Zackory T Burns1, Danielle S Bitterman2,3, Subha Perni2,3, Patrick J Boyle2,3, Carly E Guss4,5, Daphne A Haas-Kogan2,3, Kevin X Liu2,3. 1. Center for Biotechnology and Global Health Policy, University of California, Irvine School of Law, Irvine. 2. Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts. 3. Division of Radiation Oncology, Boston Children's Hospital, Boston, Massachusetts. 4. Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts. 5. Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Abstract
IMPORTANCE: More than 1 million people in the US identify as transgender; however, few studies have examined the experiences and outcomes of transgender patients with cancer. OBJECTIVE: To examine clinical characteristics, experiences, and outcomes of transgender patients with cancer. DESIGN, SETTING, AND PARTICIPANTS: This retrospective case series assessed transgender patients with at least 1 cancer diagnosis who were evaluated at Dana-Farber Cancer Institute or Brigham and Women's Hospital in Boston, Massachusetts, between January 1, 2005, and December 31, 2019. MAIN OUTCOMES AND MEASURES: Demographic, clinical, and treatment characteristics for all patients and documentation by oncologic practitioners of important aspects of providing gender-affirming care, including pronouns used by the patient, were recorded. RESULTS: A total of 37 transgender patients with cancer were assessed (mean [SD] age, 38.9 [21.8] years at first cancer diagnosis). Fifteen patients (40.5%) had hematologic malignant cancers, and 25 patients (67.6%) had solid malignant tumors. Sixteen patients (43.2%) initiated gender-affirming hormone therapy or surgery after their cancer diagnosis. Cancer treatment was frequently multimodal, with 24 patients (64.9%) receiving systemic therapy, 24 (64.9%) receiving surgery, and 20 (54.1%) receiving radiation therapy along with other cancer-directed treatment, such as cryoablation. Five patients (13.5%) had documentation from an oncologic practitioner that addressed a potential interaction between their gender-affirming care and their cancer treatment. Thirty-three patients had follow-up visits with oncologic practitioners after starting their transition. Of those patients, pronouns used were documented by a member of the oncologic team for 4 patients (12.1%). However, for 3 of the 4 patients, documentation did not consistently use patient-reported information. At the last follow-up, 5 patients (13.5%) had died of their disease, and 26 (70.3%) were living without disease. CONCLUSIONS AND RELEVANCE: This case series study found that transgender patients were diagnosed with diverse cancers, and many initiated gender-affirming hormone therapy or surgery after their diagnosis. Documentation by oncologic practitioners infrequently included pronouns used by the patient or discussion surrounding the interactions between cancer treatment and gender-affirming care, signifying that urgent improvements are needed in cancer care for transgender patients.
IMPORTANCE: More than 1 million people in the US identify as transgender; however, few studies have examined the experiences and outcomes of transgender patients with cancer. OBJECTIVE: To examine clinical characteristics, experiences, and outcomes of transgender patients with cancer. DESIGN, SETTING, AND PARTICIPANTS: This retrospective case series assessed transgender patients with at least 1 cancer diagnosis who were evaluated at Dana-Farber Cancer Institute or Brigham and Women's Hospital in Boston, Massachusetts, between January 1, 2005, and December 31, 2019. MAIN OUTCOMES AND MEASURES: Demographic, clinical, and treatment characteristics for all patients and documentation by oncologic practitioners of important aspects of providing gender-affirming care, including pronouns used by the patient, were recorded. RESULTS: A total of 37 transgender patients with cancer were assessed (mean [SD] age, 38.9 [21.8] years at first cancer diagnosis). Fifteen patients (40.5%) had hematologic malignant cancers, and 25 patients (67.6%) had solid malignant tumors. Sixteen patients (43.2%) initiated gender-affirming hormone therapy or surgery after their cancer diagnosis. Cancer treatment was frequently multimodal, with 24 patients (64.9%) receiving systemic therapy, 24 (64.9%) receiving surgery, and 20 (54.1%) receiving radiation therapy along with other cancer-directed treatment, such as cryoablation. Five patients (13.5%) had documentation from an oncologic practitioner that addressed a potential interaction between their gender-affirming care and their cancer treatment. Thirty-three patients had follow-up visits with oncologic practitioners after starting their transition. Of those patients, pronouns used were documented by a member of the oncologic team for 4 patients (12.1%). However, for 3 of the 4 patients, documentation did not consistently use patient-reported information. At the last follow-up, 5 patients (13.5%) had died of their disease, and 26 (70.3%) were living without disease. CONCLUSIONS AND RELEVANCE: This case series study found that transgender patients were diagnosed with diverse cancers, and many initiated gender-affirming hormone therapy or surgery after their diagnosis. Documentation by oncologic practitioners infrequently included pronouns used by the patient or discussion surrounding the interactions between cancer treatment and gender-affirming care, signifying that urgent improvements are needed in cancer care for transgender patients.
Authors: Zackory T Burns; Danielle S Bitterman; Kevin X Liu; Stephanie A Terezakis; Paula M Neira; Daphne A Haas-Kogan Journal: Lancet Oncol Date: 2019-03 Impact factor: 41.316
Authors: Gwendolyn P Quinn; Julian A Sanchez; Steven K Sutton; Susan T Vadaparampil; Giang T Nguyen; B Lee Green; Peter A Kanetsky; Matthew B Schabath Journal: CA Cancer J Clin Date: 2015-07-17 Impact factor: 508.702
Authors: Jennifer Griggs; Shail Maingi; Victoria Blinder; Neelima Denduluri; Alok A Khorana; Larry Norton; Michael Francisco; Dana S Wollins; Julia H Rowland Journal: J Clin Oncol Date: 2017-04-03 Impact factor: 44.544