Surprise: US Tops Europe for Women Oncologists on Panels 

Nick Mulcahy

March 23, 2021

The United States appears to be a more egalitarian place for women to participate on influential clinical practice guideline panels in cancer care compared with Europe, suggests a new study.

An analysis of 60 clinical practice guideline panels from the National Comprehensive Cancer Network (NCCN) found that women comprise 56% of the seats.

On the other hand, a review of 79 panels from the European Society of Medical Oncology (ESMO) revealed that just 28% of the seats belonged to females.

"I am indeed surprised by the difference," said lead author Thejaswi Poonacha, MD, MBA, from the University of Minnesota Medical Center, Minneapolis, in comments to Medscape Medical News.

"Europe is generally perceived as more 'forward' in terms of global policies, but our data on women authors in cancer organizations [guidelines] clearly show the opposite," he commented.

All praise goes to individual cancer centers, said Robert Carlson, MD, chief executive officer of NCCN, which is headquartered in Plymouth Meeting, Pennsylvania.

"The NCCN Guidelines panel members are appointed separately by the 30 NCCN Member Institutions. Gender equity on our panels is thus a reflection of the commitment and efforts of our member institutions to assure equitable opportunity and representation on our panels," he explained to Medscape Medical News in an email. (He also said the analysis data had not been verified by NCCN.)

The study was presented as a poster at last week's 2021 annual meeting of the NCCN, held virtually because of the pandemic.

"There has been significant interest [in the poster] as the abstract has been downloaded multiple times already," Poonacha said.

The NCCN has a total of 2522 panelists; 1400 (56%) were female and 1122 (44%) male. Of the 60 panels, 35 had "predominant" female representation (>50% of the members being female) and 24 were male predominant.

ESMO had a total of 816 panelists; 582 (71.3%) were male and 234 (28.7%) female. However, only two panels had predominant female membership (breast cancer and hereditary syndromes). The remainder of the 77 CPGs were male predominant.

ESMO has not ignored this issue, suggested Poonacha. The group's president, Martine Piccart, MD, PhD, of the Université Libre de Bruxelles in Brussels, Belgium, began the Women for Oncology (W4O) initiative in 2013.

Poonacha cited a survey generated by the W4O Committee that reported a lack of work–family balance as the main barrier to achieving gender parity in leadership roles by 52.8% of respondents (both men and women).

But he pointed out that "perception-based" barriers to leadership also carried importance. For example, 39.9% of the female survey participants said that men are perceived as natural leaders whereas women are perceived more as team members and supporters.

Poonacha pointed out that women are increasingly joining the oncology profession in the US.

"Nearly half of US hematology-oncology fellowship trainees are women, and the proportion of female academic oncology faculty, which is increasing at the same rate as trainees, is now approaching almost 40%," he said, citing two studies from 2019.  

The American landscape for women in oncology is not without incident. Last year, Pamela Kunz, MD, created a stir in US oncology circles when she announced on social media her departure from Stanford University after 19 years.

"The accumulated gender discrimination and harassment had taken their toll," Kunz tweeted about her latter years at Stanford Cancer Institute.

https://twitter.com/PamelaKunzMD/status/1271233862912241670

 

Kunz, who is now at Yale University in New Haven, Connecticut, emphasized that her ascension into power triggered male colleagues' discrimination.

"As I entered mid-career, assumed leadership roles, and gained some degree of success, I was perceived as a threat by some male colleagues. At that point, I experienced insidious microaggressions and retaliation from male faculty," she explained in a Twitter thread.

When Medscape Medical News reported on Kunz's experience, some male physicians who were critical of Kunz and said that the work is a rough-and-tumble place and that women can also be exclusionary in their own ways.

Poonacha and Carlson have disclosed no relevant financial relationships.

National Comprehensive Cancer Network (NCCN) Annual Meeting 2021:  Abstract QIM21-078. Presented March 18, 2021.

Nick Mulcahy is an  award-winning  senior journalist for Medscape, focusing on oncology, and can be reached at  nmulcahy@medscape.net and on Twitter:   @MulcahyNick

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