ASCO: Coordinated effort needed to provide high-quality care to sexual and gender minorities
Sexual and gender minorities diagnosed with cancer may encounter specific challenges, including discrimination and greater risks for anxiety and depression, according to an ASCO guideline published in Journal of Clinical Oncology.
“Sexual and gender minorities face unique challenges related to cancer risk, discrimination and other psychosocial issues,” ASCO president Daniel F. Hayes, MD, FASCO, FACP, said in a press release. “Compounding these challenges is the fact that providers may have a lack of knowledge and sensitivity about the health risks and health needs facing their sexual and gender minority patients.”
Individuals who are lesbian, gay, bisexual, transgender and intersex (LGBTI) bear a disproportionate cancer burden. Lesbian and bisexual women, for example, have higher rates of obesity and a greater risk for breast cancer. Gay men have a greater risk for anal cancer, and people who are LGBTI are more likely to smoke cigarettes than heterosexuals.
Sexual and gender minorities also are less likely to have cancer screenings, in part because of lower rates of insurance coverage or previous experiences with health care providers, and as a result may be more likely to present with late-stage disease.
Because of fear of discrimination and stigmatization, sexual and gender minorities often do not disclose their sexual orientation to health care providers, which may create additional barriers to care.
Also, a lack of information on sexual orientation and gender identity in large databases often leads to gaps in the knowledge base about the disease burden, quality of care, opportunities for improvement, and research needs for sexual and gender minorities.
Among its recommendations — which were reviewed by the Gay and Lesbian Medical Association —ASCO calls for a coordinated effort to address the following patient-level strategies:
Enhance patient education and support by providing resources addressing the most common types of malignancies and risk behaviors affecting the sexual and gender minorities community, as well as the effects of treatment and appropriate follow-up care, including the creation of safe and welcoming environments;
Provide LGBTI cultural competency and sensitivity training to health care providers to address the unique issues and concerns of sexual and gender minority communities;
Revise all data forms, especially electronic medical records, to include sexual orientation and gender identity variables in quality-of-care metrics, to allow sexual and gender minority populations to accurately record their medical history and receive useful and specific information on the basis of those variables;
Ensure adequate insurance coverage and inclusion in diagnostic testing, provide gender-neutral bathrooms in cancer care facilities and promote policies prohibiting discrimination; and
Increase research to determine patterns of risk, promote inclusion of sexual and gender minority individuals in cancer registries and clinical trials, and promote an increase in research among these populations.
“Our objective was to raise awareness among oncology providers, patients, policy makers, and other stakeholders about the cancer care needs of sexual and gender minority populations and the barriers that sexual and gender minority individuals face in getting the highest-quality care,” Jennifer J. Griggs, MD, MPH, professor in the department of internal medicine, hematology and oncology division at the University of Michigan, said in the release. “To address these barriers, a coordinated effort is needed to enhance education for patients and providers, to improve outreach and support, and to encourage productive policy and legislative action.”
In the statement, ASCO said these recommendations are aimed at raising the quality of care and health maintenance for the sexual and gender minority population, as well as for members of the oncology workforce who identify as members of these communities.
“The hope is that implementing these recommendations will bring us closer to the goal of providing high-quality cancer care to everyone, regardless of their sexual orientation or gender identity,” said Karen Winkfield, MD, PhD, chair of ASCO’s health disparities committee and associate professor of radiation oncology at Wake Forest Baptist Comprehensive Cancer Center. – by Chuck Gormley
Disclosure: Please see the full statement for a list of all authors’ relevant financial disclosures.