Breaking News

Cancer Care Has A Long Way To Go To Meet LGBTQ Patients’ Needs

Cancer Care Has A Long Way To Go To Meet LGBTQ Patients’ Needs

A new national survey reveals LGBTQ patients have unique risk factors for cancer and oncologists admit they don’t know enough about them.

Cancer Care Has A Long Way To Go To Meet LGBTQ Patients’ Needs

The LGBTQ population’s health care needs are often different from those of cis-hetero patients when it comes to cancer detection and treatment. Gender minority individuals are at higher risk for certain kinds of cancers and barriers to health care for this group are well documented but even when these patients make it to the doctor’s office physicians probably unprepared to meet their needs. 

A new national survey of oncologists found that most providers feel they don’t know enough about the specific health needs of lesbian gay bisexual and transgender patients(LGBT). 

About 6 aspects of cancer care and prevention among LGBTQ patients including the effects of screening interventions lifestyle risk factors and access to health insurance many of the 149 oncologists that responded to the survey reported not knowing the facts or not being confident in their knowledge. All of the doctors work at National Cancer Institute designated cancer centers. 

“I continue to be surprised at how low the knowledge is.” Dr. Gwendolyn Quinn one of the study’s authors and a professor of population health at NYU Langone Health said.

The new survey was an expansion of a pilot study Quinn and her collaborators conducted in Florida and published in 2017 in which less than half of oncologists correctly answered knowledge questions related to LGBTQ patients.

I continue to be surprised at how low the knowledge is.
Dr. Gwendolyn Quinn, one of the study’s authors

The new survey asked a group of oncologists to review a similar set of questions about LGBTQ cancer care and say whether they thought the statements were true “Agree,” “Strongly agree” believed they were false “Disagree,” “Strongly disagree” or admit that they were not sure “Neutral/do not know”.

A very high percentage of providers responded “Neutral/do not know” to most questions including whether regular anal cancer screening for gay and bisexual men could increase life expectancy 47.7% if there was a higher prevalence of smoking among LGBTQ individuals 67.1% and whether transgender patients are less likely to have health insurance 57.7%.

Quinn said participants were asked about confidence in their knowledge of LGBTQ patients’ health needs at the beginning of the survey and then again after the knowledge questions. At the start of the survey 53% of oncologists felt really confident regarding lesbian gay and bisexual patients’ health needs and 37% felt confident regarding transgender patients’ health needs. After responding to the questions, the physicians’ confidence dropped to 39% and 19.5% respectively.

“I think it’s really sad if medical providers don’t even understand some of these basic points” Dr. NFN Scout deputy director of the National LGBT Cancer Network and an expert in transgender health said. “But of course it’s not taught in schools. On average medical schools provide less than an hour of information on the LGBTQ population it's not enough. Seriously how can we expect this to change until the systems that are a part of the medical world start to change?”

Meeting The Needs Of LGBTQ Patients

Differences in the risks and needs of LGBTQ cancer patients stem from social and economic lifestyle and challenges factors. Data show adults in the U.S. are less likely to have jobs and health insurance. But even with health insurance (LGBT) adults are more likely to delay medical care compared to their heterosexual counterparts a fact that is particularly worrisome given the importance of early cancer detection for treatment and survival.

“We have seen this again and again that exposure to discrimination or even fear of discrimination from health care providers and health care systems can actually lead to health care avoidance” Dr. Megan Sutter said another author on the study and an OBGYN at NYU’s School of medicine. “In the case of cancer treatment if you are not screening appropriately getting preventive care and are also delaying potential treatment it can have detrimental effects.”

Barriers to health care are even greater for transgender Americans who have even higher rates of poverty unemployment homelessness and poor health linked to discrimination and a general lack of legal protections. 

“Out of the LGBTQ population the trans population often experiences the most extreme health discrimination the most extreme barriers to care the most extreme level of societal exclusion”said Scout. “We are often poor we are often suicidal. We are often struggling to get work and certainly struggling to get health care.”

Also there are behavioral and lifestyle factors which increase LGBTQ individuals’ risk for some kinds of cancers according to Quinn. 

“For instance women who don’t ever have a child have increased risk for gynecologic cancer and women that identify as lesbian are less likely to have a child though certainly many of them do,” said Quinn who is done separate research into how some cancers disproportionately impact LGBTQ individuals. “People who engage in receptive anal intercourse have increased risk for HPV related anal cancer.”

Cigarette smoking among LGBTQ individuals in the U.S. is higher than among heterosexual Americans  leaving the population at higher risk for many forms of cancer including cervical cancer lung cancer and colon cancer.  Higher smoking rates in the community are likely due to stigma related stress and lack of access to tobacco treatment according to the American Lung Association.

Cancer Care Has A Long Way To Go To Meet LGBTQ Patients’ Needs

Changing The System

One big step toward understanding the LGBTQ community’s cancer risks and meeting their needs is for doctors to collect data on the sexual orientation and gender identity of their patients Scout said.  Something he noted is recommended by the American Society of Clinical Oncology (ASCO).

 “Providers Unfortunately rarely collect sexual and gender minority data in health records so that means that we don’t have cancer related data for our population,”Scout explained. 

Most physicians that responded to the survey said that they felt it was important to know the sexual orientation and gender identity of their patients 63% said their institution’s intake forms did not inquire about a patient’s sexual orientation 54% said they did not inquire about a patient’s sex at birth and 55% did not inquire about current gender identity.

Many providers insisted they would treat all their patients the same regardless of how they identified. This is a nice sentiment in theory she said but in practice doctors should be prepared to tailor prevention discussions and treatment options to LGBTQ individuals’ specific needs. Quinn said. 

Referring to the survey section from which results have not been published “Many physicians would respond ‘I treat all my patients the same I give them all good care so I don’t need to know this.’ So we have a duty to help physicians understand why they need to know the sexual orientation and gender identity of their patient. And what they can do about it once they have that information.”  Quinn said 

“I would only hope that evidence like this can help move people to take steps to remedy the situation,” said Scout referring to the survey’s findings. “I don’t think anyone is proud of offering substandard care to one element of the population.”

Researchers found one bright spot: Roughly 70% of respondents said they were interested in receiving education regarding (LGBTQ) patients’ unique health needs.

The solution requires more than the efforts of individual providers to improve their own practices Scout argued underscoring the need for reform in the medical community.

"A rainbow sticker in your office doesn’t say we do it perfectly or we suddenly become experts but it says we are willing to learn." NFN Scout deputy director of the National LGBT Cancer Network

“We need to change systems to solve this problem; we need all the medical schools to change their curriculum routinely. We need professional societies like ASCO to provide more detailed information to their member doctors on the subject” he said organizations should also provide accreditation that includes competency in LGBTQ needs and fund research that helps support prevention campaigns. “There are a lot of different system changes that need to happen to fix this.” 

“We think physicians are a great place to start but we know for patients to get the best possible care that institutions need to be trained from the nurses to schedulers to the valet about culturally relevant interactions.” Quinn agreed. 

Small changes can make important differences. Providers can make their offices more welcoming to LGBTQ individuals by doing things like making intake forms and health promotion materials more inclusive. Scout said.

“We have a long history of problems with the medical system which means we come in wary. If you are trying to be a welcoming provider it’s really up to you to provide some sign of welcome and that can be as literal and as small as a rainbow sticker in your waiting room. Those are the kinds of things that help us relax.” he said.

No comments