Our organisations unreservedly condemn discrimination in all forms. This is true for our members, Fellows and employees, as well as the wider society we serve.
There are approximately 3.6 million people in the UK who identify as lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ+) and are considered to be in sexual and gender minority (SGM) groups. The published literature suggests that LGBTQ+ patients continue to experience inequalities throughout the cancer pathway, from screening through to late-effects and end-of-life care.
It is hard to collect high-quality UK-specific data about cancer care for LGBTQ+ patients due to the lack of routine recording of sexual orientation and gender identity in healthcare data, and, in particular, cancer registries. Societal constructs inhibit visibility and patients may fear to disclose their status due to fears of inappropriate questions or discrimination.
Some LGBTQ+ patient groups have higher cancer risk factors, for example tobacco consumption, and can have complex competing co-morbidities, such as anxiety and depression, which affect their engagement with healthcare services. It must be acknowledged that LGBTQ+ patients are not a homogenous group and a person-centred approach is required, with particular consideration of intersectionality. Some particular patient groups can have very specific issues such as managing sex-associated cancers in transgender patients. Some SGM groups, such as black trans women, experience disproportionate inequalities compared to the remainder of the LGBTQ+ population.
A recent study in collaboration with The Royal College Radiologists (RCR), Association of Cancer Physicians (ACP) and Royal College of Physicians (RCP) identified low rates of self-perceived knowledge by UK oncologists with regard to the specific cancer care needs of SGM patients. Three-quarters felt that they would like further training in this area and two-thirds thought that the cancer care needs of SGM patients should be mandatory within the postgraduate oncology curriculum.
With this in mind, we are committed to improving cancer care for SGM patients through ten action points. These echo those highlighted in a position statement from the American Society of Clinical Oncology as well as recent reviews on this topic.
Education and training
1. Work towards integrating cancer care considerations for LGBTQ+ patients into the training and assessment of the oncology workforce.
2. Produce education and training materials covering the cancer care needs of LGBTQ+ patients.These should be co-designed and produced with SGM patients.
3. Encourage local training in cultural competency and humility with feedback from LGBTQ+patients as this has been shown to be most effective in improving patient experience.
4. Encourage the recording of sexual orientation, gender identity, preferred name and pronouns as part of routine oncology consultations and provide example scripts for how to do this sensitively.
5. Support the increased inclusion of sexual orientation and gender identify recording in healthcare data within primary and secondary care providers and disease registries.
6. Support ongoing audit and quality improvement of the care of LGBTQ+ patients within oncology.
7. Encourage the participation of LGBTQ+ patients in clinical trials, as well as their involvement in study conception and development.
8. Support the development of studies pertinent to the specific healthcare needs of LGBTQ+ patients, as they are perceived by patients themselves.
9. Ensure that study information materials are inclusive of LGBTQ+ patients.
10. Encourage diversity, not only within the oncology workforce but also within their representative committees, in line with these organisations’ equality and diversity policies.
Beyond this, we value and continue to support the excellent work done by charities, voluntary organisations, cancer alliances, health boards and other healthcare providers to improve LGBTQ+ patient experience and reduce healthcare inequalities. These include inclusive information materials, holistic patient support and bespoke clinical services. We will continue to work together to provide inclusive oncology care.
This statement has been reviewed and endorsed by the following LGBTQ organisations with health and care expertise, and by Cancer Research UK, which supports the commitments in line with its own Equality, Diversity and Inclusion strategy.