A survey of oncologists finds that most say they don’t know enough about how to treat people in the lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) community, but want to learn more. The study was led by researchers from the NYU School of Medicine and Moffitt Cancer Center. It was published January 16, 2019 in the Journal of Clinical Oncology.
The survey was designed to measure attitudes and knowledge about LGBTQ health issues. Authors of the study say this is the first survey of its kind. It was sent to 450 oncologists from 45 large cancer centers in the US, and 149 of them answered. More than half of those who answered (65.8%) said knowing the gender identity of patients is important, but less than half (39.6%) agreed that knowing the sexual orientation of patients is important. Most (70.4%) said they were interested in learning more about the unique health needs of LGBTQ patients.
The survey found that oncologists’ confidence in their knowledge of the health needs of the LGBTQ community dropped from the beginning to the end of the survey. Gwendolyn Quinn, PhD, co-author of the study and a professor in the Departments of Obstetrics and Gynecology, and Population Health at NYU Langone Health said this could mean the survey itself was educational for the oncologists.
“The more they answered those questions, the more they realized they weren’t confident in their answers,” said Quinn. “It also pointed to an increase in the number of physicians who wanted further education, which we saw as very positive.”
The survey shows oncologists had gaps in their knowledge about the increased cancer risk factors affecting the LGBTQ community.
Studies have shown that as a group, they smoke more, drink more, and have greater rates of obesity than other populations – all behaviors linked to increased cancer risk. They are also less likely to be up-to-date on cancer screenings. People in the LGBTQ community are less likely to have health insurance. They report lower satisfaction with cancer treatment and higher rates of feeling discriminated against in health care settings.
Quinn also says lesbian women are less likely than heterosexual women to have had a child, which puts them at greater risk for breast cancer and gynecological cancers. She says men who have sex with men and have anal sex are more likely to be exposed to human papillomavirus (HPV), which puts them at greater risk for anal cancer.
The study authors say a deeper understanding of LGBTQ issues will help oncologists to deliver better care to their LGBTQ patients. They recommend cancer centers create an inclusive environment that makes it safe for patients to disclose their sexual orientation and gender identity, and that training in the care of LGBTQ patients with cancer be developed and made available.
Quinn says clinics can create inclusive environments in a number of ways. For example, they can display not only the patient bill of rights, but also the human rights campaign symbol and/or rainbow symbols. Patient intake forms can offer “partnered” as an option in addition to “married” or “single.” Forms can also ask for “assigned gender at birth” vs. “gender with which you identify.”
She says LGBTQ patients can advocate for themselves by finding a culturally competent provider through word-of-mouth from others in the community, or by searching online through the National LGBT Cancer Network.
“Even though our study focused on oncologists, some of the next steps for this study are to survey other staff involved in health care,” says Quinn. “It’s not enough to just have a culturally competent physician, you need schedulers, physician assistants, nurses, and others to also be on board with this too. Physicians are a great place to start, but they’re not the end.”
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National Survey of Oncologists at National Cancer Institute–Designated Comprehensive Cancer Centers: Attitudes, Knowledge, and Practice Behaviors About LGBTQ Patients With Cancer. Published January 16, 2019 in the Journal of Clinical Oncology. First author Matthew B. Schabath, PhD, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fla.
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