Improving cancer care in the LGBTQ+ community
Dan Saunders, Consultant in Clinical Oncology at The Christie
For the LGBTQ+ community, there is a significant lack of understanding of both risk factors and symptoms and signs of cancer compared to the general population. On average, there is a higher consumption of alcohol within LGBTQ+ communities, alongside a higher prevalence of smoking; both of which increase your risk of developing cancer. Transgender people receiving hormonal therapy to support their transition may also have different risk profile to cisgender people.
An apparent lack of support in areas of treatment and diagnostics means LGBTQ+ people are less likely than heterosexual people to be given written information about the type of cancer they have. An absence of honest conversation can also mean that there isn’t sufficient specific advice regarding somebody’s sexual orientation and the implications of treatments on subsequent intercourse and reproduction.
Additionally, there is an inadequate collection of data by the NHS on the sexual orientation of patients. If this information was routinely collected, it would act to inform the best practices for caring for these patients and identify areas of weakness.
Throughout my work in cancer care and the LQBTQ+ community, I have experienced recurring issues with the delivery of primary care. Many LGBTQ+ patients have reported problems in accessing primary care, whilst also facing adversities such as lack of understanding and feeling unwelcome in the healthcare environment. This dynamic can subsequently influence patient compliance and result in things such as delayed presentation, which is detrimental to patient outcomes.
I have been involved with medical issues to do with LGBTQ+ people since I was a medical student. When I became a consultant, I was looking for work that was relevant to what I did. A few years ago, I met a gay man with prostate cancer who had found that there was no information on how a homosexual man should make choices on his cancer treatment. I subsequently looked into this and failed to find anything that would provide advice. This is the stage at which I began a piece of work to form better advice for gay men with prostate cancer, which is now greatly supported by Prostate Cancer UK.
Other aspects of my work have included looking at the care that is provided from a patient perspective and how we can do better. I have done various pieces of education and training around the UK, and more recently we have been working with two medical oncology colleagues from London to evaluate the education and training needs of oncologists in the UK. This was done with the support of the Royal College of Radiologists (RCR) and the Association of Cancer Physicians, and the study revealed that those surveyed received a stark lack of background information at medical school on caring for those within the LGBTQ+ community.
After running an educational summer school for the RCR last summer, we are now in the process of arranging one for the European Society for Medical Oncology to try and bridge these barriers in knowledge.
The Joint Collegiate Council for Oncology (JCCO) has just announced a commitment which encourages several medical royal colleges and other organisations to work together towards improving the care of LGBTQ+ patients with cancer; this is a very positive step in the right direction and I am proud to have played a part in making this a reality.
The impact on cancer care and precision for all
There’s good evidence that LGBTQ+ patients are not as engaged in research as they should be at the moment and as a result, we don’t have cancer outcomes for most malignancies that show how LGBTQ+ patients respond to specific treatment and care. If we facilitate programmes that look at the specific cancer needs of patients within particular communities then we can use these findings to inform individualised cancer care. In this sense, we will have a greater amount of data to tailor the treatment to one individual.
Manchester specific EDI steps
Manchester has one of the most diverse populations in the world, and as a city we pride ourselves on inclusivity. The LGBT Foundation which is based in Manchester has a very strong interest in healthcare and improving health outcomes. They have worked alongside The Christie previously and are keen to continue this ongoing collaboration to help in improving cancer care for the LGBTQ+ communities in and around Greater Manchester.
We also have a great strategy of Team Science and real-world cancer outcomes here in Manchester, that Rob Bristow is supporting. This ultimately means we should have better precision medicine and personalised cancer care for all.
Hopes for the future
The ultimate impact of these interventions is that there should be earlier presentation of LGBTQ+ patients which will result in better cancer outcomes. Although this will take time and will require a stratified approach to the healthcare system, if we can get to the point where we have a hospital system that records data of protected characteristics and uses it to produce an evidence base of how to provide better care for people in these communities, that would feed into some real-world cancer outcomes evidence that is missing at the moment.
My personal hopes are that people feel included and treated as individual human beings, that we offer care that meets their specific needs and produces better outcomes for them.