The George Washington University Cancer Center recently launched a new training program, Addressing the Need for LGBTQ-Affirming Cancer Care: A Focus on Sexual and Gender Minority Prostate Cancer Survivors (2017), funded through a grant from the Association of Oncology Social Work (AOSW). The program, now archived and available here, aims to help social workers and other health care professionals better support this specific patient group.

Presenters Heather Goltz, PhD, MSW, MEd; David Latini, PhD, MSW; and William Goeren, LCSW-R, ACSW, OSW-C, BCD, uniquely focus on the special needs of sexual and gender minority prostate cancer survivors. The program was based on a survey conducted among AOSW members as well as interviews with sexual and gender minority prostate cancer survivors. Supplemental patient resources for men who have sex with men and for transgender women were developed as well as a provider guide.

There are over nine million sexual and gender minorities in the U.S. today including lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) Americans. Sexual and gender minorities continue to face discrimination, stigma and marginalization—all of which result in chronic stress, delays in seeking health care and sometimes denial of care (Joint Commission, 2014). Sexual and gender minorities come from all strata of income, race/ethnicity, education, religion and nationality with varying levels of social support needs. Those who identify as both a sexual or gender minority and a racial/ethnic minority often face greater challenges in seeking, obtaining and adhering to recommended cancer care. Transgender women of color are at particular risk for housing instability, financial insecurity, employment challenges and social isolation—all of which make it harder for patients to prioritize their health and health care (Santos, Wilson, Rapues, Macias, Packer & Fisher, 2014).

Patients are often reluctant to share their true selves with their health care providers for fear of being treated differently or ruining the relationship they have with their provider. A recent study reported that of those who were “out” to their providers, 58% had to correct heteronormative, cisnormative assumptions (Margolies & Scout, 2013). This is somewhat unsurprising, since health care professional schools rarely cover the health needs of sexual and gender minorities adequately (Obedin-Malliver et al., 2011).     

Given the substantial lack of education on how to care for sexual and gender minority cancer patients, the training fills a gap for health care professionals seeking to better understand interpersonal and institutional determinants that lead to LGBTQI health inequities. The program provides strategies for practitioners to model affirming, culturally sensitive cancer care. Some unique considerations when caring for sexual and gender minority prostate cancer survivors include supportive care for:

•    Emotions around masculine identity for men who have sex with men,
•    Gender dysphoria for transgender women,
•    Distress regarding sexual dysfunction and role changes, and
•    Pain when bottoming during anal sex.

For easy reference, the provider guide also includes strategies to assess and address patient needs while improving provider communication. When caring for sexual and gender minority prostate cancer survivors, providers can use these simple and impactful tools:

•    Listen to the terms your patients use to identify themselves and communicate those terms back to the patient. When in doubt, politely ask. The glossary of common terms available in the provider guide may help.
•    Use the patient’s chosen name during interactions, not their birth name.
•    Check your assumptions and recognize your own biases (we all have them), including the ways they may influence how you provide care.

Many LGBTQI individuals face some level of rejection by family; thus, many sexual and gender minority patients have unconventional support networks. You can be a critical champion for this group of patients and their loved ones by assessing social and emotional needs, asking open-ended questions, demonstrating genuine interest and compassion, and advocating for cultural competency training for all staff and providers in your health care system.

Resources

• Provider Guide
• Patient Resources:
  • Prostate Cancer: Resources to Take Charge of Your Health (A fact sheet for men who have sex with men): bit.ly/MSMPrCaFactSheet
  • Living with Prostate Cancer: Resources to take charge of your health (A fact sheet for transgender women): bit.ly/TransPrCaFactSheet

Acknowledgements
Special thanks to Allison Harvey, MPH, CHES, for directing day-to-day activities and Rhea Suarez for making this project a success. Additional thanks to my co-investigator, Charles Kamen, PhD, and the Advisory Board: Heather Goltz, PhD, MSW, MEd (co-chair); David Latini, PhD, MSW (co-chair); Jennifer Bires, LICSW; William Goeren, LCSW-R-ACSW, OSW-C, BCD; and Darryl Mitteldorf, LCSW.

References

George Washington University Cancer Center. (2017). Addressing the need for LGBTQ-affirming cancer care: A focus on sexual and gender minority prostate cancer survivors. Available at bit.ly/GWCCOnlineAcademy.

The Joint Commission. (2014). Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community. Available at https//www/jointcommission.org/lgbt/.

Margolies, L., & Scout, N. (2013). LGBT Patient-Centered Out-comes: Cancer Survivors Teach us How to Improve Care for All. Available at https://cancer-network.org/wp-content/uploads/2017/02/lgbt-patient-centered-outcomes.pdf.

Obedin-Maliver, J., Goldsmith, E.S., Stewart, L., White, W., Tran, E., Brenman, S., Wells, M., Fetterman, D., Garcia, G., & Lunn, M.R. (2011). Lesbian, gay, bisexual, and transgender–related content in undergraduate medical education. JAMA, 306, 971–977.

Santos, G., Wilson, E., Rapues, J., Macias, O., Packer, T., & Fisher, R. (2014). HIV treatment cascade among transgender women in San Francisco respondent drive sampling study. Sexually Transmitted Infections, 90, 430-434.