Gender- and Sexual Orientation- Based Inequities: Promoting Inclusion, Visibility, and Data Accuracy in Oncology

Policy Priorities in Cancer Care for Transgender People

This Viewpoint calls for health care systems, oncologists, and staff to prioritize and adopt policies that are inclusive and respectful of transgender patients with cancer.

Prevalence of self-reported cancer based on sexual orientation in the United States: a comparative analysis between lesbian, bisexual, gay, and heterosexual individuals

PURPOSE

Our study aimed to compare the prevalence and likelihood of self-reported (SR) cancer diagnosis between lesbian, gay, and bisexual (LGB) groups and the heterosexual population in the United States between 2017 and 2021.

METHODS

This study analyzed data from the National Health Interview Survey (NHIS) 2017-2021, which included 134,372 heterosexual and 4576 LGB individuals aged 18 and above. The prevalence of any SR cancer and some selected cancers were calculated for the LGB and compared with heterosexual adults. Sexual orientation was used to predict SR cancer diagnosis for each sex using multiple logistic regression, adjusting for other sociodemographic determinants.

RESULTS

The unadjusted prevalence of any SR cancer among the LGB population was 9.0%. Lesbian and Bisexual women had higher prevalence of SR cancer of the cervix, uterus, ovary, thyroid, bone, skin melanoma, leukemia, and other blood cancers than Heterosexual women. Gay and Bisexual men had a higher prevalence of SR cancer of the bladder, kidney, skin (non-melanoma, and other kinds), bone, lymphoma, and leukemia than Heterosexual men. After adjusting for other socio-demographic factors, gay men were 1.73 (CI 1.14-2.63, p = 0.01) times more likely than heterosexual men to be diagnosed with cancer, while lesbian women were 2.26 (CI 1.24-4.16, p = 0.009) times more likely to be diagnosed with cancer than heterosexual women.

CONCLUSION

Some sexual minority subgroups are more likely to be diagnosed with cancer than their heterosexual counterparts. As a result, more research and SM-specific intervention efforts should focus on cancer risk assessment, screening, prevention, treatment, and survivorship in SM populations.

Position paper of the Italian association of medical oncology on health disparities among transgender and gender-diverse people: the Assisi recommendations

Transgender and gender-diverse individuals experience substantial health disparities across the cancer care continuum. Despite well recognized unique healthcare needs, there are barriers in accessing cancer prevention and treatment services, influenced by disadvantages in key social-economic determinants of health which result in worse clinical outcomes, as compared to the general population. The Italian Association of Medical Oncology (AIOM) acknowledges the critical relevance of this issue. The "Assisi Recommendations" here summarize the outcomes of the "AIOM Oncology Ethics Day" dedicated to gender differences in oncology and cancer care of transgender and gender-diverse people. The recommendations generated during a 2-day multidisciplinary discussion address the various aspects of cancer care experience of transgender and gender-diverse people. The promotion of research in this field, through the generation of new evidence and the collection of prospective data, has been identified as a priority action to mitigate these disparities. By acknowledging the challenges of cancer care in transgender and gender-diverse people and recognizing the need for dedicated policy and clinical recommendations, AIOM demonstrates its commitment to improving the health and well-being of all patients with cancer, regardless of their gender identity or any other personal or social circumstances, as part of health-for-all societal vision.

Sexual and gender minority cultural humility training for oncology settings: An example of iterative adaptation and implementation

Background

Multiple national organizations recommend that cancer care providers and oncology practices be responsive to the needs of sexual and gender minority (SGM) patients. Oncology practices have attempted to incorporate this recommendation through SGM-focused cultural humility training interventions. It is unclear how best to adapt and implement such training across practices. This manuscript outlines one process for adapting a widely-used SGM training from The Fenway Institute to the context of oncology settings using the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) model.

Methods

We conducted training sessions in two oncology care settings: a breast oncology center and a radiation oncology department. Subsequently, we conducted in-depth interviews with the three trainers involved in adapting The Fenway Institute's training to these two practices. Two independent investigators coded the interviews using components of the FRAME model as an analytic guide.

Results

Training team members described the mechanisms by which FRAME adaption occurred both proactively and reactively; the importance of involving SGM-identified trainers of diverse backgrounds as well as champions from within oncology practices in which trainings were conducted; the importance of adapting both the context and content of training to be relevant to oncology audiences; and the ways in which fidelity to the core principles of improving health care for SGM patients was maintained throughout the process.

Discussion

SGM cultural humility training for oncology providers and staff must undergo iterative adaptation to address the political and social context of specific practice environments and advocate for broader institutional culture change to achieve responsiveness to SGM health needs.