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Arthur EK, Ridgway-Limle EA, Krok-Schoen JL, Boehmer U, Battle-Fisher M, Lee CN. Scoping review of experiences of sexual minority women treated for breast cancer. J Psychosoc Oncol 2024:1-24. [PMID: 38501984 DOI: 10.1080/07347332.2024.2323471] [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: 03/20/2024]
Abstract
PURPOSE To summarize and critique research on the experiences and outcomes of sexual minority women (SMW) treated with surgery for breast cancer through systematic literature review. METHODS A comprehensive literature search identified studies from the last 20 years addressing surgical experiences and outcomes of SMW breast cancer survivors. Authors performed a quality assessment and thematic content analysis to identify emergent themes. RESULTS The search yielded 121 records; eight qualitative studies were included in the final critical appraisal. Quality scores for included studies ranged 6-8 out of 10. Experiences and outcomes of SMW breast cancer survivors were organized by major themes: 1) Individual, 2) Interpersonal, 3) Healthcare System, and 4) Sociocultural and Discursive. CONCLUSIONS SMW breast cancer survivors have unique experiences of treatment access, decision-making, and quality of life in survivorship. SMW breast cancer survivors' personal values, preferences, and support network are critical considerations for researchers and clinicians.
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Affiliation(s)
- Elizabeth K Arthur
- Nursing Research, The James Comprehensive Cancer Center, The Ohio State Wexner Medical Center, Columbus, Ohio, USA
| | - Emily A Ridgway-Limle
- Nursing Research, The James Comprehensive Cancer Center, The Ohio State Wexner Medical Center, Columbus, Ohio, USA
| | - Jessica L Krok-Schoen
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Ulrike Boehmer
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Clara N Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Ohio State University, Columbus, Ohio, USA
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Zhou X. Care in transition: Global norms, transnational adaptation, and family-centered gender-affirming care in China. Soc Sci Med 2024; 344:116658. [PMID: 38359525 DOI: 10.1016/j.socscimed.2024.116658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/11/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
In recent years, trans medicine has increasingly shifted towards gender-affirming care, focusing on assisting transgender people in finding safe and effective ways to support their gender identity. Through standards of care, clinical guidelines, and classification systems, international experts have established global norms with profound downstream implications. However, how local providers respond to these new norms remains underexplored. Drawing on ethnographic work in clinical settings, conferences, and 30 in-depth interviews with healthcare providers, I argue that family-centered gender-affirming care has emerged in China as providers strive to balance global ideals of "good" trans medicine with the constraints of the local healthcare system. While international standards assist providers in adopting a less pathologizing and binary view of care, they provide limited practical guidance for navigating local social and institutional challenges. Faced with a lack of legal and institutional support, providers increasingly rely on family members' involvement to mitigate medical dispute risks. This reliance manifests in two forms: restrictive gatekeeping, where care is delayed or denied based on family members' attitudes and providers' assessment of transgender adults' ability to lead a "normal life," and affective gatekeeping, where providers use psychological support and gender diversity education to involve family members as caregivers. These findings enrich sociological studies in global health by illustrating how the interactions between global norms and local healthcare systems can both alleviate and reproduce barriers to care.
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Affiliation(s)
- Xiaogao Zhou
- Department of Sociology, The University of Chicago, United States.
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Griffin C, Fairhurst K, Stables I, Brunsden S, Potter S. Outcomes of Women Undergoing Mastectomy for Unilateral Breast Cancer Who Elect to Undergo Contralateral Mastectomy for Symmetry: A Systematic Review. Ann Surg Oncol 2024; 31:303-315. [PMID: 37749407 PMCID: PMC10695874 DOI: 10.1245/s10434-023-14294-6] [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: 07/19/2023] [Accepted: 08/29/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Breast reconstruction (BR) is routinely offered to restore symmetry after mastectomy for breast cancer. Not all women, however, may want reconstructive surgery. A contralateral mastectomy (CM) to achieve "flat symmetry" can be an excellent alternative, but surgeons are often reluctant to offer this procedure. This systematic review aimed to summarize the available evidence regarding the outcomes of CM as the first step to developing guidelines in this area. METHODS PubMed, MEDLINE, CINAHL and PsycINFO were searched to identify primary research studies, published in English between 1 January 2000 and 30 August 2022, evaluating clinical or patient-reported outcomes for women who underwent a CM without reconstruction after a mastectomy for unilateral breast cancer. Simple descriptive statistics summarized quantitative data, and content analysis was used for qualitative data. RESULTS The study included 15 studies (13 quantitative, 1 qualitative, and 1 mixed-methods) evaluating outcomes for at least 1954 women who underwent a bilateral mastectomy without reconstruction (BM) after unilateral breast cancer. The risk of surgical complications after BM was higher than after unilateral mastectomy without reconstruction (UM) but significantly less than after BR. Satisfaction with the decision for BM was high in all the studies. Key themes relating to flat denial, stigma, and gender-based assumptions were identified. CONCLUSION Women electing to undergo BM reported high levels of satisfaction with their decision and complication rates similar to those for UM. Further study is needed to comprehensively explore the outcomes for women seeking BM, but these data should give surgeons confidence to offer the procedure as an alternative option for symmetry after unilateral mastectomy for breast cancer. REGISTRATION This systematic review was prospectively registered on the PROSPERO database (CRD42022353689).
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Affiliation(s)
- Cora Griffin
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Imogen Stables
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - Shelley Potter
- Bristol Medical School, University of Bristol, Bristol, UK.
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK.
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Wugalter K, Perovic M, Karkaby L, Einstein G. The double-edged sword of PCOS and gender: exploring gender-diverse experiences of polycystic ovary syndrome. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2023; 25:251-267. [PMID: 38681493 PMCID: PMC11044764 DOI: 10.1080/26895269.2023.2183448] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Background: Past research on polycystic ovary syndrome (PCOS), a chronic endocrine condition, has focused on the experiences of cisgender women. Aims: The purpose of the present study was to address the knowledge gap about gender-diverse individuals by exploring their lived experiences with PCOS and to better understand if and how their gender identity affected their experience of PCOS. Methods: To explore this, we recruited nine non-binary people and one transgender man with a PCOS diagnosis for qualitative interviews. Results: Three overarching themes emerged: PCOS as a burden, PCOS as an occasion, and PCOS as a benefit. While some aspects of PCOS created an additional burden for our participants, other symptoms such as excess body and facial hair could be empowering and affirming, revealing a positive aspect of this chronic condition. Conclusion: This study is the first to describe the lived experiences of gender-diverse individuals with PCOS, uncovering burdens as well as some benefits. Future research in this population may reveal not only the particulars of what PCOS is like for them but also more generalizable insights into the highly gendered perception and treatment of PCOS.
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Affiliation(s)
- Katrina Wugalter
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, University of Illinois Chicago, Chicago, Illinois, USA
| | - Mateja Perovic
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Laurice Karkaby
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Gillian Einstein
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Tema Genus, Linköping University, Linköping, Sweden
- Rotman Research Institute, Baycrest Hospital, Toronto, Ontario, Canada
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MacKinnon KR, Ashley F, Kia H, Lam JSH, Krakowsky Y, Ross LE. Preventing transition "regret": An institutional ethnography of gender-affirming medical care assessment practices in Canada. Soc Sci Med 2021; 291:114477. [PMID: 34666278 DOI: 10.1016/j.socscimed.2021.114477] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 10/20/2022]
Abstract
When a person openly "regrets" their gender transition or "detransitions" this bolsters within the medical community an impression that transgender and non-binary (trans) people require close scrutiny when seeking hormonal and surgical interventions. Despite the low prevalence of "regretful" patient experiences, and scant empirical research on "detransition", these rare transition outcomes profoundly organize the gender-affirming medical care enterprise. Informed by the tenets of institutional ethnography, we examined routine gender-affirming care clinical assessment practices in Canada. Between 2017 and 2018, we interviewed 11 clinicians, 2 administrators, and 9 trans patients (total n = 22), and reviewed 14 healthcare documents pertinent to gender-affirming care in Canada. Through our analysis, we uncovered pervasive regret prevention techniques, including requirements that trans patients undergo extensive psychosocial evaluations prior to transitioning. Clinicians leveraged psychiatric diagnoses as a proxy to predict transition regret, and in some cases delayed or denied medical treatments. We identified cases of patient dissatisfaction with surgical results, and a person who detransitioned. These accounts decouple transition regret and detransition, and no participants endorsed stricter clinical assessments. We traced the clinical work of preventing regret to cisnormativity and transnormativity in medicine which together construct regret as "life-ending", and in turn drives clinicians to apply strategies to mitigate the perceived risk of malpractice legal action when treating trans people, specifically. Yet, attempts to prevent these outcomes contrast with the material healthcare needs of trans people. We conclude that regret and detransitioning are unpredictable and unavoidable clinical phenomena, rarely appearing in "life-ending" forms. Critical research into the experiences of people who detransition is necessary to bolster comprehensive gender-affirming care that recognizes dynamic transition trajectories, and which can address clinicians' fears of legal action-cisgender anxieties projected onto trans patients who are seeking medical care.
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Affiliation(s)
- K R MacKinnon
- School of Social Work, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
| | - F Ashley
- Faculty of Law and Joint Centre for Bioethics, University of Toronto, 78 Queens Park, Toronto, ON, M5S 2C5, Canada
| | - H Kia
- School of Social Work, The University of British Columbia, 2080 West Mall, Vancouver, BC, V6T 1Z2, Canada
| | - J S H Lam
- Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada
| | - Y Krakowsky
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, 149 College Street, Toronto, ON, M5T 1P5, Canada; Division of Urology, Women's College Hospital and Sinai Health System, 77 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - L E Ross
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
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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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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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