The Multinational Association of Supportive Care in Cancer has released recommendations for providers caring for transgender patients with cancer who may experience unique challenges in healthcare settings. Based on a review of available literature, the recommendations were published Dec. 9 in CA: A Cancer Journal for Clinicians, the flagship journal of the American Cancer Society.
Researchers from cancer centers and academic institutions across the U.S. compiled and analyzed relevant studies from PubMed for their review. Based on their analysis, their recommendations focus on the epidemiology of cancer for transgender individuals, creating welcome and affirming healthcare settings and how gender affirming-therapy may affect cancer treatment.
Here are 10 takeaways from the review:
- Authors of the review provide a list of preferred terms to use when caring for transgender individuals, based on expert consensus and the Gay and Lesbian Alliance Against Defamation. They note the importance of recognizing that many transgender individuals do not identify with one, binary gender.
- Researchers found a lack of studies examining the care experiences for transgender cancer patients. They did find evidence that transgender individuals appear to be underscreened and at a higher risk for cancer while experiencing later-stage diagnoses and earlier mortality.
- Transgender individuals appear to have a lower incidence of breast cancer overall compared to cisgender women. Transgender women on gender-affirming hormone therapy appear to have a lower risk of developing prostate cancer than cisgender men.
After estrogen supplementation, transgender women may have a higher risk of breast cancer than cisgender men. Compared to cisgender women's risk of breast cancer, transgender women's risk is low.
Researchers did not find evidence of higher rates of endocrine-associated cancers in transgender individuals in their review, though they assert more studies are needed for a more complete understanding of the epidemiology of cancer for transgender individuals. - The review highlights the minority stress model, which asserts individuals who face discrimination are more likely to engage in the risk-taking behaviors that influence health.
WIth that understanding, researchers found that transgender individuals are at a higher risk for cancers related to viral infections and smoking. - The review found evidence to support the strong effect gender affirmation, or lack of affirmation, can have on a transgender cancer patient's healthcare experience. The researchers provided a list of specific recommendations for providers and health systems to make the care experience more affirming and welcoming.
- The review discusses specific laboratory values that may be affected by gender-affirming hormone therapy, acknowledging that hormone therapy is not standardized. The recommendations encourage providers to understand the dosing, timing and duration of a patient's hormone therapy when interpreting laboratory values.
- Similarly, researchers said gender-affirming hormonal therapy and surgical care should be considered when cancer treatment decisions are made. Providers should collaborate with a patient's previous endocrine or surgical care providers to fully understand a patient's health history when pursuing potential cancer treatment options.
- Transgender individuals on hormonal therapy who are diagnosed with hormone-related cancers face the dilemma of whether or not to continue hormone therapy during cancer treatment.
Authors of the review said, "in the absence of clinically relevant outcome data, a tailored conversation around whether to continue GAHT should be informed by the patient and their choices should be respected." - Researchers found that providers discuss the side effects of cancer treatment, such as loss of fertility and sexual side effects, less frequently with transgender patients. Providers are encouraged to discuss all side effects and fertility-saving options with patients, regardless of gender identity.
- Certain cancer screening procedures may be avoided by transgender individuals due to potential triggering of gender dysphoria. Providers are encouraged to have sensitive discussions when sharing the risks and benefits of cancer screening.
Read the full recommendations here.