Female leadership in oncology-has progress stalled? Data from the ESMO W4O authorship and monitoring studies

[Representation of women in senior positions in emergency medicine]

BACKGROUND

Gender equality and the empowerment of women is one of the 17 Sustainable Development Goals formulated by the United Nations. Gender-specific inequalities still exist, especially in medicine. Women are particularly lacking in leadership positions and in visible roles outside of patient care, such as at conferences and in scientific journals.

AIM

The aim of the study was to analyse the proportion of women in leadership positions in emergency medicine and the visible roles at emergency medicine conferences and scientific journals.

MATERIALS AND METHODS

A selective literature search in PubMed and an evaluation of the conference programmes from 2020-2021 as well as the editorial boards of journals were conducted with regard to the proportion of women.

RESULTS

Women continue to be significantly underrepresented on the editorial boards of emergency medicine journals and on the boards of leading emergency medicine organisations. Internationally, there are already programmes to increase the proportion of women in field of publications and scientific conferences; to date, there are only a few such programmes for women in emergency medicine in Germany.

CONCLUSION

Women in healthcare in general and in emergency medicine in particular are not equally represented outside of patient care. To date, there are hardly any programmes to promote women in emergency medicine in Germany. Mentoring, collegial support and organisational change are key to increasing the proportion of women in nonpatient care roles in emergency medicine.

Gender inequity in the medical profession: the women doctors in Spain (WOMEDS) study

BACKGROUND

The long-standing underrepresentation of women in leadership positions in medicine is well-known, but poorly documented globally. There is some evidence of the gender gap in academia, medical society leadership, or specific problems in some specialties. However, there are no investigations analyzing all medical specialties together and reporting the glass ceiling from a 360º perspective that includes positions in academia, research, professional organizations, and clinical activity. Additionally, the majority of studies have a US perspective, and we wonder if the perspective of a European country might be different. The WOmen in MEDicine in Spain (WOMEDS) project ( https://womeds.es ) aims to describe and characterize, in a systematic and detailed way, the gender bias in the medical profession in Spain in order to monitor its evolution over time and contribute to prioritizing gender policies.

METHODS

We retrieved data for the calendar years 2019-2021 from several sources and selected surveys. We built four groups of indicators to describe leadership positions in the medical profession: (i) leadership in healthcare according to specialty and region; (ii) leadership in scientific and professional bodies; (iii) academic career; and (iv) leadership in clinical research activity. As a summary measure, we reported the women ratios, calculated as the percentage of women in specific top positions divided by the percentage of women in the relevant population.

RESULTS

We found gender inequity in leadership positions in all four settings. During the observed period, only 27.6% of the heads of departments in hospitals were women compared to 61.1% of women in medical staff. Ten of the 46 medical societies grouped in the Spanish Federation of Medical Societies (FACME) (21.7%) had a women president at some point during the study period, and only 4 annual congresses had ratios of women speakers higher than 1. Women were over-represented in the lower positions and underrepresented in the top academic ones. Only 26% and 27%, respectively, of the heads of departments and deans were women. The applications for public funding for research projects are led by women only in 45% of the cases, and the budget granted to women in public calls was 24.3% lower than that of men.

CONCLUSION

In all the areas analyzed, the leadership positions are still mostly occupied by men despite the feminization of medicine in Spain. The severe gender inequity found calls for urgent interventions within a defined time horizon. Such measures must concern all levels, from national or regional regulation to changes in organizational culture or incentives in specific organizations.

Challenges in oncology career: are we closing the gender gap? Results of the new ESMO Women for Oncology Committee survey

BACKGROUND

Following a European Society for Medical Oncology Women for Oncology (ESMO W4O) survey in 2016 showing severe under-representation of female oncologists in leadership roles, ESMO launched a series of initiatives to address obstacles to gender equity. A follow-up survey in October 2021 investigated progress achieved.

MATERIALS AND METHODS

The W4O questionnaire 2021 expanded on the 2016 survey, with additional questions on the impact of ethnicity, sexual orientation and religion on career development. Results were analysed according to respondent gender and age.

RESULTS

The survey sample was larger than in 2016 (n = 1473 versus 482), especially among men. Significantly fewer respondents had managerial or leadership roles than in 2016 (31.8% versus 51.7%). Lack of leadership development for women and unconscious bias were considered more important in 2021 than in 2016. In 2021, more people reported harassment in the workplace than in 2016 (50.3% versus 41.0%). In 2021, ethnicity, sexual orientation and religion were considered to have little or no impact on professional career opportunities, salary setting or related potential pay gap. However, gender had a significant or major impact on career development (25.5% of respondents), especially in respondents ≤40 years of age and women. As in 2016, highest ranked initiatives to foster workplace equity were promotion of work-life balance, development and leadership training and flexible working. Significantly more 2021 respondents (mainly women) supported the need for culture and gender equity education at work than in 2016.

CONCLUSIONS

Gender remains a major barrier to career progression in oncology and, although some obstacles may have been reduced since 2016, we are a long way from closing the gender gap. Increased reporting of discrimination and inappropriate behaviour in the workplace is a major, priority concern. The W4O 2021 survey findings provide new evidence and highlight the areas for future ESMO interventions to support equity and diversity in oncology career development.

Gender representation on editorial boards of leading oncology journals

Background

There has historically been women underrepresentation on editorial boards of peer-reviewed medical journals. High-ranked oncology journals showcase cancer-related scientific work at the forefront of the discipline. There is urgent need to investigate gender representation on editorial boards at leading oncology journals.

Materials and methods

Sixty high-ranked oncology journals based on impact factor calculated by the Journal Citation Reports (JCR) 2021 from Web of Science/Clarivate Analytics were identified. Gender-related information of editorial boards was obtained from each journal’s website. The gender of each member of the editorial team was confirmed by an internet search for picture and/or gender-specific pronoun from journal or personal profile. Fisher’s exact tests and analysis of variance were used to analyze categorical and continuous variables, respectively. Significance was set at P < 0.05.

Results

Among 4898 members on editorial boards of top oncology journals with the highest impact factor, 1177 were women. Women made up 24% (1177 of 4898) of members on editorial boards in top oncology journals, and there was significantly less women board members than men (P < 0.0001). The mean female composition of editorial boards of oncology journals was 27% (range from 4% to 100%). Among 71 editors-in-chief of the top oncology journals, 14 (20%) were women. There was a positive correlation between the presence of women in journal editorial leadership and the percentage of women on editorial boards (r_s = 0.340, P = 0.008). The underrepresentation of women on oncology journal editorial boards was significantly different among quartiles of journal impact factor. There was no significant correlation between women’s representation on journal editorial boards (%) and journal impact factors (r_s = 0.226, P = 0.086).

Conclusions

The results demonstrated that there are gender disparities among editorial leadership at high-impact oncology journals. There are cultural and structural barriers and prejudices to gender parity and diversity on editorial boards of oncology journals.

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The representation of women on editorial boards of oncology journals has not been verified.

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This large-scale study found that women comprised only 24% of editorial boards of top-ranked oncology journals.

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The results demonstrated that there are gender disparities among editorial leadership at leading oncology journals.

Gender profile of principal investigators in a large academic clinical trials group

Introduction

Gender equity in medicine has become a significant topic of discussion due to consistently low female representation in academia and leadership roles. Gender imbalance directly affects patient care. This study examined the gender and craft group of the Principal Investigators (PI) of clinical trials run by the Australasian Gastro-Intestinal Trials Group (AGITG)

Methods

Publicly available data was obtained from the AGITG website. Trials were divided into upper, lower gastrointestinal cancer, miscellaneous (neuroendocrine and gastrointestinal stromal tumours). Where multiple PIs were listed, all were counted. Craft group was assigned as surgical, medical, radiation oncology or other.

Results

There were 69 trials with 89 PI, where 52 trials were represented exclusively by male PIs. Of all PIs, 18 were women (20.2%); all were medical oncologists. Prior to 2005, all PIs were male. The craft group distribution of PIs was: 79% medical oncologists, 12% surgical oncologists, 8% radiation oncologist, 1% nuclear medicine physicians. Regarding trials with multiple PI's, there were 19 in total. Of these, 11 had only male PIs, which included 5 surgeons. Females were more likely to be a co-PI (42%) as opposed to sole PI (18%). There was no gender policy publicly available on the AGITG website.

Conclusions

There is a low percentage of female PIs in academic oncology trials in the portfolio of this large international trials group. No trial was led by a female surgical or radiation oncologist. There is a need to understand the reasons driving the disparity so that specific strategies can be put in place.

Trends in Women's Leadership of Oncology Clinical Trials

It has been widely reported that women are underrepresented in leadership positions within academic medicine. This study aimed to assess trends in women representation as principal investigators (PIs) in oncology clinical trials and to characterize trends in women’s leadership in such trials conducted between 1999 and 2019. The gender of 39,240 PIs leading clinical trials was determined using the gender prediction software Genderize.io. In total, 11,516 (27.7%) women served as PIs. Over the past 20 years, an annual increase of 0.65% in women PIs was observed. Analysis by geographic distribution revealed higher women representation among PIs in North America and Europe compared to Asia. Industry-funded trials were associated with lower women PI representation than academic-funded trials (31.4% vs. 18.8%, p<0.001). Also, women PIs were found to be underrepresented in late-phase as compared to early-phase studies (27.9%, 25.7%, 21.6%, and 22.4% in phase I, II, III, and IV, respectively; Cochran-Armitage test for trend, p<0.001). Furthermore, an association was found between the PI’s gender and enrolment of female subjects (50% vs. 43% female participants led by women vs men PIs, respectively, p<0.001). Taken together, while the gender gap in women’s leadership in oncology trials has been steadily closing, prominent inequalities remain in non-Western countries, advanced study phases, industry-funded trials and appear to be linked to a gender gap in patient accrual. These observations can serve for the development of strategies to increase women’s representation and to monitor progress toward gender equality in PIs of cancer clinical trials.