Protecting Transgender and Gender-Diverse Patients With Cancer in a Shifting Political Landscape

Abstract

An estimated 1.4 million adults and 150,000 youths in the United States identify as transgender and gender diverse (TGD), 1 and disproportionately experience negative health outcomes and discrimination in health care settings. These disparities extend to, and are amplified within, cancer care. In May 2019, the US Department of Health and Human Services (HHS) first proposed a regulatory reform to eliminate federal protections against health care discrimination on the basis of gender identity in Section 1557 of the Patient Protection and Affordable Care Act. This reform purportedly seeks to promote religious freedom and help reduce unnecessary costs to the American public. However, if implemented, the changes will substantially limit the rights of all patients while eliminating prohibitions against discrimination by insurers, hospitals, and individual providers. The burden of these changes will undoubtedly be felt by the LGBT community as a whole and represent especially imminent threats to the safety and health of our country's TGD people, including those with cancer. Within this context, we urge the oncology community to commit collectively to protecting and promoting the rights of our TGD patients to receive high-quality and inclusive cancer care.

Why Good Cancer Care Means Gender-Affirming Care for Transgender Individuals With Gendered Cancers: Implications for Research, Policy, and Practice

“…However, the decision to publish a single case study of a minoritized patient should be a collaboration between the researcher and the transgender individual, affirming a patient-centered approach and shared decision making. 5,30…”

“…However, the decision to publish a single case study of a minoritized patient should be a collaboration between the researcher and the transgender individual, affirming a patient-centered approach and shared decision making. 5,30 To address disparities in cancer care, there is also a need for more inclusive language to be applied to clinical studies so transgender individuals are included in these trials. 31 Future research should also explore the lived experience of transgender individuals who have a gendered cancer and investigate psychosocial interventions designed to improve their well-being and quality of life.…”

“…At the governmental level, adopting antidiscrimination policy would be a first step in helping transgender individuals feel more welcome in medical settings and ensuring their access to care. 30 Another policy implication is the need for all marriages, civil unions, and other nontraditional unions to be legally recognized, so partners have authority to be involved in the patient's care and, if necessary, to make medical decisions. 35,36 This would ensure that both members of a couple have access to important resources such as medical insurance, life insurance, and other financial benefits.…”

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

“…All institutions should ensure that nondiscrimination policies cover sexual orientation and gender identity along with other protected classes and that grievance policies are explicit and accessible for patients who have experienced discrimination. [149][150][151] Rooming policies should be based on gender identity rather than sex assigned at birth and should prioritize the safety of SGM people who are at greater risk of harm.…”

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

“…21 Many National Cancer Institutedesignated cancer centers lack antidiscrimination policies related to gender identity and expression, 22-24 yet such policies along with grievance policies are needed to ensure the safety of transgender people. [22][23][24] Thoughtful consideration should also be given to organizations and other institutions that an institution may partner with to ensure that their policies protect the safety of transgender people. For example, although partnering with a community-based organization that addresses social determinants of health may increase trust and increase access to care and clinical research, such an alliance may be counterproductive if the community-based organization is not welcoming of transgender people.…”