Pursuing Quality Cancer Care for Sexual and Gender Minority Patients

According to LGBT HealthLink, lesbian, gay, bisexual, and transgender people are at an elevated risk for several types of cancer, including lung, anal, breast, and prostate. In addition, LGBT cancer survivors are 60 percent less likely than others to self-report good health and twice as likely to smoke than are heterosexuals. The healthcare community is increasingly recognizing that the social and economic factors that disproportionately affect LGBT+ people can have negative repercussions on their health, creating a mounting public health issue.

The National Coalition for Cancer Survivorship (NCCS) held its 2019 Cancer Policy Roundtable on November 14 in Washington, D.C. Among the topics featured was a dynamic presentation on the health disparities that sexual and gender minority (SGM) communities experience. Speaker Matt Schabath, PhD, an Associate Member at the Moffitt Cancer Center in Florida, discussed how patients who identify as SGM are often misrepresented or overlooked in healthcare. Included in sexual and gender minority communities are any individuals who do not identify as heterosexual or cisgender (i.e., individuals whose gender identity matches with the sex they are assigned at birth). Dr. Schabath's presentation brought to light the issues these SGM communities face and what oncology professionals can do to improve quality cancer care for SGM individuals.

According to Dr. Schabath, 3.4 to 12 percent of the adult population in the U.S. identifies as LGBTQ. Although a vast number of studies have aimed to quantify the number of LGBTQ students in the U.S., adults are not as well represented in research. Therefore, studies aimed to determine the population of SGM individuals tend to produce a large, fluctuating percentage. This statistical misrepresentation extends into the healthcare community, creating a gap in provider education and ultimately in patient care. Some of today’s healthcare professionals may still be unfamiliar with the LGBTQ community and the specific cancer-related health risks associated with this group.

Dr. Schabath says that although social acceptance has grown for SGM communities, LGBTQ-specific health risks and recommended screenings are not consistently taught to healthcare providers and SGM patients. After comparing health disparities for SGM populations over the last decade, Dr. Schabath concludes that, “Researchers are seeing the same disparities in 2019 as we did in 2009.”

Dr. Schabath enumerated several barriers to quality cancer care in SGM communities, including:

• Marginalization in society, being underserved and stigmatized
• Inability to obtain or afford health insurance
• Increased risk for depression, anxiety, eating disorders, and suicide
• Higher likelihood of remaining silent about important health issues
• Providers’ limited, or lack of, knowledge of SGM healthcare needs, including screening for higher-risk cancers
• Providers’ negative attitudes toward SGM communities
• Lack of culturally sensitive intake forms, resources, and referrals

To reduce these barriers, Dr. Schabath suggests promoting and collecting SGM information whenever patient demographics are collected. This could mean adding language that asks patients their preferred name and pronouns to create gender-neutral intake forms. Dr. Schabath explains this eliminates unintended discrimination and helps all patients feel welcome and comfortable. He also warns, however, that collecting this information can be a “double-edged sword.” Recent initiatives aimed at collecting SGM demographics have met with some pushback from LGBTQ patients who want to know why this data is being collected. Dr. Schabath urges providers to educate patients about why such information is needed and how it will be used.

Dr. Schabath also urges providers to create a welcoming and inclusive environment in their office and to employ cultural sensitivity when interviewing patients. He explains that when a patient refers to their husband or wife, the provider should follow suit. Healthcare professionals should remain respectful of all patients, educating themselves about SGM communities and their health risks and simply asking questions if they do not know the answer.

Exhibiting such openness is vital. In a nationwide survey of oncologists to identify potential gaps in attitude and knowledge regarding LGBTQ patients, Dr. Schabath found that while a majority of oncologists (95 percent) are comfortable treating lesbian, gay, and bisexual patients, only 53 percent are confident they know the health needs of these patient populations. And only 37 percent said they feel they understand the needs of transgender patients.

Mandi Pratt-Chapman, MA, PhD, and Jennifer Potter, MD, aim to help fill this provider learning gap with their recent Oncology Issues article, “Cancer Care Considerations for Sexual and Gender Minority Patients.” The authors suggest a series of initiatives providers can adopt throughout the cancer care continuum to help SGM patients feel safer in clinical environments.