Since the first question about sexual and gender identity was posed in 2012, when 3.5 % of American adults identified as LGBTQIA +, this percentage has more than doubled. In contrast to 3.3 % of Generation X( birth years 1965 – 1980 ) and 2.7 % of Baby Boomers( 19 birth years 1946 – 1964 ), the increase appears to be driven by younger generations, with 19.7 % in Generation Z ( born after 1997 ) and 11.2 % of Millennials( 19born years 1981 – 1997 ) identifying as LGBTQIA +. & nbsp,
The number of LGBTQIA + people and cancer patients both increase, necessitating care facilities to adapt to the unique needs of the community. In a commentary published in Cancer Discovery, Scout, MPH, PhD, executive director of the National LGBT Cancer Network, stated that” the desire for specific professional strategies to better serve this population has noted uptick.” The current state of the field is one of high need and low action, despite the fact that some strategies are very simple for offices to implement.
The lived experiences of LGBTQIA + people influence how they approach cancer prevention, screening, and treatment, according to Scout’s commentary in Cancer Discovery. Scout was questioned about how health care systems and decision-makers can assist in removing these obstacles. & nbsp,
Medical Mistrust and Health Disparities, & nbsp,
The disparities in cancer care experienced by members of the LGBTQIA + community have been brought to light by a number of recent studies. Cancer patients from sexual and gender minority ( SGM ) groups were, on average, younger at diagnosis, according to a study presented at the AACR Annual Meeting 2023, which was held from April 14 to 19. Additionally, they reported lower rates of physical activity and higher tobacco and alcohol consumption. According to other studies that have been published, transgender patients had a 1.76 times higher likelihood of being diagnosed with late-stage lung cancer, less than half as likely to receive kidney and pancreatic cancer treatment, and an overall survival rate that was lower for non-Hodgkin lymphoma and prostate cancer. & nbsp,
The LGBTQIA + communities have a different experience than the general population at every stage of the cancer care continuum, and I believe many people are unaware of this until they view it through our lens, according to Scout. For instance, Scout suggested that the higher reported rates of some modifiable risk factors, like drinking and smoking, may be a result of widespread stress.
According to Scout, LGBTQIA + patients have reported that stereotype-based presumptions about their care, such as being told that their ongoing pain is caused by sexual behaviors rather than potential cancer, have had an impact on their treatment. Additionally, providers may be unsure of best practices due to a lack of training on issues specific to LGBTQIA + cancer care. & nbsp,
LGBTQIA + cancer patients have fewer social support resources than the majority of the population, despite the fact that patients frequently need more support when they first start receiving cancer treatment. A patient must interact with more providers as a result of cancer treatment. According to Scout, many SGM people continue to experience discrimination and disrespect outside of the states where religious freedom laws may permit the denial of care based on sexual orientation or gender identity. & nbsp,
Our community feels under attack with more than 500 pieces of anti-LGBT legislation pending in the U.S., according to Scout. & nbsp,
Scout clarified in the commentary that a 2010 Affordable Care Act provision forbade health care discrimination based on gender identity and sexual orientation. This included safeguards for transgender people whose doctors had previously infrequently disclosed the gender of their patients in their medical records. & nbsp,
Transgender people and their providers felt more at ease disclosing their status as a result of the legislative change. However, many of these safeguards were lifted by June 2020, and the Religious Freedom Restoration Act was strengthened to permit medical refusal. Patients who could now see their sexual orientation and gender identity in their medical records were once again at risk of discrimination. & nbsp,
In a recent instance, according to Scout, transgender patients at Vanderbilt University Medical Center were informed that their medical records had been subpoenaed and given to Tennessee’s Attorney General as part of an investigation into state funding and gender-affirming care. Scout added that the transgender community has experienced significant distress as a result of the action. & nbsp,
LGBTQIA + people have a high level of medical mistrust and frequently go above and beyond to make sure that potential providers will accept them. LGBTQIA + people are less likely to have a primary care provider who can, for instance, suggest and arrange cancer screenings for many reasons. & nbsp,
Scout added that such a search can cause care to be delayed due to the mental and emotional strain. They claimed that if I could locate a colonoscopy provider who assured me that they were excellent with trans people, I would be able to get one much more quickly. However, I am unable to, so I delay them by about a year.
Scout emphasized the significance of making that information widely accessible for healthcare facilities that welcome LGBTQIA + people. In a study conducted in 2020 at cancer centers that have been designated by the National Cancer Institute, it was discovered that nearly 25 % of centers did not explicitly include gender identity and expression in their patients’ Bills of Rights. Over 50 % of these centers also failed to do so. & nbsp,
The issue, according to Scout, is that in the face of that legislative assault, silence these days is incredibly loud. You are unquestionably contributing to the ongoing disparities if you are being quiet while we are trying to determine what is safe.
Supporting Patients in Research and Health Care, & nbsp
Scout made a number of recommendations to healthcare facilities looking to publicly declare their acceptance of LGBTQIA + people. & nbsp,
Regarding hiring diverse staff and allowing them to express themselves, they stated that” Creating visible champions among health care staff is one of the best ways one can continue to create change across an organization.” How can you treat your patients with the same dignity if you aren’t respecting the diversity of your staff and their expertise ?& nbsp
Scout also went into detail about the safety indicators that LGBTQIA + patients look for during intake, in the waiting area, and online. & nbsp,
Will anything come up if I search for” bisexual” or” transgender” on your website? Will I see posters in your office that depict families I know or just those that resemble the general population? Scout remarked. Will I be asked if I’m an SGM when I go to intake? Will you respect it if I say that my name was not given to me at birth? Will I be referred to by those pronouns if I say that they are not what you might expect them to be? & nbsp,
In terms of online visibility, Scout advised including acceptance statements on the provider’s website as well as joining curated lists of welcoming providers, such as those run by the National LGBT Cancer Network and the Gay and Lesbian Medical Association. Staff members can express their acceptance in person by donning rainbow lanyards and / or pronoun pins. & nbsp,
The National LGBT Cancer Network provides training to assist hospitals and healthcare facilities in providing LGBTQIA + patients with a welcoming environment. In addition, they provide the LGBTQIA + community with a variety of educational resources to help spread knowledge about cancer screening, cancer prevention, and what to expect while receiving cancer treatment. They also provide virtual support groups for cancer patients. & nbsp,
Scout and colleagues are adamant about including information about SGM populations in federal surveys and health care facilities. Scout asserted that without data, there is no way to solve any problems.” Our entire system for measuring, researching, and fixing health disparities starts with data.” & nbsp,
They argued that it is challenging to demonstrate the validity of targeted interventions for these populations due to a dearth of information about SGMs, particularly when researchers are vying for scarce funding. Researchers can assist by gathering data on SGM status as well as by incorporating them into clinical studies. & nbsp,
Scout remarked,” Every time someone gathers that data, you give a little bit more authority to the people who care about our communities to actually address, fix, measure, and change health disparities.” When you arrive at the hospital or doctor’s office and they routinely inquire,” Are you LGBTQIA +?,” it will be a great day in our world. Also, what race are you? Do you belong to any of these other historically underserved populations as well? “& nbsp,
The first article to appear on American Association for Cancer Research ( AACR ) was Pride and ( Health Care ) Prejudice: Challenges Faced by LGBTQIA + Cancer Patients.