Quality and Equality in LGBTQ+ Cancer Care

• Every patient who comes to Fox Chase has a unique medical history and set of needs. Providing the highest quality cancer care depends on understanding the whole patient, including sexual orientation and gender identity.

  Nicolle Strand, Assistant Director of Bioethics at Temple University and Co-chair for Temple Health’s LGBTQ Alliance Task Force, called out the additional challenges LGBTQ+* patients face due to stigma and lack of clinician knowledge, a sentiment shared by The American Society of Clinical Oncologists.

  “LGBTQ+ patients may have a real hesitance to seek out medical care after prior bad experiences with healthcare providers. The disrespect they have faced means they may be bracing themselves, which can lead to a lack of trust,” Strand said.

  LGBTQ+ concerns are justified. Attacks on the basis of sexual orientation and gender identity account for nearly a fifth of hate crimes in the United States, according to the FBI. LGBTQ+ people have high rates of anxiety, depression, and substance abuse due to social stigmatization. Health surveys from the CDC confirm that LGBTQ+ patients are treated differently.

  “Early detection is key and the LGBTQ+ community may be excluded—sometimes unintentionally—from screening campaigns,” Strand said.

  For example, a woman who is transitioning but has not had complete gender reassignment surgery may still need a Pap smear. A man who is transitioning may need prostate screening.

  Anne Jadwin, Chief Nursing Officer at Fox Chase Cancer Center, said healthcare professionals need to be mindful of these things.

  “Clinicians need to learn to ask the right questions,” Jadwin said.

  The scope of the problem is far reaching because about 10 million Americans self-identify as LGBTQ+, and this is likely an underestimate. “If we don’t understand how to meet patients’ needs we are at risk of failing an entire population,” Strand added.

  According to the American Cancer Society, LGTBQ+ people can have worse health outcomes due to fear of discrimination, past negative healthcare experiences, and lower rates of insurance –  many health insurance policies don’t cover unmarried partners. 

  For example:

  • Lesbian and bisexual women have a slightly higher risk of breast cancer and get less routine health care than other women, including cancer screening
  • Gay and bisexual men are much more likely to smoke than heterosexual men, and thus have an increased risk of lung cancer.

  Strand said these concerns are the reason why the Temple University Health System created an LGBTQ Alliance Task Force.

  “The group was formed to create a welcoming environment for LGBTQ+ patients, visitors, students, and staff,” Strand said. “Education is a big part of what we do. We have mandatory training for every employee and are launching a Master’s level course in LGBTQ+ ethics and health disparities.”

  In just over a year, Temple Health’s Task Force has made significant progress to create a more LGBTQ+ inclusive environment in areas such as community outreach, education, employee benefits, and gender-neutral bathroom signage. 

  “Good communication, respect and understanding are crucial to overcoming healthcare barriers,” Strand said. “Small changes can make a big impact. We tell health providers it is okay not to have all the answers right now. The best thing is to be sensitive and if you make a mistake apologize and correct it. Patients are looking to be treated with respect,” Strand said. 

  Fox Chase and the Temple Health system are continuously ensuring that the needs of LGBTQ+ patients, visitors, and staff are met. “We want to see what we are already doing well and what other opportunities can we pursue,” Jadwin said.

  Verdi J. DiSesa, the President and CEO of Temple University Hospital said TUH has worked to earn the designation of LGBTQ Healthcare Equality Leader from the Human Rights Campaign Foundation.

  “We are committed to creating an inclusive and compassionate care environment for our LGBTQ+ patients, visitors, staff and in particular transgender and gender non-conforming people,” DiSesa said in an announcement about the designation.

  “Many of us are seeking information so we can be responsive to the LGBTQ community. It is good medical practice,” Jadwin said.

  At Fox Chase and Temple Health, we strive to ensure respectful quality care. To get it right we:

  • Ask patients how they would like to be addressed.
  • Ask direct questions when there is a medical need to know. In some cases it is important to know whether a transgender patient has had surgery; in other cases it is not. 
  • Ask patients to introduce themselves and the persons in their support system to avoid inappropriate mistakes.

  To find out more about health disparities the LGTBQ+ community faces and what Temple Health is doing to support this community, visit the resources page on Temple Health’s LGBTQ Task Force website.

  *LGBTQ+ = Lesbian, Gay, Bisexual, Transgender, Queer, and related communities