Oncologists in the United States have a lot to learn about the health and cancer needs of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) patients, and most of them realize this, according to responses obtained in a national survey.
Most oncologists (95.3%) reported they were comfortable taking care of patients who identified as lesbian, gay, or bisexual.
However, only 53.1% felt they had the expertise to do so, and only 36.9% said they knew how to address the cancer needs of a transgender patient.
Overall, the responses show that oncologists have limited knowledge of this "diverse and medically underserved population," conclude the authors, led by Matthew B. Schabath, PhD, of the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida.
The nationwide survey results were published online yesterday in the Journal of Clinical Oncology.
"Such data provide crucial evidence to develop both culturally sensitive and clinically knowledgeable curriculum and guidelines addressing cancer disparities in LGBTQ patients across the cancer care continuum," Schabath and colleagues write. "Future research will be needed to assess these metrics among other health care providers, such as allied health professionals, nurses, and advanced practice providers."
Survey Details
A total of 149 oncologists responded to the survey, which was sent to a random sample of 450 oncologists at 45 cancer centers. The survey respondents were primarily male (68.5%) and 63.8% were white, 87.3% were non-Hispanic, and 90.6% identified as heterosexual.
A large percentage of the questions testing clinicians’ knowledge about health issues affecting sexual and gender minorities (SGM) elicited responses such as "neutral" and "do not know or prefer not to answer." Most of the oncologists (70.4%) expressed a "high interest" in receiving more education specific to LGBTQ health and cancer issues.
"Cancer care within the LGBTQ community is a largely ignored public health issue," said coauthor Gwendolyn P. Quinn, PhD, New York University Medical School/NYU Langone Health. "To address this problem, we have to start by understanding the gaps in knowledge among physicians.
When asked by Medscape Medical News whether these findings reflect any increase in physician awareness and acceptance of the unique healthcare issues associated with patients who identify as LGBTQ, Quinn responded, "Yes and no."
She explained that while 70.4% of oncologists surveyed said they wanted to improve their cultural competency, others questioned why they would need to know the sexual orientation/gender identity of patients because they "treat everyone the same."
The survey showed that 65.8% of oncologists thought it was very important to know the "gender identity of patients" but only 39.6% thought it was important to know a patient’s "sexual orientation."
The survey also revealed that oncologists’ self-rated confidence about treating LGBTQ patients with cancer plummeted after completing the survey, dropping from 53.1% while taking the assessment to 38.9% upon completion (P < .001). Self-confidence ratings on treating transgender patients fell more than 17 percentage points post-survey, from 36.9% to 19.5%.
The researchers believe this finding reflects the fact that by taking the survey, oncologists began to realize just how much they did not know about LGBTQ health and cancer issues.
"At the start of the survey, confidence was high," said Quinn. "We think as the oncologists went through the survey, it began to dawn on them that there were aspects of LGBT health with which they were unfamiliar. We saw this as very positive."
The researchers note that efforts to address cancer disparities by sexual orientation and gender identity (SOGI) have been limited. However, the cumulative evidence to date suggests that patients who identify as LGBTQ face an increased cancer risk — particularly anal, oral and cervical cancers — and poorer outcomes. Previous studies have shown that LGBTQ individuals are less likely to comply with recommended cancer screening than members of the general population. They are more likely to have risk factors for cancer such as smoking, drinking alcohol, obesity, and nulliparity.
Patients who identify as LGBTQ are also more likely to report dissatisfaction with cancer care treatment than their heterosexual counterparts, and to have higher rates of psychological distress in survivorship.
The authors cite various studies/surveys estimating that 3.4% to 12% of adults in the US identify as members of the LGBTQ community, which spans all races, ethnicities, ages, socioeconomic statuses, and geographic regions of the country.
The researchers "were thrilled to see the desire for education," Quinn said, noting that LGBTQ health is now part of the curriculum in medical schools. "There’s been a big shift," she pointed out.
The survey results have been used to develop an online curriculum for oncologists treating LGBTQ patients, noted lead author Schabath.
The cultural competency program is a collaborative effort with Sylvester Comprehensive Cancer Center at the University of Miami and the UF Health Cancer Center at the University of Florida, Schabath said.
The Curriculum for Oncologists on LGBT populations to Optimize Relevance and Skills, or COLORS Training Program, is comprised of four 30-minute online training modules. Two modules cover general topics, such as sexual orientation and gender identity, and two discuss topics specific to LGBTQ patients undergoing cancer treatment.
The COLORS program "can substantially improve oncologists' knowledge and attitudes regarding LGBT cancer patients, which in turn can lead to better care for this patient population," said Schabath.
Results from a pilot study of the training program involving 20 Florida oncologists showed that the percentage who could correctly answer 90% of the LGBTQ knowledge questions increased from 33% before the online training to 85% after the training.
This study was funded by the H. Lee Moffitt Cancer and Research Institute and the National Cancer Institute.
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