Cancer care in transgender and gender-diverse persons: results from two national surveys among providers and health service users by the Italian Association of Medical Oncology

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

“… Participants: representatives of AIOM and Fondazione AIOM, institutional and governmental stakeholders, HCPs involved in the care of patients with cancer (medical oncologists, surgeons, general practitioners, psycho-oncologists, nurses), jurists, philosophers, theologians, journalists, LGBTQIA + communities such as the Italian association of LGBTQIA + medical care providers (AMIGAY), and the Association for transgender culture and ethics (ACET), patients and their representatives, and representatives of other scientific societies. Topics: based on the data presented in our previous narrative review 7 and national surveys, 8 ten macro-areas were identified and further explored during the discussions that took place over the course of the two working days. The topics covered included: gender identity data collection, clinical trial inclusion, creation of inclusive environments, screening, coordination between gender affirming care and cancer treatments, psychological dimensions of cancer care, HCPs training, primary prevention education for transgender and gender-diverse youth, the social-economic drivers of marginalization, collaboration with LGBTQIA + associations.…”

“…Topics: based on the data presented in our previous narrative review 7 and national surveys, 8 ten macro-areas were identified and further explored during the discussions that took place over the course of the two working days. The topics covered included: gender identity data collection, clinical trial inclusion, creation of inclusive environments, screening, coordination between gender affirming care and cancer treatments, psychological dimensions of cancer care, HCPs training, primary prevention education for transgender and gender-diverse youth, the social-economic drivers of marginalization, collaboration with LGBTQIA + associations.…”

“…Transgender and gender-diverse individuals seem to be less likely to adhere to cancer screening programs because of structural barriers. 8 , 37 For example, during the meeting, we learnt that in Italy, citizens in the national healthcare system receive a letter of invitation to participate to population-based screenings based on the gender assigned at birth, or re-assigned. This means that individuals who undergo gender affirmation and get the legal gender recognition are then excluded by risk-appropriate screening programs because invitations are only based on the gender, assuming the population is only cis-gender.…”

“…Several cross-sectional studies and surveys, conducted in Europe, United States, and Australia have demonstrated how most oncologists recognize their limited knowledge regarding the unique needs of transgender and gender-diverse individuals in oncology, especially in terms of primary and secondary prevention. 8 , 13 , 38 , 39 , 40 , 41 , 42 It has also been highlighted that oncologists do not feel adequately equipped and confident to provide optimal care for transgender patients. Across all these studies, most respondents expressed the desire for this topic to be better addressed in medical schools, residency programs, and professional training.…”

“…This event marked the concluding step of a more extensive project that began with the release of a scoping narrative review summarizing the existing knowledge regarding cancer care in transgender and gender-diverse individuals 7 and a survey-based study which presented a snapshot of the experiences, viewpoints, and inclinations of healthcare professionals (HCPs) and the transgender community in Italy. 8 Building on the foundation laid by these preceding endeavours, the stakeholders engaged in discussions leading to the recommendations here presented, designed to facilitate substantial change.…”