Gender- and Sexual Orientation– Based Inequities: Promoting Inclusion, Visibility, and Data Accuracy in Oncology

Abstract

Sexual and gender minority (SGM) people, including agender, asexual, bisexual, gay, gender diverse, genderqueer, genderfluid, intersex, lesbian, nonbinary, pansexual, queer, and transgender people, comprise approximately 10% or more of the U.S. population. Thus, most oncologists see SGM patients whether they know it or not. SGM people experience stigma and structural discrimination that lead to cancer disparities. Because of the lack of systematic and comprehensive data collection, data regarding SGM cancer incidence, outcomes, and treatment responses are limited. Collection of data regarding sexual orientation, gender identity, transgender identity and/or experience, anatomy, and serum hormone concentrations in oncology settings would drastically increase collective knowledge about the impact of stigma and biologic markers on cancer outcomes. Increasing the safety of oncology settings for SGM people will require individual, institutional, and systems changes that will likely improve oncologic care for all patients.

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

“…In this regard, we believe that only a comprehensive and prospective data collection of gender identity as well as the inclusion of TGD patients in clinical trials would enrich the incomplete knowledge of clinicians and improve the quality of care provided to the patients at the same time, creating a win–win scenario. 37 …”

Social Determinants of Health and Cancer Care: An ASCO Policy Statement

“…2 Structural barriers to cancer care exist because of many such social risk factors, such as educational attainment, SES, geographic location, or sexual/gender minority status. 10,11 These barriers can impede an individual's access to appropriate cancer screening, leading to a cancer diagnosis at a later stage and ultimately contributing to the well-known and persistent disparities in cancer outcomes that are often seen between subpopulations. This includes racial/ethnic disparities, such as with breast cancer in Black women.…”

“…Systematic SDOH data must be collected across the cancer continuum leveraging published measures for both adverse and protective SDOH. 11…”

State of Cancer Care in America: Achieving Cancer Health Equity Among Sexual and Gender Minority Communities

“…Several manuscripts on SGM trainings have been published in ASCO journals, including Journal of Clinical Oncology (JCO). [19][20][21][22] These publications have begun moving away from the idea of cultural competence and toward the concept of cultural humility, which advocates for an orientation toward patient centeredness and lifelong learning. Since the 2017 ASCO position statement, opportunities for SGM-relevant cultural humility training in oncology are more widely available, including the Together Equitable Accessible Meaningful Cancer Care for SGM Patients training offered at no cost by George Washington University and the Welcoming Spaces Program from the National LGBT1 Cancer Network in association with the Society of Gynecologic Oncology.…”

“…SOGI data implementation has historically underemphasized assessment of intersex individuals and those with disorders of sexual development, and the cancer-related needs of these populations are largely unknown and unexamined. 19,29,30 Finally, although research funding has increased in some areas, more training for and grants to early-stage investigators interested in SGM cancer research are still needed to ensure a strong pipeline of researchers.…”