Special Concerns in Treating LGBTQ Patients With Cancer

There are special concerns for oncology nurses when treating LGBTQ patients, according to a panel of experts that presented at the 2019 Oncology Nursing Society (ONS) Annual Congress in Anaheim, CA.¹

“We can’t talk about cancer without talking about LGBT survivors of cancer,” said Carlton Brown, PhD, RN, AOCN, NEA-BC, FAAN, president of Zenith Healthcare Solutions. “It’s not uncommon to have said, ‘Aren’t LGBTQ patients just like other patients with cancer?’”

But as the panel explained, LGBTQ individuals often face stigma, disparities, and barriers to care that can affect their healthcare experiences. According to the presentation, this group has lower rates of health insurance coverage, are more likely to have an income at or below 139% of the federal poverty level, and may have more risk factors, as higher rates of smoking and alcohol use has been reported in this population, along with greater risks for sexually transmitted diseases.

LGBTQ patients may have had negative experiences in the past that make them uneasy — or altogether avoidant – when it comes to doctor visits. “Perhaps stigma has been a problem not only with the healthcare providers, but the organizations they do to for their care, too,” Brown said.

At most institutions, medical records do not require patients to disclose their sexuality or gender identity. However, this can be an important piece of information when it comes to culturally competent cancer care and speaking to patients.

“Saying you don’t need to know the patient’s sexuality because you treat patients all the same is the antithesis of patient-centered care,” said Daivd Rice, PhD, RN, NP, director of Education, Evidence Based Practice and Research at City of Hope. “Language is important. The words we use and the nonverbal cues and therapeutic touch express our skills. Patients pick up on this.”

For example, using proper and preferred pronouns can largely impact a patient’s experience. However, it is still important that healthcare providers know a patient’s birth sex, as that can affect their treatment.

The presenters mentioned a study published in January 2019 in the Journal of Clinical Oncology, where 149 oncologists were asked about LGBTQ issues. Overall, 65.8% said that it was important to know the gender identity of patients, while 39.6% said that it was important to know their sexual orientation. More than half (53.1%) said they are confident in knowledge regarding health needs for LGB patients, while far less (36.9%) said that they were confident in the needs of transgender patients.²

However, the healthcare practitioners did mention that they were willing to learn how to better sever this patient population.

“The good news is that there is this willingness,” Brown said. “People want to be educated about the care of this population.”

Through more education, oncology nurses can become culturally competent healthcare providers, and improve the care — and outcomes – of their patients.

“We as cancer care providers are in a position to help this population navigate through what we know is a complex care system,” Rice said.

References

• Brown C, Rice D, Mendelson E, et al. Care of the LGBTQ Patient With Cancer. Presented at: Oncology Nursing Society 44^th Annual Congress; April 11-14; Anaheim, CA. Abstract 2052
• Schabath MB, Blackburn CA, Sutter ME, et al. National Survey of Oncologists at National Cancer Institute-Designated Comprehensive Cancer Centers: Attitudes, Knowledge, and Practice Behaviors About LGBTQ Patients With Cancer. J Clin Oncol. https://doi.org/10.1200/JCO.18.00551