A new report in JCO Oncology Practice published today outlines progress made towards reducing cancer disparities among sexual and gender minorities (also known as LGBTQ+ individuals) and achieving equity across patient education and support, workforce development and diversity, quality improvement, policy, and research since the American Society of Clinical Oncology’s (ASCO) 2017 position statement. The report also highlights current efforts and future directions for continued progress to achieve equity.
The COVID-19 pandemic placed a spotlight on already-existing disparities among sexual and gender minorities (SGM)1, as well as Black, Asian, and Pacific Islander individuals, given the rise of discrimination among these communities. The authors note that these events, combined with the exposure of inequities within the U.S. health care system, have galvanized national interest in health equity issues. These events were also accompanied by a reactionary surge in discriminatory legislation directly impacting SGM communities.
“While there have been strides and successes in reducing inequities among SGM populations, there is still much work to be done in areas such as data collection on sexual orientation and gender identity, policies and trainings that educate on and promote gender-affirming care, representation of SGM individuals across the oncology workforce, and research on the experiences of SGM practitioners and patients within the cancer care system,” said Charles S. Kamen, PhD, lead author of the report and co-chair of the ASCO Sexual and Gender Minorities Task Force.
Since its 2019 inception, among its accomplishments, the task force has executed the following:
- Provided recommendations around collecting data on sexual orientation and gender identity (SOGI) in the context of oncology.
- Supported research on factors related to SOGI data collection in oncology settings.
- Promoted training for the oncology workforce around SGM health disparities.
- Encouraged participation of SGM trainees and students in ASCO’s Oncology Summer Internship.
- Observed several non-profits and academic centers develop support groups, patient education materials, sexual health and screening programs designed to support to SGM patients.
- Developed guidance on best practices for including SGM patients in clinical trials.
- Recommended resources for ASCO’s Caring for LGBTQ+ Individuals web page.
In addition, ASCO has advocated for the inclusion of SOGI as a required data element in cancer registries and clinical trials, called for an increase in research on cancer in SGM populations, and appealed for de-gendering oncology research eligibility criteria and treatment guidelines.
Report findings are summarized in a side-by-side comparison of recommendations made in the 2017 statement with current and future recommendations. These recommendations address the following areas:
- Quality Improvement: Organizational change and support to collect data on SOGI for quality improvement which may include cancer centers signing onto standardized, inclusive quality metrics. In 2022, ASCO published a study which called for improved data collection and reporting.
- Workforce Development and Diversity: Data collection using an intersectional lens which may be used to inform mentorship and promotion programs and protection of SGM oncology workforce members from microaggressions from both co-workers and patients.
- Patient Education and Support: Distribution of patient education materials for SGM individuals across the cancer care continuum, and use of SOGI quality metrics to identify needs for patient support and programs.
- Research: Efforts to include SGM patients in clinical trials, more studies on transgender and gender diverse people with cancer, as well as grants and training for early-stage investigators interested in SGM cancer research.
- Policy: Privacy and nondiscrimination protections for patients across health care systems, universal training to create affirming clinical care environments, mandates on SGM cultural competency and humility training in cancer centers, and oncology providers’ continued advocacy at local, state, and national levels to eliminate policies that contribute to inequitable care for SGM patients and other groups.
“These recommendations ensure continued progress towards achieving equity for SGM communities in cancer care and beyond,” said Shail Maingi, MD, co-author of the study and co-chair of the ASCO Sexual and Gender Minorities Task Force. “Our findings showed that a concerted, systematic approach is vital across these five core areas to start to achieve cancer care equity for SGM individuals.”
ASCO and other national organizations continue to advocate for and recognize SGM individuals as a population experiencing health disparities and have called for increased attention to SGM patients in oncology care and broader health care systems. Resources for caring for SGM and LGBTQ+ individuals are available on the ASCO website, along with patient-facing materials on Cancer.net, and advocacy opportunities via ASCO’s ACT Network.
Read the full report.
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1. ASCO’s 2017 position statement used this terminology adopted by the National Institutes of Health (NIH), “sexual and gender minorities,” to be both inclusive and consistent. As described by the NIH, the term “encompasses lesbian, gay, bisexual, and transgender (LGBT+) people, as well as those whose sexual orientation and/or gender identity varies, those who may not self-identify as LGBT+ or those who have a specific medical condition affecting reproductive development (e.g., individuals with differences or disorders of sex development, who sometimes identify as intersex).