With Jennifer Griggs, MD, MPH, of the University of Michigan
By Sarah DiGiulio
In 2015, the ASCO Health Disparities Committee outlined the need to develop a strategy to specifically address the needs of sexual and gender minority patients with cancer—the risk of those patients for receiving disparate care and having suboptimal treatment experiences. In April, ASCO published its first position statement on the topic online ahead of print in the Journal of Clinical Oncology (2017; doi:10.1200/JCO.2016.72.0441).
"It is hoped that these recommendations can also be used to help other stakeholders in the oncology community to address the needs of [sexual and gender minority] populations in the cancer care setting," the position statement reads.
The statement's recommendations fall under the following categories: patient education and support, workforce development and diversity, quality improvement strategies, policy solutions, and research strategies. They call for the following steps to be taken, among others: enhance patient navigation and care coordination (that encourages safe disclosure of sexual and gender minority identities), integrate a focus on sexual and gender minority physicians in oncology workforce diversity efforts, ensure adequate insurance coverage to meet the needs of sexual and gender minority individuals affected by cancer, and ensure policies prohibiting discrimination.
Jennifer Griggs, MD, MPH, Professor in the Department of Health Management & Policy and in the Division of Hematology & Oncology within the Department of Internal Medicine Hematology & Oncology at the University of Michigan, Ann Arbor, and one of the position statement coauthors, explained why the recommendations are important and what ASCO and others hope they will accomplish.
1. What would you say are some of the biggest cancer health disparities among sexual and gender minorities—and the biggest barriers to overcoming them?
"There are many gaps in knowledge vis-à-vis disparities among sexual and gender minorities, but we do know that there are higher rates of some cancers and risk factors for cancer. For example, lesbian and bisexual women have higher rates of obesity, [which is] associated with many cancers, including breast cancer; gay men have a greater risk of anal cancer; and people who are [lesbian, gay, bisexual, transgender, and intersex] are more likely to smoke cigarettes than their heterosexual cisgender counterparts.
"Sexual and gender minorities also have lower rates of cancer screening, in part due to lower rates of insurance coverage, exclusion from standard cancer screening and outreach campaigns, and experiences of discrimination when interacting with health care systems and providers.
"Among medical providers, there is a lack of knowledge and barriers to high-quality patient-provider communication that inevitably lead to suboptimal care and survivorship care planning.
"Finally, some people who identify as [sexual and gender minorities] may not disclose their sexual orientation or gender identification due to concerns about discrimination and stigmatization.
"The biggest barriers [to overcoming these disparities] are most likely lack of awareness among health care providers, lack of training in communication, lack of insurance, and historical discrimination that leads to lack of trust."
2. This is the first ASCO position statement on cancer care for LGBTI patients—why now?
"We have previously focused on racial and ethnic disparities in care, then policies that impact socioeconomic disparities, and the science of disparities measurement. This statement, in particular, was prompted by the 2015 curricular reform statement of the Association of American Medical Colleges. I read a summary of this report in which the authors were quoted as saying they would like to see efforts to expand their work to specialty societies.
"Our immediate response was that [ASCO] should address disparities in access and quality of care in [sexual and gender minority] patients, their loved ones, and in our workforce.
"We always try to put the patient needs first. The main goal and purpose was to raise awareness of the needs of [sexual and gender minority] populations and to make a plan for addressing these
"Developing educational and training materials for medical providers to improve patient/provider communication and patient education and support materials is the right next step. … [And] to make the greatest impact, we will need to engage patients, caregivers, medical providers, and other health care leaders, policy makers, researchers, funding agencies, insurers, and advocacy communities."
3. What is the bottom-line takeaway all practicing oncologists and cancer care providers should know about this position statement and these ASCO recommendations?
"The bottom-line is that this statement is a roadmap for improving the care of patients who identify as sexual and gender minorities, along with their loved ones, as well as to create safe workplaces for a diverse workforce. Cancer providers are committed to providing the best care for their patients, and all of us can improve our knowledge and skills in this area. In addition, expanding our knowledge base and policies that prevent discrimination will help us achieve our goals of providing equitable care."