A recent survey conducted by researchers at the NYU School of Medicine has indicated that oncologists know much less about the unique cancer needs of the LGBTQ population than they thought.
How did this become such a big issue? Primarily, it’s because on average less than one hour of instruction in medical school is spent discussing LGBTQ needs.
LGBTQ Healthcare
Primarily, the differences in healthcare needs for gender and sexual minorities revolve around social challenges, economic challenges, and lifestyle factors. These lead to not only differing cancer risks, but differences in the process of detection and treatment.
For instance, lesbian women have an increased risk of developing gynecologic cancer as these women are less likely to become pregnant (which lowers risk). Similarly, those who engage in anal intercourse are more likely to develop anal cancer. Additionally, LGBTQ individuals are at higher risk for lung cancer as there is a higher rate of smoking among that population. Targeted marketing of tobacco, stress related to stigma, and a lack of access to treatment for smoking are thought to be the reason for these higher rates.
LGBTQ individuals, and especially transgender individuals, are less likely to have health insurance and are also more likely to delay getting medical care due to fear of discrimination. This means they also do not receive the preventative care they need. Of course, cancer, like all illnesses, is better treated when detected early, causing even more complications for the queer population.
Unfortunately, most oncologists (prior to taking the survey) stated that they did not need further education on LGBTQ individuals because they treat all of their patients the same. However, there is a difference between not being discriminatory toward different populations of patients and understanding that different populations of patients may have different needs. That is where we need to make amendments.
The Survey
149 oncologists who work at National Cancer Institute-designated cancer centers participated in this survey. They were asked questions regarding six different aspects of LGBTQ cancer care. These included subjects like access to health insurance, lifestyle risk factors, and screening interventions. It was a follow-up to a survey published by in 2017 which showed that less than 50% of responders correctly understood LGBTQ care.
At the beginning of the most recent survey, oncologists were asked to assess their own knowledge of LGBTQ healthcare. 53% of participants said they were confident in their knowledge of lesbian, gay, and bisexual patient needs. 37% said they were confident in their knowledge of transgender patient needs. By the end of the survey, these numbers changed to 39% and 19.5% respectively. This in and of itself indicates the stark need for change.
Some other shocking numbers from the survey include-
- 47.7% of oncologists were unsure whether anal cancer screening could increase the life expectancy of LGBTQ men.
- 67.1% of oncologists didn’t know if there was a high prevalence of smoking tobacco among the population.
- 57.7% of oncologists could not say whether or not transgender individuals were less likely to have health insurance.
Fortunately, this survey opened many of the participating oncologist’s eyes as to their lack of knowledge and the need for reform. Following completion of the survey, 70% of responders said that they would like to receive more education concerning the needs of the LGBTQ population.
How to solve the problem
Ultimately, we can’t begin to solve the problems associated with sexual and gender minority individuals in the healthcare system if we do not know which patients fall into this category. However, even though oncologists in the survey said they believed it was important to know this information-
- 63% said their office’s intake forms did not ask about sexual orientation.
- 54% said their office’s intake forms did not ask about sex at birth.
- 55% said their office’s intake forms did not ask about gender identity.
The collection of this data is recommended by the American Society of Clinical Oncology but clearly more offices need to enforce its collection.
Additionally, oncology offices can take small steps to make LGBTQ individuals feel more welcome and therefore more likely to come in to receive cancer screening, preventative care, and/or treatment. One way to do this is to ensure that intake forms as well as health promotion materials are inclusive. It can even be as simple as putting up a rainbow sticker in the waiting room.
“A rainbow sticker in your office doesn’t say ‘we do it perfectly’ or ‘we suddenly became experts’ but it says ‘we are willing to learn.’”
This all said, the most important area of reform spans back to the training given to doctors regarding LGBTQ individuals in medical school. Organizations can also contribute to the cause by providing accreditation which includes LGBTQ needs and funding research which encourages cancer prevention for this population. Researchers indicate everyone who works in oncology offices should also be trained in LGBTQ care in order to ensure they interact with this population in the proper way.
Hopefully, with the awareness brought by this survey, we will begin to see reform for the LGBTQ population in terms of cancer care.
You can read more about this survey and its findings here.
