State of Cancer Care in America: Achieving Cancer Health Equity Among Sexual and Gender Minority Communities

Abstract

In 2017, ASCO issued the position statement, Strategies for Reducing Cancer Health Disparities Among Sexual and Gender Minority Populations, outlining five areas of recommendations to address the needs of both sexual and gender minority (SGM, eg, LGBTQ+) populations affected by cancer and members of the oncology workforce who identify as SGM: (1) patient education and support; (2) workforce development and diversity; (3) quality improvement strategies; (4) policy solutions; and (5) research strategies. In 2019, ASCO convened the SGM Task Force to help actualize the recommendations of the 2017 position statement. The percentage of the US population who publicly identify as SGM has increased dramatically over the past few years. Although increased national interest in SGM health equity has accompanied a general interest in research, policy change, and education around diversity, equity, and inclusion, resulting from public concern over discrimination in health care against Black, Indigenous, and People of Color, this has been accompanied by a surge in discriminatory legislation directly impacting the SGM community. Although much progress has been made in advancing SGM cancer health equity since 2017, more progress is needed to reduce disparities and advance equity. The five focus areas outlined in the 2017 ASCO position statement remain relevant, as we must continue to promote and advance equity in quality improvement, workforce development, patient care, research, and SGM-affirming policies. This article reports on the progress toward reducing SGM cancer disparities and achieving equity across these five areas and identifies future directions for the work that still remains.

Evolution of community outreach and engagement at National Cancer Institute‐Designated Cancer Centers, an evolving journey

“…data are yet to be collected nationally, including sexual and gender minorities (SGMs), veterans, and people with disabilities (PwDs). [134][135][136][137][138][139][140][141][142][143] The SGM community represents 7.2% of the US population and faces disparities in cancer care, with limited data available on their experiences and health outcomes. 134,135 The absence of SOGI data in major clinical databases limits research and inclusive care recommendations.…”

“…[134][135][136][137][138][139][140][141][142][143] The SGM community represents 7.2% of the US population and faces disparities in cancer care, with limited data available on their experiences and health outcomes. 134,135 The absence of SOGI data in major clinical databases limits research and inclusive care recommendations. 136 SOGI data should be collected and reported as mandated by the US Bureau of Primary Health Care, the Health Resources, and Services Administration.…”

Global Equity in Clinical Trials: An ASCO Policy Statement

“…Many clinical trials do not ensure equity in various demographic groups, including the elderly, adolescents and young adults, and sexual and gender minorities. 57 , 58 In particular, the impact of new and innovative cancer drugs in the elderly should be an important area of study, elucidating the interplay between age-related biologic changes, multiple comorbidities, functionality, and pharmacodynamics to inform safe clinical practice. In view of such gaps in the United States, the US Food and Drug Administration issued guidance to encourage recruitment of the elderly (particularly those older than 75 years) in cancer clinical trials.…”

Disparities in cancer care: A long way to go

“…Multiple studies indicate worse outcomes for SGM people of color, including in palliative care settings, in which Black and Hispanic SGM patients were two to four times more likely than their White SGM counterparts to report discrimination. 6 Current recommendations and best practices include collecting sexual orientation and gender identity data, 7,8 but current political environments focused on banning gender-affirming care may put this at risk, putting the movement to address SGM disparities to the test. Also problematic is using race as the primary characteristic around which we design efforts to effectively address cancer disparities; this is CA Cancer J Clin.…”