Representation of Sexual and Gender Minority People in Patient Nondiscrimination Policies of Cancer Centers in the United States

Abstract

Background: Sexual and gender minority (SGM) people are an underserved population who face high rates of discrimination in healthcare, including receipt of cancer treatment. Several national organizations have identified the importance of patient nondiscrimination policies that explicitly recognize SGM people in creating safe healthcare environments. Methods: We performed a web-based analysis of NCI-designated Cancer Centers to evaluate the landscape of patient nondiscrimination policies in major cancer centers with regard to representation of SGM people. Results: We found that 82% of cancer centers had a patient nondiscrimination policy on their website. The most commonly mentioned SGM-related term was “sex” (n=48; 89%), followed by “sexual orientation” (n=37; 69%) and “gender identity” (n=36; 67%). None of the policies included “sex assigned at birth” or “LGBTQ/SGM identity.” Of the policies reviewed, 65% included protections for both sexual orientation and gender identity. Cancer centers with academic affiliations were significantly more likely to have policies that included both of these protections compared with nonacademic institutions (100% vs 79%; P=.005). Conclusions: Our study shows that patient nondiscrimination policies across NCI-designated Cancer Centers are not always accessible to patients and their families online and do not consistently represent SGM people in their content. Because the SGM population is both at higher risk for cancer and for discrimination in the healthcare setting, it is crucial to create inclusive, safe, and equitable cancer care environments for this group. Administrators and clinicians should view the patient nondiscrimination policy as an opportunity to offer expansive protections to SGM people that extend beyond those offered in federal and state laws. Additionally, the patient nondiscrimination policy should be visible and accessible to patients seeking cancer care as a signal of safety and inclusion.

Overcoming LGBTQI+ Disparities in Cardio-Oncology

“…The incidence and prevalence of cancer in LGBTQI+ population remain unknown because no national health surveys or cancer registries comprehensively collect sexual orientation and gender identity data. 8 Unfortunately, LGBTQI+ people are still rarely included in cancer research so that there are significant limitations to the amount of robust data available on LGBTQI+ population with cancer. The quality of sexual orientation recording in routinely collected health data, if available, is poor, and this raises concerns around completeness and accuracy of analysis when using existing data.…”

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.…”

“…Transgender people are less likely to seek care at institutions where they experience stigmatization and may discontinue care after negative experiences with oncology clinicians. 21 Many National Cancer Institute–designated 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. 22-24 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.…”