People who identify as lesbian, gay, bisexual, transgender, and queer experience more cancer-related health disparities compared with those who identify as heterosexual (and partner with only opposite-sex individuals). Cancer incidence, for example, is more prevalent in men who are gay and women who are bisexual; disparities in people who identify as transgender are less known because that information is not collected in epidemiological studies, according to a recent "Comments and Controversies" article in the Journal of Clinical Oncology (2020; doi: 10.1200/JCO.19.03300).
Furthermore, a minority of oncology care providers (physicians, nurses, and advanced practitioners) report feeling adequately prepared to address these disparities-and a majority want more education on how to address the needs of these patients, the paper reports.
"However, few training programs have collected data regarding whether training is effective. To optimize the delivery of cancer care and reduce cancer disparities among SGM patients, we must decide which measures will tell us whether clinician training programs work," the paper's coauthors note. (The authors use the term "sexual and gender minority (SGM) individuals" to refer to those who identify as lesbian, gay, bisexual, transgender, and queer.)
They argue that more research is needed to determine which types of SGM cultural humility training programs work and more validated measures to assess the outcomes of those programs are needed. The coauthors explain more about a framework for evaluating these programs and measures.
In an interview with Oncology Times, one of the paper's coauthors, Gwendolyn P. Quinn, PhD, the Livia Wan MD Endowed Chair and Professor of Obstetrics and Gynecology, as well as Professor of Population Health at NYU Grossman School of Medicine, commented further on the framework she and her coauthors published and the work they say needs to be done.
1 Why did you and your coauthors decide to write this editorial now?
"We have submitted several grants that focused on training clinicians to improve cultural humility for the care of LGBT patients with cancer. The comments always came back asking what the patient outcomes would be. I think it's a stretch to say a patient is going to have a biologically better outcome if they have a culturally humble clinician. However, it is important to measure a patient's experience with care-and one would expect that culturally humble and trained clinicians would contribute to the patient having a better experience and feeling more psychologically safe.
"So we wrote the article trying to highlight those things. And along the way of looking at what had been done in the past, [we] discovered there are poor tools for measuring SGM cultural humility on the part of clinicians, as well as patients.
"The framework [in this paper] or ones similar provide the basis for training and how to measure the impact of that training. We have to incentivize clinicians to get the training. It's true that the majority want to do what is best for their patients and want to know their patients, but even with a good heart mistakes can be made that create a negative environment and make a patient feel 'othered' or not understood."
2 You argue that currently many providers want more education on addressing SGM-specific health disparities, but current efforts to do so are lacking. What are the shortcomings of those efforts?
"Clinicians want training. The challenges are finding the time to get it and having access to training in ways that make sense for their schedule.
"The majority of trainings that are out there are not specific to oncology. They are on general LGBT health-but oncology is different than traditional health care. It is scary, it may not always have good outcomes, and it is life-consuming.
"Another issue is providers not thinking they need training-they say, 'I am a good doctor/nurse; I treat all my patients the same.' When in fact that [attitude] defies what makes good health care experiences. For the providers to really know you, [they should know] who your support people are and what your goals are."
3 What is the solution that will help address these disparities and what is most important for cancer care providers to know about addressing the gaps in SGM-specific care in oncology?
"Training: continuing education that is tailored to the needs and position. It isn't just doctors and nurses who need training, everyone in the system needs training, from the person who schedules appointments to the staff to the CEO.
"The majority of the gap is communication and knowledge, but it is also the environment. Imagine a transgender man having to get care at the 'women's breast center' and being given a pink gown to wear; or a non-binary person having to choose to go to the 'ladies' or 'men's' bathroom; or a Black lesbian woman with breast cancer handed a brochure on sexual health after cancer with a white cisgender couple. The current oncology environment creates a very heterosexual and cisgender friendly space, which is not friendly to anyone who is not those things.
"And intersectionality is also important. A person is not just a gay transgender man-they have other identities which are important to their sense of self. It could be race or religion, too."