Addressing Barriers to Clinical Trial Participation for Transgender People With Cancer to Improve Access and Generate Data

Abstract

The opinions expressed in this article are those of the authors and do not necessarily reflect the views or policies of the authors' affiliated institutions. SUPPORTA.B.A. was supported by AHRQ T32 (HS000011).

Debunking Sex and Disentangling Gender From Oncology

“…ASCO, with the guidance of some manuscript authors, recently changed their guideline template to include a paragraph stressing the importance of gender-neutral language, 11 which is now being incorporated into ASCO guidelines. 12 This may encourage researchers to change eligibility criteria, 13 clinicians to change language with patients, and institutions to change clinic names, bathrooms, and position titles to reflect the varied bodies, experiences, and identities of people with cancers, especially those that have previously been associated with specific genders.…”

Diversity in Cancer Care

“…Other groups, for example, such as adolescents and young adults, often experience lack of availability and access to clinical trial programs 14,15 . Sexual and gender minorities including those from the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) populations are regularly impeded by societal stigma and discrimination, which leads to decreased cancer clinical trial visibility, access, and participation and inclusion 16,17 . An overarching barrier among all underserved populations is the lack of public awareness and clinical trial understanding.…”

“…14,15 Sexual and gender minorities including those from the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) populations are regularly impeded by societal stigma and discrimination, which leads to decreased cancer clinical trial visibility, access, and participation and inclusion. 16,17 An overarching barrier among all underserved populations is the lack of public awareness and clinical trial understanding. Although the issues and solutions discussed in this article are mainly that which fit in a generalized experience of racial and ethnic marginalized groups, we recognize that the challenges each group experiences are unique and acknowledge that effective and sustainable solutions must take these specific experiences into consideration.…”

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

“… 20 However, transgender and gender-diverse people are not often included in cancer clinical trials because of several barriers such as social-economic marginalization, which may hinder access to the main research cancer centers, previous experiences of discrimination in healthcare settings, and clinical trial protocol language and inclusion/exclusion criteria that may implicitly exclude transgender and gender-diverse individuals. 4 Such exclusion does not only limit our understanding of the unique challenges that transgender and gender-diverse people may face when it comes to cancer prevention, diagnosis, and treatment, but also perpetuates health disparities and inequalities in these individuals, as they may not have access to the latest treatments and therapies. 21 …”

“… 3 They often experience multiple barriers to cancer prevention and screening, face major challenges in accessing and receiving timely, quality cancer care, and are largely under-represented in clinical trials. 4 Disparities in the access to best cancer care commonly result in delayed diagnoses, poor adherence to screening programs, and worse clinical outcomes when compared to general population. 5 , 6 …”