environment, healthcare professionals can strive to ensure that LGBTQ cancer patients receive the care they deserve.
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Affiliation(s)
- Alex Siu Wing Chan
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Lok Man Leung
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | | | - Jacqueline Mei Chi Ho
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Hon Lon Tam
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Patrick Ming Kuen Tang
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Elsie Yan
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
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Ussher JM, Power R, Allison K, Sperring S, Parton C, Perz J, Davies C, Cook T, Hawkey AJ, Robinson KH, Hickey M, Anazodo A, Ellis C. Reinforcing or Disrupting Gender Affirmation: The Impact of Cancer on Transgender Embodiment and Identity. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:901-920. [PMID: 36689129 PMCID: PMC10101894 DOI: 10.1007/s10508-023-02530-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/14/2022] [Accepted: 01/02/2023] [Indexed: 05/11/2023]
Abstract
There is a pressing need for greater understanding and focus on cancer survivorship and informal cancer caring of trans people (binary and non-binary), across tumor types, to inform culturally safe trans inclusive cancer information and care. This qualitative study, part of the mixed methods Out with Cancer project, examined experiences of trans embodiment and identity after cancer diagnosis and treatment. We drew on open-ended survey responses from 63 trans cancer survivors and 23 trans cancer carers, as well as interviews and a photo-elicitation activity with a subset of 22 participants (15 cancer survivors, 7 cancer carers). Reflexive thematic analysis identified three themes: Cancer enhances trans embodiment, through experiences of gender euphoria following cancer treatment, and acceleration of decisions about gender affirmation; cancer erases or inhibits gender affirmation; trans embodiment is invisible or pathologized in cancer care. These findings demonstrate that trans embodiment and identity, as well as the process of gender affirmation, may be disrupted by cancer or informal cancer caring. Conversely, cancer and cancer treatment can positively impact the embodied identity and lives of trans people, despite the anxiety and strain of negotiating medical procedures. However, if healthcare professionals operate within a cis-heteronormative framework and do not understand the meaning of embodied change following cancer treatment for trans individuals, these positive benefits may not be realized.
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Affiliation(s)
- Jane M Ussher
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2752, Australia.
| | - Rosalie Power
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2752, Australia
| | - Kimberley Allison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2752, Australia
| | - Samantha Sperring
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2752, Australia
| | - Chloe Parton
- School of Health, Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
| | - Janette Perz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2752, Australia
| | - Cristyn Davies
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, Australia
- School of Social Sciences, Western Sydney University, Penrith, Sydney, Australia
| | - Teddy Cook
- TransHub, ACON, Surry Hills, Sydney, Australia
| | - Alexandra J Hawkey
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2752, Australia
| | - Kerry H Robinson
- School of Social Sciences and Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Melbourne, Australia
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital and School of Women's and Children's, University of New South Wales, Sydney, Australia
| | - Colin Ellis
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2752, Australia
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7
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Alpert AB, Brewer JR, Adams S, Rivers L, Orta S, Blosnich JR, Miedlich S, Kamen C, Dizon DS, Pazdur R, Beaver JA, Fashoyin-Aje L. Addressing Barriers to Clinical Trial Participation for Transgender People With Cancer to Improve Access and Generate Data. J Clin Oncol 2023; 41:1825-1829. [PMID: 36302204 PMCID: PMC10082226 DOI: 10.1200/jco.22.01174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/23/2022] [Accepted: 09/15/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ash B. Alpert
- Department of Health Services, Policy, and Practice, Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - Jamie Renee Brewer
- Office of Oncologic Diseases, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD
| | | | | | | | - John R. Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA
| | - Susanne Miedlich
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Charles Kamen
- Department of Surgery, Cancer Control Unit, University of Rochester Medical Center, Rochester, NY
| | - Don S. Dizon
- Division of Hematology-Oncology, Department of Medicine, Lifespan Cancer Institute and Brown University, Providence, RI
| | - Richard Pazdur
- Oncology Center of Excellence, US Food and Drug Administration, Silver Spring, MD
| | - Julia A. Beaver
- Oncology Center of Excellence, US Food and Drug Administration, Silver Spring, MD
| | - Lola Fashoyin-Aje
- Office of Oncologic Diseases, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD
- Oncology Center of Excellence, US Food and Drug Administration, Silver Spring, MD
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8
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Leone AG, Trapani D, Schabath MB, Safer JD, Scout NFN, Lambertini M, Berardi R, Marsoni S, Perrone F, Cinieri S, Miceli R, Morano F, Pietrantonio F. Cancer in Transgender and Gender-Diverse Persons: A Review. JAMA Oncol 2023; 9:556-563. [PMID: 36757703 DOI: 10.1001/jamaoncol.2022.7173] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Importance Transgender and gender-diverse individuals face unique challenges, including barriers to health care access and inequities in treatment, that may influence cancer risk and outcomes. Observations In this narrative review, a scoping review was conducted focusing on primary and secondary prevention and epidemiology of cancer, barriers to health care services, and health care practitioners' knowledge about specific issues pertaining to transgender and gender-diverse individuals. PubMed, the Cochrane Library, and Embase, were reviewed for citations from their inception to December 31, 2021. This review revealed that transgender and gender-diverse people had a high prevalence of tobacco consumption and alcohol use and high rates of infection with human papillomavirus (HPV) and HIV. Transgender and gender-diverse individuals were less likely to adhere to cancer screening programs and had a higher incidence of HIV- and HPV-associated cancers. Social and economic determinants seemed to drive these disparities in risk factors and outcomes. A lack of knowledge about gender minorities' health needs among health care practitioners was evidenced, and it represented a major hurdle to cancer prevention, care, and survivorship for transgender and gender-diverse individuals. Discrimination, discomfort caused by gender-labeled oncological services, stigma, and lack of cultural sensitivity of health care practitioners were other barriers met by transgender and gender-diverse persons in the oncology setting. Conclusions and Relevance The findings suggest that transgender and gender-diverse peoples' needs in the cancer care continuum are not optimally addressed. Effective solutions are needed to offer the best care to every patient in a person-centric and gender diversity-sensitive environment.
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Affiliation(s)
| | - Dario Trapani
- European Institute of Oncology, IRCCS, Milan, Italy.,Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | | | - Joshua D Safer
- Division of Endocrinology, Icahn School of Medicine at Mount Sinai, New York, New York.,Mount Sinai Center for Transgender Medicine and Surgery, New York, New York
| | - N F N Scout
- National LGBT Cancer Network, Providence, Rhode Island
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, Genova, Italy.,Department of Medical Oncology, Unità Operativa Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Silvia Marsoni
- IFOM, FIRC Institute of Molecular Oncology, Milan, Italy
| | - Francesco Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Saverio Cinieri
- Medical Oncology Unit, Ospedale di Summa A. Perrino, Brindisi, Italy
| | - Rosalba Miceli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Morano
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Cathcart-Rake EJ, Kling JM, Carroll EF, Davidge-Pitts C, Le-Rademacher J, Ridgeway JL, Gonzalez CA, Jatoi A. Understanding Disparities: A Case Illustrative of the Struggles Facing Transgender and Gender Diverse Patients With Cancer. J Natl Compr Canc Netw 2023; 21:227-230. [PMID: 36791758 DOI: 10.6004/jnccn.2023.7005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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10
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Rivera-Custodio JJ, Soto-Sanchez AV, Alvarado-Cardona EO, Moreta-Ávila F, Silva-Reteguis J, Velez-Perez E, Jiménez-Ricaurte C, Rivera-Segarra E, Rodríguez-Madera SL, Ramos-Pibernus A. Recommendations from Latinx Trans and Non-Binary Individuals to Promote Cancer Prevention in Puerto Rico and Florida. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1213. [PMID: 36673968 PMCID: PMC9859014 DOI: 10.3390/ijerph20021213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
Latinx trans and non-binary individuals (LTNB) face increased cancer-related health disparities. Studies evidence how barriers at the individual, provider and organizational levels drive cancer disparities among LTNB individuals. These barriers increase the emotional discomfort associated with testing and disengagement from cancer prevention efforts. Moreover, there are no guidelines or interventions that address cancer prevention specifically among LTNB individuals. There is a need to develop interventions informed by the LTNB communities to promote cancer prevention and screening. The study aims to describe the recommendations provided by LTNB individuals to foster cancer screening and prevention in the communities residing in Puerto Rico and Florida. We conducted two online focus groups with a total of 15 LTNB participants. Participants were recruited using non-probabilistic purposive sampling. We used rapid-qualitative analysis for data interpretation. Findings are gathered in three main themes: (1) recommendations for promoting cancer prevention screening among providers; (2) specific recommendations to promote cancer screening among LTBN individuals; and (3) recommendations on delivery formats to foster cancer prevention. These results evidence the need and feasibility of developing community informed tailored interventions targeting cancer screening and preventative care to reduce cancer-related health disparities among the LTNB population.
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Affiliation(s)
| | - Ana V. Soto-Sanchez
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00732, Puerto Rico
| | | | | | | | - Erik Velez-Perez
- School of Public Health, Ponce Health Sciences University, Ponce 00732, Puerto Rico
| | - Coral Jiménez-Ricaurte
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00732, Puerto Rico
| | - Eliut Rivera-Segarra
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00732, Puerto Rico
| | | | - Alixida Ramos-Pibernus
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce 00732, Puerto Rico
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11
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Ussher JM, Allison K, Perz J, Power R. LGBTQI cancer patients' quality of life and distress: A comparison by gender, sexuality, age, cancer type and geographical remoteness. Front Oncol 2022; 12:873642. [PMID: 36203463 PMCID: PMC9530284 DOI: 10.3389/fonc.2022.873642] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background There is growing acknowledgement of the psycho-social vulnerability of lesbian, gay, bisexual, transgender, queer and/or intersex (LGBTQI) people with cancer. The majority of research to date has focused on cisgender adults with breast or prostate cancer. Study Aim This study examined psycho-social factors associated with distress and quality of life for LGBTQI cancer patients and survivors, across a range of sexualities and gender identities, intersex status, tumor types, ages and urban/rural/remote location using an intersectional theoretical framework. Method 430 LGBTQI people with cancer completed an online survey, measuring distress, quality of life (QOL), and a range of psycho-social variables. Participants included 216 (50.2%) cisgender women, 145 (33.7%) cisgender men, and 63 (14.7%) transgender and gender diverse (TGD) people. Thirty-one (7.2%) participants reported intersex variation and 90 (20%) were adolescents or young adults (AYA), aged 15-39. The majority lived in urban areas (54.4%) and identified as lesbian, gay or bisexual (73.7%), with 10.9% identifying as bisexual, and 10.5% as queer, including reproductive (32.4%) and non-reproductive (67.6%) cancers. Results Forty-one percent of participants reported high or very high distress levels, 3-6 times higher than previous non-LGBTQI cancer studies. Higher rates of distress and lower QOL were identified in TGD compared to cisgender people, AYAs compared to older people, those who identify as bisexual or queer, compared to those who identify as lesbian, gay or homosexual, and those who live in rural or regional areas, compared to urban areas. Elevated distress and lower QOL was associated with greater minority stress (discrimination in life and in cancer care, discomfort being LGBTQI, lower outness) and lower social support, in these subgroups. There were no differences between reproductive and non-reproductive cancers. For the whole sample, distress and poor QOL were associated with physical and sexual concerns, the impact of cancer on gender and LGBTQI identities, minority stress, and lack of social support. Conclusion LGBTQI people with cancer are at high risk of distress and impaired QOL. Research and oncology healthcare practice needs to recognize the diversity of LGBTQI communities, and the ways in which minority stress and lack of social support may affect wellbeing.
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12
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Streed CG. Health Communication and Sexual Orientation, Gender Identity, and Expression. Med Clin North Am 2022; 106:589-600. [PMID: 35725226 PMCID: PMC9219031 DOI: 10.1016/j.mcna.2021.12.005] [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: 11/19/2022]
Abstract
The purpose of this article is to provide guidance on completing a thorough, competent, and culturally appropriate health history with details specific to the care of lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) persons and communities.
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Affiliation(s)
- Carl G Streed
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Center for Transgender Medicine and Surgery, Boston Medical Center, 801 Massachusetts Avenue, Room 2082, Boston, MA 02118, USA.
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13
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Alpert AB, Scout NFN, Schabath MB, Adams S, Obedin-Maliver J, Safer JD. Gender- and Sexual Orientation- Based Inequities: Promoting Inclusion, Visibility, and Data Accuracy in Oncology. Am Soc Clin Oncol Educ Book 2022; 42:1-17. [PMID: 35658501 DOI: 10.1200/edbk_350175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Sexual and gender minority (SGM) people, including agender, asexual, bisexual, gay, gender diverse, genderqueer, genderfluid, intersex, lesbian, nonbinary, pansexual, queer, and transgender people, comprise approximately 10% or more of the U.S. population. Thus, most oncologists see SGM patients whether they know it or not. SGM people experience stigma and structural discrimination that lead to cancer disparities. Because of the lack of systematic and comprehensive data collection, data regarding SGM cancer incidence, outcomes, and treatment responses are limited. Collection of data regarding sexual orientation, gender identity, transgender identity and/or experience, anatomy, and serum hormone concentrations in oncology settings would drastically increase collective knowledge about the impact of stigma and biologic markers on cancer outcomes. Increasing the safety of oncology settings for SGM people will require individual, institutional, and systems changes that will likely improve oncologic care for all patients.
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Affiliation(s)
- Ash B Alpert
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI.,Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - N F N Scout
- National LGBT Cancer Network, Providence, RI
| | - Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Spencer Adams
- School of Interdisciplinary Health Programs, Western Michigan University, Kalamazoo, MI
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, CA
| | - Joshua D Safer
- Division of Endocrinology, Icahn School of Medicine at Mount Sinai, New York, NY.,Mount Sinai Center for Transgender Medicine and Surgery, New York, NY
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14
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Ussher JM, Power R, Perz J, Hawkey AJ, Allison K. LGBTQI Inclusive Cancer Care: A Discourse Analytic Study of Health Care Professional, Patient and Carer Perspectives. Front Oncol 2022; 12:832657. [PMID: 35619900 PMCID: PMC9127408 DOI: 10.3389/fonc.2022.832657] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/11/2022] [Indexed: 12/01/2022] Open
Abstract
Background Awareness of the specific needs of LGBTQI cancer patients has led to calls for inclusivity, cultural competence, cultural safety and cultural humility in cancer care. Examination of oncology healthcare professionals’ (HCP) perspectives is central to identifying barriers and facilitators to inclusive LGBTQI cancer care. Study Aim This study examined oncology HCPs perspectives in relation to LGBTQI cancer care, and the implications of HCP perspectives and practices for LGBTQI patients and their caregivers. Method 357 oncology HCPs in nursing (40%), medical (24%), allied health (19%) and leadership (11%) positions took part in a survey; 48 HCPs completed an interview. 430 LGBTQI patients, representing a range of tumor types, sexual and gender identities, age and intersex status, and 132 carers completed a survey, and 104 LGBTQI patients and 31 carers undertook an interview. Data were analysed using thematic discourse analysis. Results Three HCP subject positions – ways of thinking and behaving in relation to the self and LGBTQI patients – were identified:’Inclusive and reflective’ practitioners characterized LGBTQI patients as potentially vulnerable and offered inclusive care, drawing on an affirmative construction of LGBTQI health. This resulted in LGBTQI patients and their carers feeling safe and respected, willing to disclose sexual orientation and gender identity (SOGI) status, and satisfied with cancer care. ‘Egalitarian practitioners’ drew on discourses of ethical responsibility, positioning themselves as treating all patients the same, not seeing the relevance of SOGI information. This was associated with absence of LGBTQI-specific information, patient and carer anxiety about disclosure of SOGI, feelings of invisibility, and dissatisfaction with healthcare. ‘Anti-inclusive’ practitioners’ expressed open hostility and prejudice towards LGBTQI patients, reflecting a cultural discourse of homophobia and transphobia. This was associated with patient and carer distress, feelings of negative judgement, and exclusion of same-gender partners. Conclusion Derogatory views and descriptions of LGBTQI patients, and cis-normative practices need to be challenged, to ensure that HCPs offer inclusive and affirmative care. Building HCP’s communicative competence to work with LGBTQI patients needs to become an essential part of basic training and ongoing professional development. Visible indicators of LGBTQI inclusivity are essential, alongside targeted resources and information for LGBTQI people.
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Affiliation(s)
- Jane M Ussher
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Rosalie Power
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Janette Perz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Alexandra J Hawkey
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Kimberley Allison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia
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15
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Alpert AB, Komatsoulis GA, Meersman SC, Garrett-Mayer E, Bruinooge SS, Miller RS, Potter D, Koronkowski B, Stepanski E, Dizon DS. Identification of Transgender People With Cancer in Electronic Health Records: Recommendations Based on CancerLinQ Observations. JCO Oncol Pract 2021; 17:e336-e342. [PMID: 33705680 DOI: 10.1200/op.20.00634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Cancer prevalence and outcomes data, necessary to understand disparities in transgender populations, are significantly hampered because gender identity data are not routinely collected. A database of clinical data on people with cancer, CancerLinQ, is operated by the ASCO and collected from practices across the United States and multiple electronic health records. METHODS To attempt to identify transgender people with cancer within CancerLinQ, we used three criteria: (1) International Classification of Diseases 9/10 diagnosis (Dx) code suggestive of transgender identity; (2) male gender and Dx of cervical, endometrial, ovarian, fallopian tube, or other related cancer; and (3) female gender and Dx of prostate, testicular, penile, or other related cancer. Charts were abstracted to confirm transgender identity. RESULTS Five hundred fifty-seven cases matched inclusion criteria and two hundred and forty-two were abstracted. Seventy-six percent of patients with Dx codes suggestive of transgender identity were transgender. Only 2% and 3% of the people identified by criteria 2 and 3 had evidence of transgender identity, respectively. Extrapolating to nonabstracted data, we would expect to identify an additional four individuals in category 2 and an additional three individuals in category 3, or a total of 44. The total population in CancerLinQ is approximately 1,300,000. Thus, our methods could identify 0.003% of the total population as transgender. CONCLUSION Given the need for data regarding transgender people with cancer and the deficiencies of current data resources, a national concerted effort is needed to prospectively collect gender identity data. These efforts will require systemic efforts to create safe healthcare environments for transgender people.
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Affiliation(s)
- Ash B Alpert
- Division of Hematology and Medical Oncology, Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | | | | | | | | | - Robert S Miller
- CancerLinQ LLC, American Society of Clinical Oncology, Alexandria, VA
| | - Danielle Potter
- CancerLinQ LLC, American Society of Clinical Oncology, Alexandria, VA
| | | | | | - Don S Dizon
- Lifespan Cancer Institute, Division of Hematology-Oncology, Department of Medicine, Brown University, Providence, RI
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16
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Pratt-Chapman ML, Alpert AB, Castillo DA. Health outcomes of sexual and gender minorities after cancer: a systematic review. Syst Rev 2021; 10:183. [PMID: 34154645 PMCID: PMC8218456 DOI: 10.1186/s13643-021-01707-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 05/18/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Cancer research on sexual and gender minority (SGM) populations is gaining momentum. The purpose of this systematic review was to examine what is currently known in the research literature regarding patient-reported health outcomes after cancer treatment among SGM populations. METHODS In March 2021, a medical librarian conducted a systematic keyword search on PubMed, Embase, Scopus, Web of Science, PsycINFO, ClinicalTrials.gov , and the Cochrane Central Register of Controlled Trials. The primary inclusion criterion was assessment of at least one physical, psychosocial, emotional, or functional patient-reported health outcome related to the impacts of cancer diagnosis and/or treatment. Articles that met inclusion criteria were reviewed in their entirety, charted in a Word Table, and assessed for quality. Quality considerations included study design, sampling approach, diversity of sample, measures used, and analytic procedures. Studies were synthesized based on type of cancer study participants experienced. RESULTS Sixty-four studies were included in the final analysis: most were quantitative, secondary analyses or cross-sectional studies with convenience samples, and focused on people with a history of breast or prostate cancer. Differences between sexual minority men and women in terms of coping and resilience were noted. Few studies reported on experiences of transgender persons and none reported on experiences of intersex persons. CONCLUSIONS A growing literature describes the patient-reported health outcomes of SGM people with a history of cancer. This study summarizes important between-group differences among SGM and heterosexual, cisgender counterparts that are critical for clinicians to consider when providing care. IMPLICATIONS FOR CANCER SURVIVORS Sexual orientation and gender identity are relevant to cancer survivors' health outcomes. Subgroups of SGM people have differential experiences and outcomes related to cancer and its impacts.
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Affiliation(s)
- Mandi L. Pratt-Chapman
- The George Washington University, School of Medicine and Health Sciences, Washington, DC USA
- The GW Cancer Center, The George Washington University, 2600 Virginia Avenue, Suite #324, Washington, DC 20037 USA
| | - Ash B. Alpert
- Wilmot Cancer Institute, Division of Hematology and Medical Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, USA
| | - Daniel A. Castillo
- Edward G. Miner Library, University of Rochester Medical Center, Rochester, USA
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17
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Palliative and End-of-Life Care for Sexual and Gender Minority Cancer Survivors: a Review of Current Research and Recommendations. Curr Oncol Rep 2021; 23:39. [PMID: 33718997 DOI: 10.1007/s11912-021-01034-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Sexual and gender minority (SGM) cancer survivors (post-diagnosis to end-of-life) can face inadequate services along the cancer care continuum, including palliative and end-of-life (EOL) care. A growing literature base calls for more research on factors influencing palliative and EOL care access, outcomes, and distinct needs of SGM cancer survivors and caregivers. We analyzed peer-reviewed articles published 2015-present to identify trends. RECENT FINDINGS Ten articles were SGM-focused or inclusive, cancer-focused, and included substantive discussion of palliative and/or EOL care. Four were research studies (three case studies and one qualitative interview study) and six were literature reviews. Recurrent topics included disparities in cancer risk, access, and care; essential cultural and clinical competencies; and need for professional and organizational standards and policies addressing interpersonal and institutional discrimination and inclusion. Provision of equitable, competent palliative and EOL care depends on continued advancements in research, translated into person-centered approaches to care. We discuss implications of findings for improving palliative and EOL care for SGM cancer survivors.
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18
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Burns ZT, Bitterman DS, Perni S, Boyle PJ, Guss CE, Haas-Kogan DA, Liu KX. Clinical Characteristics, Experiences, and Outcomes of Transgender Patients With Cancer. JAMA Oncol 2021; 7:e205671. [PMID: 33180096 DOI: 10.1001/jamaoncol.2020.5671] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance More than 1 million people in the US identify as transgender; however, few studies have examined the experiences and outcomes of transgender patients with cancer. Objective To examine clinical characteristics, experiences, and outcomes of transgender patients with cancer. Design, Setting, and Participants This retrospective case series assessed transgender patients with at least 1 cancer diagnosis who were evaluated at Dana-Farber Cancer Institute or Brigham and Women's Hospital in Boston, Massachusetts, between January 1, 2005, and December 31, 2019. Main Outcomes and Measures Demographic, clinical, and treatment characteristics for all patients and documentation by oncologic practitioners of important aspects of providing gender-affirming care, including pronouns used by the patient, were recorded. Results A total of 37 transgender patients with cancer were assessed (mean [SD] age, 38.9 [21.8] years at first cancer diagnosis). Fifteen patients (40.5%) had hematologic malignant cancers, and 25 patients (67.6%) had solid malignant tumors. Sixteen patients (43.2%) initiated gender-affirming hormone therapy or surgery after their cancer diagnosis. Cancer treatment was frequently multimodal, with 24 patients (64.9%) receiving systemic therapy, 24 (64.9%) receiving surgery, and 20 (54.1%) receiving radiation therapy along with other cancer-directed treatment, such as cryoablation. Five patients (13.5%) had documentation from an oncologic practitioner that addressed a potential interaction between their gender-affirming care and their cancer treatment. Thirty-three patients had follow-up visits with oncologic practitioners after starting their transition. Of those patients, pronouns used were documented by a member of the oncologic team for 4 patients (12.1%). However, for 3 of the 4 patients, documentation did not consistently use patient-reported information. At the last follow-up, 5 patients (13.5%) had died of their disease, and 26 (70.3%) were living without disease. Conclusions and Relevance This case series study found that transgender patients were diagnosed with diverse cancers, and many initiated gender-affirming hormone therapy or surgery after their diagnosis. Documentation by oncologic practitioners infrequently included pronouns used by the patient or discussion surrounding the interactions between cancer treatment and gender-affirming care, signifying that urgent improvements are needed in cancer care for transgender patients.
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Affiliation(s)
- Zackory T Burns
- Center for Biotechnology and Global Health Policy, University of California, Irvine School of Law, Irvine
| | - Danielle S Bitterman
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Radiation Oncology, Boston Children's Hospital, Boston, Massachusetts
| | - Subha Perni
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Radiation Oncology, Boston Children's Hospital, Boston, Massachusetts
| | - Patrick J Boyle
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Radiation Oncology, Boston Children's Hospital, Boston, Massachusetts
| | - Carly E Guss
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Daphne A Haas-Kogan
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Radiation Oncology, Boston Children's Hospital, Boston, Massachusetts
| | - Kevin X Liu
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Radiation Oncology, Boston Children's Hospital, Boston, Massachusetts
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19
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Fortin CN, Moravek MB. Medical transition for gender diverse patients. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2020; 9:166-177. [PMID: 36714061 PMCID: PMC9881054 DOI: 10.1007/s13669-020-00297-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Purpose of review The purpose of this review is to provide an up-to-date overview of gender-affirming hormone therapy, including the various hormone regimens available, the efficacy and potential risks of these treatments, and considerations for surveillance and long-term care. Recent findings Recent studies reaffirm that hormone therapy has positive physical and psychological effects for many transgender individuals. The overall risks of treatment are low. Transgender women may have an increased risk of venous thromboembolism and breast cancer based on recent cohort studies, but these findings have yet to be confirmed with randomized controlled trials. Important long-term considerations include metabolic, cardiovascular, and skeletal health. Summary High-quality, long-term studies on the effectiveness and safety of various gender-affirming hormone treatment regimens are lacking, but the currently available evidence suggests that it is overall safe and effective with appropriate oversight.
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Affiliation(s)
| | - Molly B. Moravek
- Corresponding author: L4001 Women’s Hospital, 1500 E Medical Center Dr, Ann Arbor, MI,
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20
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Alpert A, Kamen C, Schabath MB, Hamel L, Seay J, Quinn GP. What Exactly Are We Measuring? Evaluating Sexual and Gender Minority Cultural Humility Training for Oncology Care Clinicians. J Clin Oncol 2020; 38:2605-2609. [PMID: 32552279 DOI: 10.1200/jco.19.03300] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Ash Alpert
- Division of Hematology and Medical Oncology, Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Charles Kamen
- Department of Surgery, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Matthew B Schabath
- Departments of Cancer Epidemiology and Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Lauren Hamel
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI
| | - Julia Seay
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Gwendolyn P Quinn
- Department of Obstetrics and Gynecology, Perlmutter Cancer Center, New York University School of Medicine, New York, NY
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