Every urologist and oncologist should know about treating sexual and gender minority prostate cancer patients: translating research findings into clinical practice

Abstract

In 2016, the NIH designated sexual and gender minorities (SGM) a health disparity population.The next year, the American Society of Clinical Oncology highlighted the need to improve the suboptimal cancer and survivorship care received by SGM populations. There are currently no evidence-based training programs in culturally competent care of prostate cancer patients who are gay, bisexual and/or transgender. In this selective review, we summarize findings from the largest quantitative studies focused on sexual minority prostate cancer survivors and from 65 interviews with NIH staff, clinicians, and cancer clinics in 11 US cities.The report is divided into three parts and uses a question and answer format to address 21 questions relevant to clinicians providing care to SGM prostate cancer patients. First, we identify population-specific issues that are culturally relevant in the care of SGM patients with prostate cancer. While a body of research has emerged on sexual minority prostate cancer patients, the literature on gender minorities is limited to single case reports and inadequate to inform practice. This review covers definitions, population size, cultural and historical context, sexual behavior, population invisibility, sexual orientation and gender identity (SOGI) in the electronic medical record, disparities and evidence of discrimination in treatment provision. The second part focuses on promoting evidence-informed, patient-centered care. This includes current practices in assessing sexual orientation, management of disclosure of sexual orientation, how to address common problems sexual minority men experience post-treatment, common questions sexual minority patients have, management of urinary incontinence, HIV and STI risk during and post-treatment, and sub-groups of sexual minority patients with worse outcomes. It then identifies how male partners differ in prostate cancer support, current research on rehabilitation for sexual minority men, issues in advanced prostate cancer, and things to avoid with minority patients. Finally, we examine the cultural divide between provider and patient, advocating for cultural humility when working with minority patients. Training programs and continuing education can help providers both to become more aware of their own cultural assumptions, informed about health disparities, and able to provide quality care, and to make clinics more welcoming to SGM patients. 2 Rosser et al. Treating SGM prostate cancer patients

Health Disparities of Sexual Minority Patients Following Prostate Cancer Treatment: Results From the Restore-2 Study

“…orientation as standard practice. When discussing treatment options, clinicians need to review the differential effects of treatment on insertive and receptive sexual functioning (6). In addition to sex, providers need to ask about urinary, bowel and hormonal function in sexual minority patients, and identify rehabilitation goals as appropriate.…”

“…In addition to sex, providers need to ask about urinary, bowel and hormonal function in sexual minority patients, and identify rehabilitation goals as appropriate. This may require additional time with sexual minority patients (6).…”

“…Where providers are less comfortable in treating sexual minority patients, supplemental training should be provided. Some providers may feel they strive to provide the same high quality care to all patients (6). Such providers need to be educated in the difference between equality and equity in healthcare (27).…”

“…In addition, we produced videos modeling how sexual minority men with PCa deal with sexual challenges (e.g., disclosing PCa to a sex partner); a male couple discussing how they have good sex, post-treatment; a FAQ section where participants could ask questions and read answers from experts; and a tracking program where users could monitor their rehabilitation. (6). Social support: Given the lack of social support gay and bisexual men experience and our needs assessment results showing this as a priority, participants could access to a monitored noticeboard group where they posted questions to other peers and could respond.…”

“…Of the 3.1 million men diagnosed with prostate cancer in the US, about 63,000 are sexual minorities (6). Only six quantitative studies of sexual minority prostate cancer patients have been conducted (7)(8)(9)(10)(11); and of these, only three used standardized patient-reported outcome measures (11)(12)(13).…”