Oncologists demonstrate limited knowledge about needs of LGBTQ patients but want more education

Oncologists at NCI-designated cancer centers demonstrated limited knowledge about the unique health needs of lesbian, gay, bisexual, transgender and queer/questioning patients, according to survey results published in Journal of Clinical Oncology.

However, oncologists expressed a high interest in receiving more training and education about the care of LGBTQ patients with cancer.

“It is becoming more acceptable among younger communities to disclose one’s sexual orientation and gender identity with the expectation that such disclosure to a physician will trigger health care tailored to the disclosure, particularly with a cancer diagnosis, but physicians who were trained prior to 2010 most likely had no training on the needs of [this] population,” Gwendolyn P. Quinn, PhD, professor of obstetrics and gynecology at NYU Langone Health, told HemOnc Today. “At the same time, electronic medical records are required to hold place to capture sexual orientation and gender identity, and many times nothing is done with this information.

“This is problematic on many levels,” Quinn added. “Patients don’t know why it is important to disclose — especially older patients — physicians don’t know why they should ask and, when the information is collected, nothing is done with it. We wanted to explore the knowledge, attitudes and practice behaviors of oncologists practicing at NCI-designated cancer centers, with the idea that if it is not happening at these ‘top’ centers, it’s not happening anywhere.”

Quinn and colleagues used the AMA’s Physician Masterfile to select a random sample of 450 oncologists from 45 cancer centers.

Researchers asked oncologists to complete a survey designed to measure their knowledge and attitudes about LGBTQ health and institutional practices, as well as to gauge their desire for future education and training.

Investigators used descriptive and stratified analyses, as well as a novel attitude summary measure, to quantify their results.

One-third (33.3%; n = 149) of oncologists in the random sample responded to the survey.

The majority of respondents indicated their practice’s institutional intake forms did not inquire about a patient’s sexual orientation (63.1%), did not ask about a patient’s sex at birth (54.4%) and did not ask about current gender identity (55%).

Researchers identified high agreement among survey respondents about the importance of knowing the gender identity of patients (65.8%) but low agreement about the importance of knowing a patient’s sexual orientation (39.6%).

Nearly all respondents (95.3%) indicated they were comfortable treating lesbian, gay or bisexual patients; however, only about half (53.1%) reported they were confident in their knowledge of this patient population’s unique health needs.

Fewer oncologists reported feeling comfortable treating transgender patients (82.5%) and being confident in their knowledge of these patients’ health needs (36.9%).

The survey included a series of questions designed to assess respondents’ knowledge of specific health needs or risks for this diverse and medically underserved population. Results showed high percentages of responses to these questions were “neutral” — meaning they neither agreed nor disagreed that they had sufficient knowledge — or “do not know” or “prefer not to answer.”

For example, when asked if regular anal cancer screening with anal Pap testing could prolong life expectancy for gay or bisexual men, 17.5% of oncologists responded with “neutral” and 30.2% responded with “do not know” or “prefer not to answer.”

Despite a reported higher prevalence of smoking among LGBTQ individuals, 26.2% of respondents responded with “neutral” to a question that assessed their knowledge of this topic and 40.9% responded with “do not know” or “prefer not to answer.”

A question intended to assess oncologists’ knowledge of whether LGTBQ individuals tend to engage in more sun-seeking behaviors than heterosexual or cisgender individuals yielded a similar rate of “neutral” responses (29.5%) and “do not know” or “prefer not to answer” responses (49%).

The percentage of respondents who expressed confidence in their knowledge of health needs for lesbian, gay or bisexual patients declined from 53.1% during the survey assessment to 38.9% after (P < .001). The percentage who expressed confidence in their knowledge of health needs for transgender patients also declined from the survey assessment to postsurvey period (36.9% vs. 19.5%; P < .001).

“We had done a pilot at Moffitt Cancer Center and found low knowledge but high comfort so, in the national study, we added in a component to re-examine comfort/confidence at the end of the survey and found it decreased,” Quinn told HemOnc Today. “[This suggests] respondents became more aware of what they didn’t know.”

Most respondents (70.4%) indicated they were interested in getting more education about the unique health needs of LGBTQ patients, and 43.7% expressed support for mandatory education about LGBTQ health needs in their workplaces.

Stratified analyses showed political affiliation, oncology specialty, region of the country, years since graduation, and having LGBTQ friends or family members had limited influence on oncologists’ responses.

Quinn described this as the “most surprising” result.

“None of the variables we thought would be related to knowledge and confidence actually were,” she said.

“Oncologists have low knowledge but desire training to improve their cultural competence, which will improve the care given to the LGBTQ patients with cancer,” Quinn added. “Next steps include surveying allied health professionals and other members of the health care team and developing education tailored to the needs of each of these groups.” – by Mark Leiser

For more information:

Gwendolyn P. Quinn, PhD, can be reached at NYU Langone Health, 500 First Ave., NBV 9N1-C, New York, N.Y. 10016; email: gwendolyn.quinn@nyulangone.org.

Disclosure: Quinn reports research funding to her institution from Boehringer Ingelheim. Please see the study for all other authors’ relevant financial disclosures.