With a recent survey in collaboration with SIOPE and the recognition of LGBTQ as a specific patient population in the recommendations for a Global Curriculum in Medical Oncology, ESMO is at the forefront of a more inclusive oncology
Oncologists generally feel comfortable taking care of cancer patients who belong to sexual and gender minorities, but most consider the pre- and postgraduate training they received insufficient to optimally address the specific healthcare needs of LGBTQ individuals in their clinic. This is one of the important findings of a global survey conducted by ESMO and the European Society of Paediatric Oncology (SIOPE) on oncologists’ attitudes, knowledge and education regarding the management of LGBTQ patients with cancer. Study author Emmanouil Saloustros, Associate Professor at the University of Thessaly, Greece, calls for action in both the research and educational fields to improve the personalisation of care for these patient subgroups.
What do you believe hinders effective doctor-patient communication about sexual orientation and gender identity as these relate to cancer care?
I will speak for my country, Greece, where we have seen a clear shift in attitudes towards sexual minorities in recent years: acceptance has come not only in the medical profession but throughout all of society, across generations. Overall, I believe the change in our collective mindset has contributed to making these individuals more comfortable sharing their sexual orientation during the medical visit.
The situation is different for patients with gender incongruence. Gender identity is not frequently addressed in cancer patients’ initial consultations, either because physicians assume a person’s gender to be aligned with their birth sex or because they feel uncomfortable asking such a sensitive question in a broader social context where transgender individuals still face difficulties being fully accepted for who they are. In oncology we are talking more and more about personalised medicine: tailoring your care and communication to the sexual and gender characteristics of your patient can and should be considered part of treatment individualisation.
What evidence is currently available to inform the management of LGBTQ people with cancer, and what are the gaps in knowledge?
The cancer risk factors LGBTQ patients tend to be more exposed to overall are smoking and contamination with human papillomavirus (HPV), a risk which linked to sexual activity. Many uncertainties remain surrounding cancer in transgender individuals specifically, as highlighted by the split answers we received to certain questions regarding this group’s risk factors. As oncologists, we need this information to guide both patient management and secondary prevention strategies.
One of the biggest challenges for us is the management of hormone-dependent cancers in transgender patients, particularly when the treatment requires discontinuing a gender-affirming hormone therapy and may affect the maintenance of the individual’s gender identity. There is some evidence in this area for the management of some tumour types, including breast (JAMA Oncol. 2023;9(4):473-480), in transgender individuals, but a lot more work is needed to better understand the biology of the disease and its optimal management.
Oncologists’ need for - and interest in - more education on the management of this specific patient population emerged clearly from the survey results. How would you hope to see this addressed in the future?
Both the high participation rate in the ESMO/SIOPE survey, making it the largest of its kind to date, and the responses given show that our profession perceives this as a relevant issue. Of course, one direct answer would be to develop more educational materials for the members of our respective societies. In addition, however, we need to begin familiarising doctors with the health-related specificities of LGBTQ patients from the earliest stages of their training in medical school, when we are most able to shape their attitudes towards patient care. The inclusion of LGBTQ individuals as a specific patient population with particular treatment and management needs in the most recent update to the ESMO/ASCO Recommendations for a Global Curriculum in Medical Oncology is an important milestone that will help the community move forward and better cover this topic in oncologists’ initial training around the world.
Going forward, I would also like to see oncologists start to discuss the needs of LGBTQ patients at the level of clinical units, hospitals, and national societies—and, even better, establish broad collaborations between researchers to define the optimal care for these individuals.
