What Exactly Are We Measuring?

Evaluating Sexual and Gender Minority Cultural Humility Training for Oncology Care Clinicians

Ash Alpert, MD; Charles Kamen, PhD; Matthew B. Schabath, PhD; Lauren Hamel, PhD; Julia Seay, PhD; Gwendolyn P. Quinn, PhD


J Clin Oncol. 2020;38(23):2605-2609. 

In This Article

Abstract and Introduction


Sexual and gender minority (SGM) individuals (including lesbian, gay, bisexual, transgender, and queer) experience substantial cancer-related health disparities compared with heterosexual individuals (who partner exclusively with opposite-gender people) and cisgender individuals (whose gender identities are the same as their sex assigned at birth). For example, gay men and bisexual women have higher cancer prevalence than heterosexuals.[1,2] Gender identity data were not collected in these epidemiologic studies, so less is known about cancer rates in transgender populations; limited data suggest the incidence of specific types of cancers is higher, although overall incidence may be similar.[3–5] SGM patients report negative experiences with oncologic care, including stigmatization, barriers to timely diagnoses, mistaken assumptions, disrespect of gender identities, and lack of inclusion of partners.[6] After cancer treatment, SGM patients with cancer continue to experience disparities, including increased risk factors for cancer recurrence, more tobacco use, poorer quality of life, more anxiety and depression, and more fear of cancer recurrence.[7–14]

A minority (20%-40%) of oncology clinicians (physicians, nurses, and advanced practitioners) feel knowledgeable to address SGM-specific health disparities, but a majority (70%-80%) want education regarding the unique health needs of SGM patients with cancer.[15,16] To improve clinicians' knowledge, institutions have begun providing SGM-focused training for oncology clinicians.[17,18] The goal is to reduce barriers SGM people face in accessing high-quality cancer care and decrease disparities in cancer outcomes. However, few training programs have collected data regarding whether training is effective. To optimize the delivery of cancer care and reduce cancer disparities among SGM patients, we must decide which measures will tell us whether clinician training programs work. The aims of this commentary are to outline frameworks to guide SGM-focused cultural humility training in oncology, describe existing measures of cultural humility training, and discuss future directions.