ASCO Seeks to Better Care for Sexual and Gender Minority Patients With Cancer

The American Society for Clinical Oncology (ASCO) is putting more of a focus on meeting the needs of sexual and gender minority (SGM) patients, and recent published a policy statement with treatment recommendations for this group.

“Our objective was to raise awareness among oncology providers, patients, policymakers and other stakeholders about the cancer care needs of SGM populations and the barriers that SGM individuals face in getting the highest-quality care,” explained Jennifer Griggs, M.D., M.P.H., the statement’s lead author. “To address these barriers, a coordinated effort is needed to enhance education for patients and providers, to improve outreach and support, and to encourage productive policy and legislative action.”

Sexual and gender minorities include, as described by the National Institutes of Health, individuals who are lesbian, gay, bisexual and transgender, those whose sexual orientation and/or gender identity varies, those who do not self-identify as LGBTI specifically, and those who have a specific medical condition which affects reproductive development, sometimes referred to as intersex.

The statement explains that “members of the SGM communities are at risk for suboptimal access to cancer prevention, screening, and high-quality cancer care.” Issues within the SGM population such as discrimination and a greater risk of anxiety and depression can contribute to suboptimal care and are addressed in the statement, along with the concrete steps to rectify disparities.

The recommendations cover five areas: patient education and support; workforce development and diversity; quality improvement strategies; policy solutions and research solutions.

These populations bear a larger cancer burden, stemming from factors that include hesitancy on the part of SGM patients to disclose their sexual orientation to providers because of a fear of stigmatization. This fear is one example of unique challenges that patients in this population may face. Others can be estrangement from family of origin or distrust of medical institutions and of individual providers.

A larger cancer burden among SGM patients can also be the result of lower rates of cancer screenings caused by lower rates of insurance coverage, exclusion from traditional screening campaigns, and previous examples of discrimination within the health care system.

Sometimes, it can even be the health care provider contributing to the suboptimal care. As Daniel Hayes, M.D., F.A.S.C.O., F.A.C.P., and ASCO president, explained: “Compounding these challenges is the fact that providers may have a lack of knowledge and sensitivity about the health risks and health needs facing their SGM patients.”

In the statement, which was reviewed by the Gay and Lesbian Medical Association (GLMA), ASCO called for coordinated efforts to address those health disparities.

The recommendations cover efforts such as:

• Patient access to culturally competent support services
• Cancer prevention education for SGM patients
• Policies to prohibit discrimination
• Insurance coverage to meet the needs of SGM patients affected by cancer
• Inclusion of SGM status as a required data element in cancer registries and clinical trials
• Focus on SGM populations in cancer research

The statement is aimed at raising the quality of care and health maintenance not only for SGM patients, but for oncology professionals who identify as members of the SGM community as well. ASCO lays out steps to provide safe environments and increasing the number of SGM health care staff as part of workforce diversity efforts.

Karen Winkfield, M.D., Ph.D., and Chair of ASCO’s Health Disparities Committee, said, “The hope is that implementing these recommendations will bring us closer to the goal of providing high-quality cancer care to everyone, regardless of their sexual orientation or gender identity.”