Initiative seeks to educate providers, improve care for LGBTQ+ patients with cancer
The LGBTQ+ community faces unique challenges in terms of cancer diagnosis and management.
From the use of preferred pronouns to awareness of elevated risks for some cancers among the LGBTQ+ population, several issues specific to this community are poorly understood and infrequently discussed.
A new initiative at NYU Langone Health’s Perlmutter Cancer Center aims to address these issues and create a more inclusive environment for LGBTQ+ patients by raising awareness among the hospital’s providers and staff.
Developed in conjunction with clinicians at NYU Langone’s transgender surgery services team, the program is led by Abraham Chachoua, MD, the Jay and Isabel Fine professor of oncology in the department of medicine and associate director of cancer services at Perlmutter Cancer Center. It was inspired in part by the research of Gwendolyn P. Quinn, PhD, the Livia S. Wan, MD, professor of obstetrics and gynecology in the department of obstetrics and gynecology, and professor in the department of population health at NYU Langone Health.
One study by Quinn and colleagues showed that only half of oncologists feel confident in their knowledge of LGBTQ+ health issues.
“Dr. Quinn did a couple of interesting studies. The first assessed the attitudes of oncologists based in a cancer center when treating a person who is LGBTQ+,” Chachoua said in an interview with Healio. “It showed that doctors were not very familiar, but they were willing to learn.”
Chachoua spoke with Healio about NYU’s history of treating the LGBTQ+ population, the pillars of the new initiative and the impact of COVID-19 in delaying its launch.
Question: How did this initiative come about?
Answer: When I first started at NYU, it was the epicenter of HIV. We had a large LGBTQ+ population. More importantly, we recruited Dr. Quinn, who came to us from Moffitt Cancer Center and had done these studies. The second paper she wrote looked at which cancers the LGBTQ+ population is at increased risk for and why.
Q: What did she find?
A: She reported increased risks for certain cancers. In some cases, we don’t know why the risks are higher, but in a lot of cases, we do know. For example, there’s a high incidence of smoking among the LGBTQ+ population, so these individuals may be at higher risk for lung cancers or smoking-related cancers purely due to smoking.
Another interesting finding was that people who undergo gender-affirming surgery are less likely to receive certain screenings. For example, for a patient who has transitioned from male to female, we might overlook the prostate. It is not comfortable to get a prostate exam if you are a woman. Imagine being outwardly female and going to a urology office for a prostate exam. It’s an odd situation for that patient. Likewise, in cases of female-to-male transition, there may be breast tissue remaining after surgery. This doesn’t get as much attention as it would otherwise in terms of screening.
There also are hormonal considerations for patients who have undergone surgery, including the implications of longer-term exposure to hormones. Little is known about that. Additionally, there might be barriers to screening related to patient awareness. When I read these two papers, knowing that we have this big program here, I said, “The cancer center should really do something in terms of screening, prevention and early detection for this group.” That’s what led me down this path.
Q: What has the initiative done so far?
A: We’ve been a bit derailed by COVID-19, but we are preparing to start over.
The first important pillar of a program like this is education of physicians. I consider the second pillar to be some form of screening for early detection of lung cancer. I’ve put together a group of people who also are also interested in this topic, including representatives of NYU’s LGBTQ+ Youth Council.
In terms of education, we plan to develop a questionnaire very similar to the one Quinn used to study physician and staff knowledge and comfort with LGBTQ+ patients. We hope to roll that out in the next few months. We’ve had at least a couple of lectures to introduce the topic to the faculty. There are several educational programs out there for physicians, and we’re trying to find the best one for our staff and faculty.
Another thing we are going to do at the cancer center is find out the preferred pronoun to use to address people. If you look at a patient’s charts, that’s not always there. We’re going to institute a program where we ask that question of every new patient and incorporate that in our discussions.
We also formed a Patient Advisory Board, which met once before the pandemic but has not met since. One of the things we determined was that we needed to establish safe spaces. We have about 20 radiology facilities, but maybe one should be where LGBTQ+ patients mostly go and the staff is trained.
We’re trying to get some ideas in terms of laboratory research. Once we’re up and running, we might biobank tissue of people who have had surgery and see where that gets us.
Fortunately, some faculty here are very, very interested in and focused on this. It will be important for us to establish a presence. One important thing that I’m trying to do is establish linkages. Various community organizations in New York City are very focused on LGBTQ+ issues, and we need to be able to work with these folks to establish better parameters for screening and early detection. It is, I think, a work in progress.
For more information:
Abraham Chachoua, MD, can be reached at 160 E. 34th St., 8th Floor, New York, NY 10016.