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Kosche C, Chio MTW, Arron ST. Skin cancer and HIV. Clin Dermatol 2023:S0738-081X(23)00258-4. [PMID: 38142792 DOI: 10.1016/j.clindermatol.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
The risk of skin cancer in persons living with HIV (PLWH) is an evolving subject area shaped by the use of antiretroviral therapy. Keratinocyte carcinomas, including basal cell carcinoma and squamous cell carcinoma, have a high incidence in the general population as well as in PLWH. PLWH may have a higher risk of squamous cell carcinoma when compared to the general population. In addition, Merkel cell carcinoma and sebaceous carcinoma exhibit higher incidence rates in PLWH. Data on melanoma risk are varied. Risks of skin cancer may be influenced by vigilant surveillance, photosensitivity, and immune status. Screening for skin cancer is generally recommended, although national guidelines vary in specific recommendations. Treatments range from topical therapies to surgeries to immune checkpoint inhibitors, with Mohs micrographic surgery playing an important role. Data on immune checkpoint inhibitors suggest safe and efficacious use in PLWH, although larger trials are warranted. The dynamic interplay among HIV, antiretroviral use and immunosuppression, and the risk and treatment of skin cancer underscores the importance of rigorous research studies and screening and treatment guidelines specific to this population.
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Affiliation(s)
- Cory Kosche
- Department of Dermatology, University of California Medical School, San Francisco, California, USA
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2
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Lagacé F, Noorah BN, Conte S, Mija LA, Chang J, Cattelan L, LeBeau J, Claveau J, Turchin I, Gulliver W, Gniadecki R, Netchiporouk E, Miller Jr. WH, Salopek TG, Rahme E, Peláez S, Litvinov IV. Assessing Skin Cancer Risk Factors, Sun Safety Behaviors and Melanoma Concern in Atlantic Canada: A Comprehensive Survey Study. Cancers (Basel) 2023; 15:3753. [PMID: 37568569 PMCID: PMC10417242 DOI: 10.3390/cancers15153753] [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: 04/19/2023] [Revised: 07/10/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The incidence of cutaneous melanoma (CM) is increasing at an alarming rate in Canada and elsewhere around the world. Significant regional differences in CM incidence have been identified in Atlantic provinces. The goal of this study is to compare ultraviolet exposure, sun protective behaviours, level of worry and baseline CM knowledge in provinces with a high versus low incidence of CM as well, as between various demographic groups. METHODS A cross-sectional survey study was conducted in Atlantic provinces between July 2020 and August 2022. All participants aged ≥ 16 years with a completed survey were eligible. Survey responses were summarized using frequency counts, percentages, and means. Two-sided Z-tests for equality of proportions and logistic regression models were used to compare the survey results between geographic and demographic groups. RESULTS In total, 7861 participants were included (28.0% men; mean age 61.3 years; response rate 28%). Our results (gender- and age-adjusted odds ratio, 95% confidence interval) show that high-incidence provinces for CM (Prince Edward Island and Nova Scotia) had significantly more sunburns (OR 2.00, 1.72-2.31), total sun exposure (OR 2.05, 1.68-2.50), recreational sun exposure (OR 1.95, 1.61-2.35) and tans (OR 1.77, 1.53-2.05) than individuals in low-incidence provinces (Newfoundland and Labrador). However, individuals in high-incidence provinces displayed more protective behaviors: there were less tanning bed users (OR 0.82, 0.71-0.95), they checked their skin more frequently for new moles (OR 1.26, 1.06-1.51) and practiced more sun protection overall. Additional analyses are presented based on education, income, sexual orientation and gender. DISCUSSION These findings suggest that future efforts aimed at reducing the CM burden in Atlantic Canada should be tailored for target geographic and/or demographic groups. LIMITATIONS the study participants are not representative of the population in Atlantic Canada due to recruitment strategies.
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Affiliation(s)
- François Lagacé
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, QC H4A 3J1, Canada; (F.L.)
| | - Bibi Nuzha Noorah
- Faculté de Médecine, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Santina Conte
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC H4A 3J1, Canada
| | | | - Jasmine Chang
- Department of Family Medicine, McGill University, Montréal, QC H4A 3J1, Canada
| | - Leila Cattelan
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, QC H4A 3J1, Canada; (F.L.)
| | - Jonathan LeBeau
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC H4A 3J1, Canada
| | - Joël Claveau
- Centre Hospitalier Universitaire de Québec, Hôtel-Dieu de Québec, Melanoma and Skin Cancer Clinic, Québec City, QC G1R 4H6, Canada
| | - Irina Turchin
- Division of Dermatology, Dalhousie University, Halifax, NS B3H 2Y9, Canada
| | - Wayne Gulliver
- Division of Dermatology, Department of Medicine, Memorial University of Newfoundland, St. John’s, NL A1C 5S7, Canada
| | - Robert Gniadecki
- Division of Dermatology, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Elena Netchiporouk
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, QC H4A 3J1, Canada; (F.L.)
| | - Wilson H. Miller Jr.
- Department of Medicine and Oncology, McGill University, Montréal, QC H3T 1J4, Canada
| | - Thomas G. Salopek
- Division of Dermatology, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Elham Rahme
- Division of Clinical Epidemiology, McGill University, Montréal, QC H3T 1J4, Canada
| | - Sandra Peláez
- École de Kinésiologie et des Sciences de L’activité Physique, Université de Montréal, Montréal, QC H3C 3J7, Canada;
| | - Ivan V. Litvinov
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, QC H4A 3J1, Canada; (F.L.)
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3
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Ussher JM, Quinn GP, Perz J. Editorial: Cancer prevention, treatment and survivorship in the LGBTQIA community. Front Oncol 2023; 13:1227911. [PMID: 37496659 PMCID: PMC10368242 DOI: 10.3389/fonc.2023.1227911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023] Open
Affiliation(s)
- Jane M. Ussher
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Gwendolyn P. Quinn
- Department of Obstetrics and Gynecology and Population Health, New York University (NYU) Grossman School of Medicine, New York, NY, United States
| | - Janette Perz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia
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4
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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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5
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Das RK, McLawhorn J, Clayton AS, Perdikis G, Thayer WP. National utilization and reimbursement patterns for Mohs micrographic surgery in the ambulatory surgery setting. J Plast Reconstr Aesthet Surg 2023; 83:12-15. [PMID: 37267859 DOI: 10.1016/j.bjps.2023.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 05/14/2023] [Indexed: 06/04/2023]
Affiliation(s)
- Rishub K Das
- Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Justin McLawhorn
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anna S Clayton
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Galen Perdikis
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wesley P Thayer
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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6
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Wheldon CW, Spradau JZH. Indoor Tanning among Sexual and Gender Minority Adolescents and Adults: Results from the 2020 Pennsylvania LGBT Health Needs Assessment. J Skin Cancer 2023; 2023:3953951. [PMID: 37234933 PMCID: PMC10208760 DOI: 10.1155/2023/3953951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/25/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
Sexual and gender minority (SGM) populations include individuals whose sexual orientation, gender identity, or reproductive development is characterized by nonbinary sexual constructs (e.g., lesbian, gay, bisexual, and transgender (LGBT) individuals). Previous research suggests that some SGM populations have higher rates of skin cancer. The purpose of this study was to assess the association of diverse SGM identities with indoor tanning, a risk factor for skin cancer, while exploring other relevant co-occurring risk factors. A secondary analysis was performed on the 2020 LGBT Health Needs Assessment collected by the Pennsylvania Department of Health. Measures included sexual orientation, gender identity, healthcare utilization, and cancer risk factors. Cisgender SGM men are more likely to use indoor tanning devices (adjusted odds ratio (aOR) = 1.79; 95% CI: 1.31-2.44) compared to other SGM subpopulations independent of sexual orientation. Indoor tanning was also associated with alcohol (aOR = 1.94; 95% CI: 1.50-2.51) and tobacco use (aOR = 1.64; 95% CI: 1.21-2.21). Findings suggest that targeted screening for skin cancer risk behaviors could accompany standard tobacco and alcohol screenings in clinical practice.
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Affiliation(s)
- Christopher W. Wheldon
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
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7
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Skin Cancer Behavioral Risk Factors and Screening Among U.S. Adults in Same-Sex Relationships: A Population-Based Study from 2000 to 2015. LGBT Health 2022; 10:331-337. [DOI: 10.1089/lgbt.2022.0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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8
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An Epidemiological Update on Indoor Tanning and the Risk of Skin Cancers. Curr Oncol 2022; 29:8886-8903. [PMID: 36421352 PMCID: PMC9689757 DOI: 10.3390/curroncol29110699] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
Indoor tanning (sunbeds, solarium) uses artificial ultraviolet radiation (UVR) to stimulate cosmetic tanning of the skin. Indoor tanning has been officially classified as a human carcinogen in 2009 by the International Agency for Research on Cancer of the World Health Organization (WHO). The differences in the prevalence of sunbed use across countries and over the years highlight underlying legislative, climatic, and cultural differences. Indoor tanning-seeking behaviors may be driven by motivations for an appealing appearance, largely influenced by gender and age, and several misconceptions that a prevacation tan safeguards the skin, that sunbeds can be used to treat acne or to increase vitamin D, or that tanning is a healthy habit. This review provides an epidemiological update on the prevalence of sunbed use, who tends to use sunbeds and why, and details the current evidence on the association of sunbeds with skin cancers, including cutaneous melanoma, basal cell carcinoma (BCC), and cutaneous squamous cell carcinoma (cSCC). A statistically significant higher risk of cutaneous melanoma, BCC and cSCC with the use of sunbeds has been consistently demonstrated. This risk of skin cancer is even higher with the more frequent use of sunbeds, underscoring a dose-response relationship, and in those first exposed to sunbeds at a younger age. Preventive measures against sunbed use include legislation restricting sunbed use, educational campaigns to inform and discourage from indoor tanning, as well as using the internet, online advertising messages and the social media to reach larger audiences and to promote an untanned appearance.
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9
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The current state of lesbian, gay, bisexual, and transgender cultural competency among U.S. dermatology residents. Int J Womens Dermatol 2022; 8:e030. [PMID: 35822191 PMCID: PMC9270600 DOI: 10.1097/jw9.0000000000000030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 06/01/2022] [Indexed: 11/25/2022] Open
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10
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Ussher JM, Perz J, Allison K, Power R, Hawkey A, Dowsett GW, Hickey M, Parton C, McDonald FEJ, Davis ID, Quinn GP, Boydell K, Robinson KH, Chambers S, Anazodo A. Attitudes, knowledge and practice behaviours of oncology health care professionals towards lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) patients and their carers: A mixed-methods study. PATIENT EDUCATION AND COUNSELING 2022; 105:2512-2523. [PMID: 34998663 DOI: 10.1016/j.pec.2021.12.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/21/2021] [Accepted: 12/11/2021] [Indexed: 05/25/2023]
Abstract
OBJECTIVE There is growing recognition that health care professionals (HCPs) and policy makers are insufficiently equipped to provide culturally competent care to lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) cancer patients and their families. We examined HCP attitudes, knowledge, and practices regarding LGBTQI cancer care using a mixed-methods research design. METHOD Surveys were completed by 357 oncology HCPs in nursing (40%), medical (24%), allied health (19%), and clinical leadership roles (11%); 48 of the surveyed HCPs were interviewed. RESULTS Most HCPs reported being comfortable treating LGBTQI patients, but reported low levels of confidence and knowledge and systemic barriers to LGBTQI cancer care. Most wanted more education and training, particularly on trans and gender-diverse people (TGD) and those born with intersex variations. CONCLUSION Education of HCPs and health system changes are required to overcome barriers to the provision of culturally competent cancer care for LGBTQI patients. PRACTICE IMPLICATIONS These findings reinforce the need for inclusion of LGBTQI content in HCP education and professional training curricula, and institutional support for LGBTQI-inclusive practice behaviours. This includes administrative and visual cues to signal safety of LGBTQI patients within cancer care, facilitating inclusive environments, and the provision of tailored patient-centred care.
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Affiliation(s)
- Jane M Ussher
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia.
| | - Janette Perz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| | - Kimberley Allison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| | - Rosalie Power
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| | - Alexandra Hawkey
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| | - Gary W Dowsett
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Melbourne, Australia
| | - Chloe Parton
- School of Health, Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
| | - Fiona E J McDonald
- Canteen and Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ian D Davis
- Eastern Health Clinical School, Monash University and Eastern Health, Melbourne, Australia
| | - Gwendolyn P Quinn
- Departments of OB-GYN, Population Health, Grossman School of Medicine, New York University, NY, USA
| | - Katherine Boydell
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Kerry H Robinson
- School of Social Sciences and Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Suzanne Chambers
- Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital and School of Women's and Children's Health, University of New South Wales, Sydney, Australia
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11
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Gannon T, Phillips B, Saunders D, Berner AM. Knowing to Ask and Feeling Safe to Tell - Understanding the Influences of HCP-Patient Interactions in Cancer Care for LGBTQ+ Children and Young People. Front Oncol 2022; 12:891874. [PMID: 35814480 PMCID: PMC9263369 DOI: 10.3389/fonc.2022.891874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/26/2022] [Indexed: 12/03/2022] Open
Abstract
Background Lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ+) people experience healthcare inequalities in cancer care. Previous studies have focused on knowledge, attitudes and behaviours of healthcare professionals (HCPs) treating adults with cancer and how these contribute to inequalities. To date, no research has focused on HCPs treating LGBTQ+ children and adolescents with cancer in the UK. This is important given that this group may be at a critical time for exploring their gender identity and sexual orientation, whilst also facing a cancer diagnosis. We aimed to explore the knowledge, attitudes and behaviours of paediatric, teenage and young adult oncology HCPs treating LGBTQ+ patients in the UK. Methods We carried out semi-structured interviews with 8 HCPs in paediatric, teenage and young adult (TYA) oncology from the Royal Marsden NHS Foundation Trust. Eight questions were asked, which centred around participants' knowledge, attitudes and behaviours regarding management of LGBTQ+ patients in oncology. Interview transcripts were analysed by inductive thematic analysis. Results We identified 10 themes, including novel themes (how HCPs acquire knowledge and expectations of a 'third party' to be the expert) which may underlie previously observed trends in knowledge, attitudes and behaviours of HCPs. We highlight other themes and HCP concerns specific to care of LGBTQ+ patients in paediatrics (influence of the parental-carer dynamic, concerns around patient age and development as a barrier to disclosure) which require further research. We found evidence of the interrelatedness of HCP knowledge, attitudes and behaviours and the ability of these elements to positively influence each other. We mapped our themes across these elements to form a new suggested framework for improving HCP-patient interactions in LGBTQ+ Cancer Care. We found a need both for individual HCP education and organisational change, with creation of a culture of psychological safety to improve patient care. Conclusion Knowledge, attitudes and behaviours of HCPs are closely interdependent when providing care to young LGBTQ+ patients with cancer. The authors suggest that future efforts to improve care of these patients address this complexity by spanning the domains of our suggested framework. Whilst HCP education is essential, change must also occur at an organisational level.
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Affiliation(s)
- Tamsin Gannon
- Paediatric and Teenage and Young Adult Oncology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom,*Correspondence: Tamsin Gannon,
| | - Bob Phillips
- Paediatric and Teenage and Young Adult (TYA) Oncology, Leeds Children’s Hospital, Leeds, United Kingdom
| | - Daniel Saunders
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Alison May Berner
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom,Gender Identity Clinic, Tavistock and Portman NHS Foundation Trust, London, United Kingdom
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12
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Sun H, Li Y, Zeng F, Meng Y, Du S, Deng G. Melanoma survivors are at increased risk for second primary keratinocyte carcinoma. Int J Dermatol 2022; 61:1397-1404. [PMID: 35726477 DOI: 10.1111/ijd.16309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/15/2022] [Accepted: 05/26/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent large cohorts have reported that melanoma survivors are at risk of developing second keratinocyte carcinoma (KC). However, the detailed proportion and risk are still unknown. We aimed to comprehensively analyze the risk of developing keratinocyte carcinoma after primary melanoma. METHODS We conducted systematic literature research in PubMed, Embase, Web of Science, and Cochrane Library published prior to September 13, 2021. Proportion and standardized incidence ratios (SIR) with its corresponding 95% confidence interval (CI) were pooled for assessing the risk. RESULTS A total of 15 studies encompassing 168,286 patients were included in our analysis. The pooled proportions of melanoma survivors that developed a subsequent basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and KC were 4.11% (95% CI, 1.32-6.90), 2.54% (95% CI, 1.78-3.31), and 5.45% (95% CI, 3.06-7.84), respectively. The risks of developing a second BCC, SCC, and KC in melanoma survivors were 5.3-fold (SIR 5.30; 95% CI, 4.87-5.77), 2.6-fold (SIR 2.58; 95% CI, 1.33-5.04), and 6.2-fold (SIR 6.17; 95% CI, 3.66-10.39) increased in comparison with the general population. Both fixed effects and random effects models were applied in conducting meta-analysis and reached a consistent conclusion. CONCLUSIONS Our results indicated melanoma survivors are at elevated risk of experiencing second primary BCC and SCC, which suggested the significance of surveillance for second primary KC and efforts for prevention in patients with a history of melanoma.
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Affiliation(s)
- Huiyan Sun
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Department of Oncology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
| | - Yayun Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Department of Oncology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Furong Zeng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Department of Oncology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yu Meng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Department of Oncology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Songtao Du
- Department of Colorectal Surgical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Guangtong Deng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Department of Oncology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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13
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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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Primeau CA, Vader K, Philpott HT, Xiong Y. A Need for Greater Emphasis on 2SLGBTQIA+ Health Among Physiotherapists in Canada. Physiother Can 2022; 74:117-120. [PMID: 37323717 PMCID: PMC10262744 DOI: 10.3138/ptc-2021-0107-gee] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 07/21/2023]
Affiliation(s)
- Codie A. Primeau
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Kyle Vader
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Holly T. Philpott
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Yijun Xiong
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
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15
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Primeau CA, Vader K, Philpott HT, Xiong Y. La nécessité d’insister davantage sur la santé LGBTQI2SA+ chez les physiothérapeutes au Canada. Physiother Can 2022. [DOI: 10.3138/ptc-2021-0107-gef] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Codie A. Primeau
- École de physiothérapie, faculté des sciences de la santé, Université Western, London, Ontario, Canada
- École des sciences de la santé et de la réadaptation, faculté des sciences de la santé, Université Western, London, Ontario, Canada
- Bone and Joint Institute, Université Western, London, Ontario, Canada
| | - Kyle Vader
- École de réadaptation, Université Queen’s, Kingston, Ontario, Canada
| | - Holly T. Philpott
- École des sciences de la santé et de la réadaptation, faculté des sciences de la santé, Université Western, London, Ontario, Canada
- Bone and Joint Institute, Université Western, London, Ontario, Canada
| | - Yijun Xiong
- École de physiothérapie, faculté des sciences de la santé, Université Western, London, Ontario, Canada
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16
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Pagoto SL, Waring ME, Groshon LC, Rosen AO, Schroeder MW, Goetz JM. Proof-of-Concept Feasibility Trial of a Dissonance-Based Sun Safety Intervention for Young Adult Tanners. Ann Behav Med 2022; 56:830-841. [PMID: 35179176 PMCID: PMC9345184 DOI: 10.1093/abm/kaab116] [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: 12/30/2022] Open
Abstract
BACKGROUND Melanoma is the second most common cancer in young adults. Social media may be a means to conduct interventions to increase sun safety in young adults. PURPOSE We conducted a randomized proof-of-concept pilot trial to evaluate the feasibility and acceptability of a dissonance-based social media intervention designed to promote sun safety in young adult tanners. METHODS Young adult tanners (N = 66) were randomized into two 4-week interventions in which participants were incentivized to create content for a social media campaign on healthy skin or healthy lifestyle. Feasibility outcomes included retention, participation, acceptability, and contamination. We also examined the impact of participation on motivation to engage in the target health behaviors and outdoor tanning intentions. RESULTS Retention was 100%. Most Healthy Skin (88%) and Healthy Lifestyle participants (91%) created ≥1 post. Acceptability was high with 94% and 97% of participants in Healthy Skin and Healthy Lifestyle conditions, respectively, agreeing they would recommend the campaign to a friend. At 4 weeks, Healthy Skin participants reported greater declines in motivation to tan indoors (p = .0017) and outdoors (p = .0003), and greater increases in motivation to wear sunscreen (p = .0009) and protective clothing (p = .0342). Healthy Skin participants reported greater declines in intentions to tan outdoors in the next year (p = .0286). CONCLUSIONS A dissonance-based, social media sun safety intervention was feasible and acceptable. Future research should examine the efficacy and longer-term effects of this intervention in young adults at elevated risk for skin cancer. TRIAL REGISTRATION Clinicaltrials.gov NCT03834974 https://clinicaltrials.gov/ct2/show/NCT03834974.
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Affiliation(s)
| | - Molly E Waring
- Department of Allied Health Sciences, University of Connecticut, 2006 Hillside Road, Unit 1248, Room 22, Storrs, CT 06268, USA
| | - Laurie C Groshon
- Department of Allied Health Sciences, University of Connecticut, 2006 Hillside Road, Unit 1248, Room 22, Storrs, CT 06268, USA
| | - Aviana O Rosen
- Department of Allied Health Sciences, University of Connecticut, 2006 Hillside Road, Unit 1248, Room 22, Storrs, CT 06268, USA
| | - Matthew W Schroeder
- Department of Allied Health Sciences, University of Connecticut, 2006 Hillside Road, Unit 1248, Room 22, Storrs, CT 06268, USA
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17
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Covelli I, Ahrens K, Onchiri FM, Inwards-Breland D, Boos MD. Influence of gender and sexual identity on adolescent skin health. Pediatr Dermatol 2021; 38 Suppl 2:65-72. [PMID: 34272896 DOI: 10.1111/pde.14686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND/OBJECTIVE Studies have identified dermatologic conditions and relevant skin-related behaviors that distinctly or disproportionately impact sexual and gender minority (SGM) adults compared with their cisgender/heterosexual counterparts, but whether these observations apply to SGM adolescents remains unknown. We aimed to describe the nature and frequency of skin conditions in SGM youth relative to their cisgender/heterosexual peers and explore adolescents' attitudes toward their skin health and accessing dermatologic care. METHODS SGM and cisgender/heterosexual youth aged 13-21 years seen at Seattle Children's Hospital Adolescent Medicine and Gender clinics from June to December 2019 were invited to participate in this cross-sectional survey study, with subsequent statistical analysis. RESULTS One-hundred and eighteen subjects were included in the study. Sexual orientation did not affect how participants personally felt about and cared for their skin, though gender identity did influence this relationship. (P = .012) Both sexual and gender minority youth demonstrated a preference for a dermatologist who identified as SGM and would be more likely to actively seek care from these providers. (P < .001) There was no difference in the reported prevalence of most dermatologic conditions among groups based on sexual orientation or gender identity. CONCLUSION Dermatologists should inquire with adolescent and young adult patients how their sexual orientation and gender identities influence how they view their skin, in an effort to guide counseling and demonstrate holistic support for adolescents. Therapeutic alliances with SGM youth may be strengthened by providers who openly identify as SGM.
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Affiliation(s)
- Isabela Covelli
- University of Washington School of Medicine, Seattle, WA, USA
| | - Kym Ahrens
- Division of Adolescent Medicine, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA, USA
| | - Frankline M Onchiri
- Core for Biostatistics, Epidemiology, Analytics in Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - David Inwards-Breland
- Division of Adolescent and Young Adult Medicine, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA
| | - Markus D Boos
- Division of Dermatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA, USA
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D’Ecclesiis O, Caini S, Martinoli C, Raimondi S, Gaiaschi C, Tosti G, Queirolo P, Veneri C, Saieva C, Gandini S, Chiocca S. Gender-Dependent Specificities in Cutaneous Melanoma Predisposition, Risk Factors, Somatic Mutations, Prognostic and Predictive Factors: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7945. [PMID: 34360236 PMCID: PMC8345480 DOI: 10.3390/ijerph18157945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Over the last decades, the incidence of melanoma has been steadily growing, with 4.2% of the population worldwide affected by cutaneous melanoma (CM) in 2020 and with a higher incidence and mortality in men than in women. We investigated both the risk factors for CM development and the prognostic and predictive factors for survival, stratifying for both sex and gender. METHODS We conducted a systematic review of studies indexed in PUB-MED, EMBASE, and Scopus until 4 February 2021. We included reviews, meta-analyses, and pooled analyses investigating differences between women and men in CM risk factors and in prognostic and predictive factors for CM survival. DATA SYNTHESIS Twenty-four studies were included, and relevant data extracted. Of these, 13 studies concerned potential risk factors, six concerned predictive factors, and five addressed prognostic factors of melanoma. DISCUSSION The systematic review revealed no significant differences in genetic predisposition to CM between males and females, while there appear to be several gender disparities regarding CM risk factors, partly attributable to different lifestyles and behavioral habits between men and women. There is currently no clear evidence of whether the mutational landscapes of CM differ by sex/gender. Prognosis is justified by a complex combination of phenotypes and immune functions, while reported differences between genders in predicting the effectiveness of new treatments are inconsistent. Overall, the results emerging from the literature reveal the importance of considering the sex/gender variable in all studies and pave the way for including it towards precision medicine. CONCLUSIONS Men and women differ genetically, biologically, and by social construct. Our systematic review shows that, although fundamental, the variable sex/gender is not among the ones collected and analyzed.
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Affiliation(s)
- Oriana D’Ecclesiis
- Department of Experimental Oncology, IEO—European Institute of Oncology IRCCS, 20139 Milan, Italy; (O.D.); (C.M.); (S.R.)
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo il Vecchio 2, 50139 Florence, Italy; (S.C.); (C.S.)
| | - Chiara Martinoli
- Department of Experimental Oncology, IEO—European Institute of Oncology IRCCS, 20139 Milan, Italy; (O.D.); (C.M.); (S.R.)
| | - Sara Raimondi
- Department of Experimental Oncology, IEO—European Institute of Oncology IRCCS, 20139 Milan, Italy; (O.D.); (C.M.); (S.R.)
| | - Camilla Gaiaschi
- GENDERS Center, Department of Social and Political Sciences, Università degli Studi di Milano, 20122 Milan, Italy; (C.G.); (C.V.)
- Faculty of Social and Political Sciences, Institute of Social Sciences, University of Lausanne, 1015 Lausanne, Switzerland
| | - Giulio Tosti
- Division of Melanoma Surgery, Sarcoma and Rare Tumors, IEO—European Institute of Oncology IRCCS, 20139 Milan, Italy; (G.T.); (P.Q.)
| | - Paola Queirolo
- Division of Melanoma Surgery, Sarcoma and Rare Tumors, IEO—European Institute of Oncology IRCCS, 20139 Milan, Italy; (G.T.); (P.Q.)
| | - Camilla Veneri
- GENDERS Center, Department of Social and Political Sciences, Università degli Studi di Milano, 20122 Milan, Italy; (C.G.); (C.V.)
| | - Calogero Saieva
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo il Vecchio 2, 50139 Florence, Italy; (S.C.); (C.S.)
| | - Sara Gandini
- Department of Experimental Oncology, IEO—European Institute of Oncology IRCCS, 20139 Milan, Italy; (O.D.); (C.M.); (S.R.)
| | - Susanna Chiocca
- Department of Experimental Oncology, IEO—European Institute of Oncology IRCCS, 20139 Milan, Italy; (O.D.); (C.M.); (S.R.)
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