Trans-Inclusive Cancer Care: Why It’s an Important Part of Health Equity

Today, the rights of the transgender community are at the forefront of many states’ legislative bodies, who are either widely adopting or restricting these rights. With some blocking bathroom use and participation in sports based on one’s gender assigned at birth to others banning books in school libraries and restricting gender-affirming medical care, much is being done to curb the transgender community’s trust in society and the overall health care system.

The health care transgender people with cancer need should not be determined by political or personal opinions. Further, what politicians and legislatures may not understand—as other marginalized groups already do—is that one misstep today can impact the health outcomes of this community for generations to come. Building trust among all marginalized groups, including the larger lesbian, gay, bisexual, transgender, queer and/or questioning community (LGBTQ+), is vital to ensure the American health care system does not fail them, too.

For National Pride Month this year, the Association of Community Cancer Centers (ACCC) is highlighting the transgender community and what it means for cancer programs and practices nationwide to provide trans-inclusive care.

What Is Trans-Inclusive Cancer Care?

The National LGBT Cancer Network’s “TRANSforming Cancer” initiative offers patients’ perspectives on what it means to be transgender and have cancer. These stories highlight the diverse experiences of these individuals—those who may have a gender-based cancer (eg, ovarian cancer) where the prescribed treatment can be impacted by their hormone-related gender affirming care, those who have experienced transphobia from their care team or suffer from exhaustion with having to explain their story to multiple team members throughout many different medical visits, and/or those who have to delay or cannot get their transition surgery because of a cancer diagnosis. The reality here is that transgender people face many unique barriers to cancer care that cisgender providers may not readily think about. Therefore, education is key for both patients and health care professionals alike. “We don't need you [healthcare professionals] to be an expert on trans [gender] care, right now our main question is, will you treat me with dignity and professionalism? Even something as simple as adding a pronoun pin on your lanyard is huge for us,” said Scout, executive director of the National LGBT Cancer Network.

Trans-inclusive cancer care is health care that is aligned with the needs of the transgender community and its scope encompasses the complete care continuum—screening and prevention, detection, diagnosis, treatment, and survivorship. Addressing these needs requires an in-depth understanding of each person, their care goals, and their priorities. For example, there is a lack of inclusion of transgender people in clinical trials, especially in studies that are examining hormone-related therapies. According to the National LGBT Cancer Network, “Many transgender people who have cancer are told that there isn’t enough research about the long-term effects of hormones on cancer or [anti-]cancer treatments.” Therefore, further research is needed to fully understand how anti-cancer treatments impact transgender individuals who are already or want to undergo hormone-related gender affirming therapy in the future. Doing so would ensure that all oncology patients, including those who are transgender, can participate in informative and shared decision-making when it comes to their cancer care.

Additionally, current standards of care in oncology are not optimized for transgender people. According to experts, some anti-cancer treatments require hormone deprivation, which could result in negative patient outcomes and reduced treatment compliance for those individuals being treated with exogenous hormones for their gender affirming care. Providers must create better and informed treatment pathways for transgender people, as they would for other patient populations with specific treatment-related needs.

Cancer Screening + Prevention

While the importance of cancer screening for eligible individuals is recognized by most, understanding how to target effective cancer screening in the transgender community is the first step to protecting this population’s health. The National LGBT Cancer Network and other experts identify 3 common barriers that keep transgender people from accessing healthcare and not getting screened for cancer:

1. Discrimination
2. Lack of insurance
3. Discomfort or dysphoria with physical exams.

By working to address these barriers, health care professionals can help ensure the transgender people in their patient population feel comfortable and supported when visiting a medical office and receive the appropriate cancer screening for their body.

Patient Resources for Support

To assist the transgender community, the National LGBT Cancer Network shares a list of questions from the American Cancer Society that all patients should ask their health care providers prior to receiving any cancer screening. Additionally, the network maintains a database that helps people locate an LGBTQ+-friendly provider in their area. Both resources should be used in tandem to ensure everyone in the LGBTQ+ community is receiving the appropriate cancer screening for their body while feeling comfortable and supported by their health care provider.

Finally, to better support the entire LGBTQ+ community, the National LGBT Cancer Network established its LGBTQ+ cancer peer support groups, which help individuals feel less isolated during their cancer journey and build a community of support. These groups meet three times a week via Zoom and are free-of-charge for participants. “In this political environment silence on the point of whether your trans-welcoming isn't neutral, it's an active position,” Scout said. “Please don't be part of that silence, hold your staff accountable. Use our correct names and pronouns. Treat us with dignity.”

More from ACCC

• Pride Month & Equality in Cancer Care
• Examining LGBTQ+ Disparities in Cancer Care
• NCCN Policy Summit: Addressing the Barriers to Care LGBTQ+ Communities Face
• NCCN Policy Summit: The Value of Empathy and LGBTQ+ Representation