Gender Disparities in Cancer Care: What Can We Do?

Prominent gender disparities exist not only within the health care industry, but specifically in the field of oncology, Nick Smith-Stanley, MBA, said in a presentation during the Association of Community Cancer Centers (ACCC) 37th Virtual National Oncology Conference. To address such disparities, it is important for institutions to embrace and promote the fostering of an inclusive culture and environment for health care professionals of all races and genders, and to adequately equip women specifically with the tools they need to achieve success in the field.¹

When examining the current landscape of women in oncology, the disparities begin early on with regard to medical schooling, according to Smith-Stanley, the associate director of Administration and Strategic Planning with LIVESTRONG Cancer Institute and the associate director of Administration and Strategic Planning, Oncology at Dell Medical School. Currently, there are women in medical school than men for the first time in history, but the difference remains very small, said Smith-Stanley.

“While the number of women graduating from medical school is higher than men, the percentage of women [who are] African American or Latina [represent] less than 50% [of female graduates],” explained Smith-Stanley. “We’re doing a good job of recruiting women to medical school; however, we’re still doing a terrible job of recruiting women of color.”

As women progress through their residency and fellowship, a slight decrease in representation can be observed; approximately 47% of these students are women. Although more women are attending medical school, at some point between year 1 of their program and beginning a residency, some women do not continue. Similar decreases can be observed when examining female residents who are specifically interested in hematology and oncology residencies and fellowships. “Again, we notice a trend. As they continue to go through educational pipeline, we are losing women in these programs,” said Smith-Stanley.

Only 35% of practicing physicians are women, which equates to a bigger reduction than what had been observed when looking closely at the medical education process, noted Smith-Stanley. Women who specifically practice in the oncology field represent an even smaller number of all practicing physicians, he added.

The lack of women is not just apparent in the medical space, but in research, as well. “We are somewhat encouraged about the numbers [of women] in research,” said Smith-Stanley. Fifty percent of positions in STEM were found to be held by women in 2018.

“However, like medicine, we see a dramatic decrease in representation as we look at post-graduate physicians.” For example, in science and engineering, women represent approximately one-third of all physicians working in the space; they also only represent 29% of all physicians who are specific to research. Moreover, 36.6% of K award recipients are women.

“Probably the most disturbing statistic [to share with you at this point] is that 50% of women who give birth do not return to work or they only come back in a part-time position; this is true for only 20% of men,” said Smith-Stanley. “That highlights that we are not doing a good job of supporting women as they make that transition to parenthood.”

Across all disciplines, in science and oncology, women face challenges with being considered for opportunities for promotions and leadership. Many women have witnessed male colleagues with fewer accomplishments receive promotions at the same time that they did, noted Smith-Stanley. “This underscores that this is not a personal issue; it is by far a systemic issue,” he said.

Similar disparities are seen in academic positions, with 21% of all full professors being women in 2019, and only 19% are department chairs and 19% have permanent deanships. This also represents a lack of mentorship opportunities for women. When students and junior faculty members are unable to identify women in positions of leadership to help guide them, they are also reduced likelihood of progressing in their own careers added Smith-Stanley.

“The decrease of women as we work through the educational pipeline is staggering,” stressed Smith-Stanley, “[We go from] 50%-51% of medical students being women to an embarrassing 19% of deanships being held by women. These numbers are unacceptable. There are more women in the United States than men, but only 1 in 5 hold positions of leadership in academics and medicine.”

The key to closing the gender divide in oncology, research, and academics boils down to strategies focused on culture, hiring, and professional development. It’s important for institutions to embrace and promote an inclusive culture and environment for healthcare professionals of all races and genders, according to Smith-Stanley.

Specific training around diversity, such as implicit bias, is a critical component of fostering inclusive culture. When hiring, gender-neutral language should be used when drafting job descriptions, while prioritizing the shortlisting of women in recruitment; this constitutes actively going out into the community to talk to more women and encourage that they apply for open positions. “Statistics show that women are less likely than men to apply for a position if they don’t meet 100% of the requirements for the job posting, so we must go out and we must find women to talk to them about these roles,” stressed Smith-Stanley.

Once hired, efforts need to be made to provide opportunities for professional development so that institutions can retain these women. These efforts should include bias training, mentorships, and peer networking.

One of the most impactful strategies to address the lack of women in oncology is through mentorship and early educational intervention, said Smith-Stanley. To boost opportunities for mentorship, the LIVESTRONG Cancer Institute implemented the Summer Healthcare Experience (SHE) in Oncology.2 “SHE is our emerging cancer and career enhancement education program that introduces high school juniors and seniors who identify as female to various career opportunities in our field; it gives women the tools that they will need to overcome challenges and succeed in not only the health sciences, but any field,” said Smith-Stanley.

The program launched in the summer of 2019, with 8 women of varying racial and ethnic backgrounds having been selected for participation. The goal of the program is to empower young women to take control of their education and career. Students will actively participate in active research and multidisciplinary tumor board meetings.

By the end of the program, students should have a general knowledge of cancer biology; function as a researcher in a laboratory, clinic, and community setting; gain an understanding of how cancer is treated and how patient-centered care is provided; and develop awareness of the challenges patients with cancer and their families face. Outside of the program, students will be taught about professionalism and how to appropriately operate in research and clinical settings, to develop effective communication skills, and to acquire leadership skills that can be translated to any field of interest.

References

1. Smith-Stanley N. Addressing the disparities of women in oncology. ACCC 37th Virtual National Oncology Conference; September 14-18, 2020; Virtual.

2. Smith-Stanley N. Building support for underrepresented people in oncology. The University of Texas Dell Medical School. September 9, 2019. Accessed September 18, 2020. https://bit.ly/3hF0lnv.

This article was originally publised on OncLive as, "Smith-Stanley Shares Strategies to Address Gender Disparities in Oncology."