Lack of Knowledge of LGBTQ+ Needs Among UK Oncologists

Liam Davenport

September 25, 2020

While most oncologists are comfortable treating lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ+) cancer patients, very few are confident in their knowledge of the needs of these patients and even fewer routinely ask about patients' sexual orientation, reveals a UK survey.

The research was presented at the European Society for Medical Oncology (ESMO) Virtual Congress 2020 on September 19, which was held digitally this year due to the COVID-19 pandemic.

Knowledge Deficit

The research was presented by Dr Alison May Berner, who works at both the Barts Cancer Institute, Queen Mary University of London, and the Gender Identity Clinic at the Tavistock and Portman NHS Foundation Trust, London. She and colleagues surveyed more than 250 consultant and trainee medical and clinical oncologists, finding that over four fifths were comfortable treating LGBTQ+ cancer patients, with only 3% stating they were not comfortable.

However, fewer than 1 in 10 felt confident in their knowledge of their patients’ specific healthcare needs, and only 1 in 20 reported asking about their patients’ sexual orientation on a regular basis. Three quarters said they would benefit from further education.

The team say that the research "highlights a deficit in knowledge of oncologists of specific cancer care needs of LGBTQ+ patients and a desire to address this through training".

While oncologists generally "feel comfortable treating LGBTQ+ patients", they may "fail to identify these patients in their clinic, making it more difficult to meet those needs".

Dr Berner told Medscape News UK that "people are really crying out to end health inequalities for this population".

The team is working with the Royal College of Radiologists to develop an online learning hub for LGBTQ+ cancer care training and resources, with the aim that it be available to allied oncology healthcare professionals.

Dr Berner said that, based on discussions with NHS England and the Association of Cancer Physicians among others, "everyone’s feeling behind it, and the key thing now is to bring all of those people together to not waste energy but to keep that momentum going".

She said that the important thing is "to work together to create really good quality content and to avoid tokenism, which is what can happen when you are trying to address inequalities for various groups and people don’t want to be seen to be left out".

She added: "We want to do this properly…so if you’re wearing a rainbow badge it should be that anybody can ask you about it. You should be knowledgeable on the subject, you should be putting those things into practice."

The crucial aspect to all of this is to collect data, not just on the healthcare professional side but also on the patient side.

"If we don’t collect the data we don’t know what the inequalities are," Dr Berner said, adding: "If you don’t count us, we don’t count.

"This is a call that we need to be involving the whole population in the research from the grassroots, and that’s really the only way to take this work forward."

Twitter Support

The research received a warm response on Twitter.

Dr Ruth Board, a consultant medical oncologist at Lancashire Teaching Hospitals NHS Foundation Trust, echoed many when she described the work as "so important".

She added that it is "good to see the majority are comfortable treating LGBTQ+ patients but let’s aim for 100%!"

https://twitter.com/drruthboard/status/1307750727985573888?s=21

Sean Ralph, a therapeutic radiographer at The Clatterbridge Cancer Centre NHS Foundation Trust in Merseyside, commented that it is an "excellent piece of work".

He said it highlights "why there is still much work needed to be done to bring cancer care out of the closet".

https://twitter.com/sean_c_ralph/status/1307681000701530113?s=21

 

Cancer Care Inequalities

Dr Berner and colleagues said that approximately 1.3 million people in the UK identify as LGBTQ+, and there is an increasing body of literature showing that they not only have different cancer risk factors from other people, but also face "persistent inequalities in cancer care".

Inspired by recent research in the USA on oncologist attitudes, knowledge, and behaviour towards LGBTQ patients with cancer, which revealed limited knowledge but a high interest in receiving education, they aimed to perform a similar analysis among UK oncology consultants and trainees.

The team performed a literature search to develop a 53-item anonymised survey covering respondent demographics as well as knowledge, attitudes, and behaviours regarding LGBTQ+ patients, with the majority of items having Likert-scale responses.

Consultant and trainee medical and clinical oncologists were recruited via social media, email campaigns by professional oncology bodies, and endorsement of the survey by the Royal College of Radiologists.

There were 258 complete responses. The respondents had a median age of 43 years, 58% identified as female gender, 41% as male, and 1% were undisclosed. Fourteen percent identified as LGBQ.

The distribution of ethnicities reflected the NHS workforce, with 75% White and 25% Black, Asian or Minority Ethnic.

The majority (65%) were consultants and 35% were registrars. Fifty-four percent were clinical oncologists, and 42% medical oncologists.

The results show that 84% of respondents said they were comfortable treating LBGTQ+ patients, but 3% were not.

More than half of the participants thought it important to know a patient’s gender identity to better understand their healthcare needs, while 29% thought it important to know an individual’s sexual orientation.

Yet only 5% often or always asked about a patient’s sexual orientation as part of their consultation, 3% asked about their gender identity and 2% asked about patients' preferred pronouns.

In terms of knowledge, while 8% of respondents said they were confident in their knowledge of the specific healthcare needs of LGBTQ+ cancer patients, 67% felt confident in their ability to communicate effectively with LGBTQ+ patients with cancer.

Knowledge about the incidence of cancer risk factors among the LGBTQ+ population was variable, with between 12% and 35% of respondents saying they did not know whether factors such as smoking, obesity, alcohol and social drug use were more common than in the general population.

Seventy-five percent of respondents felt that they would benefit from further education about the specific healthcare needs of LGBTQ+ cancer patients, and 68% said it should be a mandatory part of the postgraduate curriculum in oncology.

Dr Berner explained that the educational hub is currently in its "infancy" and discussions with the Royal College of Radiographers are ongoing to "scope out what exactly needs to be done and to apply for specialist funding to do that".

The team will use the already existing educational platform hosted by the College but the aim is to "make sure that can be accessed by everybody; not just clinical oncologists in the UK but medical oncologists and other professionals".

The British Medical Association and the Royal College of Physicians were unavailable for comment.

No funding declared.

Dr Berner declares honoraria from Pfizer Oncology unrelated to this work.

ESMO Virtual Congress 2020: Abstract 1614P. Presented September 19.

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