On April 3, 2017, ASCO issued recommendations addressing the needs of sexual and gender minority (SGM) populations as they relate to cancer. The recommendations, published in a policy statement in the Journal of Clinical Oncology, are designed to focus attention on the challenges facing the SGM community—including discrimination and greater risk of anxiety and depression, resulting in disparate care—and concrete steps that can help minimize health disparities among SGM individuals.
“Sexual and gender minorities face unique challenges related to cancer risk, discrimination, and other psychocosial issues,” said ASCO President Daniel F. Hayes, MD, FASCO, FACP. “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.”
Sexual and gender minorities include those who are lesbian, gay, bisexual, transgender, and intersex (also referred to as those with differences in sex development). The statement notes that SGM populations bear a disproportionate cancer burden stemming from several factors, including:
- Lower rates of cancer screening, in part due to lower rates of insurance coverage, exclusion from traditional screening campaigns, and previous experience of discrimination in the health care system
- A hesitancy on the part of SGM patients to disclose their sexual orientation to providers due to a fear of stigmatization, which can create additional barriers to care.
In the statement, which was reviewed by the Gay and Lesbian Medical Association (GLMA), ASCO calls for a coordinated effort to address health disparities among SGM populations, including:
- Increased patient access to culturally competent support services
- Expanded cancer prevention education for SGM individuals
- Robust policies prohibiting discrimination
- Adequate insurance coverage to meet the needs of SGM individuals affected by cancer
- Inclusion of SGM status as a required data element in cancer registries and clinical trials
- Increased focus on SGM populations in cancer research.
“Our objective was to raise awareness among oncology providers, patients, policy makers, and other stakeholders about the cancer care needs of SGM populations and the barriers that SGM individuals face in getting the highest-quality care,” said Jennifer J. Griggs, MD, MPH, lead author of the statement and Professor in the Department of Internal Medicine, Hematology & Oncology Division, and Department of Health Management & Policy at the University of Michigan. “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.”
Part of ASCO’s long history of working to reduce disparities in cancer care, these recommended actions are aimed at raising the quality of care and health maintenance for the SGM population, as well as for members of the oncology workforce who identify as members of SGM communities. For oncology professionals, ASCO recommends concrete steps to help provide safe environments and focusing on increasing the number of SGM health care staff as part of oncology workforce diversity efforts.
“These recommendations are intended to address the needs of SGM patients with cancer and their loved ones, as well as members of their care teams,” said Karen Winkfield, MD, PhD, Chair of ASCO’s Health Disparities Committee and Associate Professor of Radiation Oncology at Wake Forest Baptist Comprehensive Cancer Center. “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.”