Elephants And Tea - December 2020 - 36

Conversation

LGBTQ+

Cancer Care for the
LGBTQ+ Patient
CREATING EQUITY IN ONCOLOGY AND COMMUNITY
BY H A I L E Y JOH NS TON

L

esbian, gay, bisexual, transgender,
queer/questioning, plus (LGBTQ+)
folx come from a variety of cultures,
ethnicities, races, age-groups and
life experiences. These highlighted
intersections are to act as a guide for the LGBTQ+
community, allies, and medical professionals
on barriers the LGBTQ+ community faces in
cancer-related care, what resources are available, and how we can support equitable change
in oncology care and cancer community spaces. 
The LGBTQ+ community faces more barriers to healthcare than their heterosexual
and cisgender peers. In a recent rollback on
protections for sexual and gender minority individuals stated in section 1557 of the
Affordable Healthcare Act (ACA), healthcare providers can now deny services to the
LGBTQ+ population if they 'disprove of' their
sexual orientation and/or gender identity.
What does this mean for the LGBTQ+ community? Studies have shown that LGBTQ+
individuals disproportionately face discrimination in healthcare throughout history and
do not have full access to preventative care or
treatment options for cancer. 
The discrimination LGBTQ+ people face in
healthcare is multi-faceted and prevalent in
several different ways. LGBTQ+ individuals
experience homelessness and unemployment

at significantly higher rates than those who
identify as cisgender and heterosexual. These,
among other factors such as transportation
and rural location, substantially reduce the
LGBTQ+ community's access to healthy living and inhibit the ability to obtain health insurance. If an LGBTQ+ individual has health
insurance, not only can healthcare providers
legally deny them treatment/care on the basis of 'religious freedom,' but the privatized
nature of the United States healthcare system
allows insurance companies to choose what
they cover on their available insurance plans.
Gender-affirming surgery is often not covered
under insurance and is considered 'cosmetic'
and 'non-essential.' For individuals who have
had their gender marker legally changed from
male to female or female to male, insurance
may also deny coverage on lifesaving cancer
preventative care. For example, transgender
men who have not undergone a bilateral mastectomy or hysterectomy may have a more
challenging time receiving or may be denied
insurance coverage for breast and cervical
cancer screening such as pap smears and
mammograms if they have legally changed
their gender marker to 'male.'
Due to these barriers regarding healthcare
and more, distrust in healthcare professionals
providing quality medical treatment is com-

For individuals who have had their gender marker
legally changed from male to female or female
to male, insurance may also deny coverage on
lifesaving cancer preventative care.
36

ELEPHANTSANDTEA.COM
DECEMBER 2020

mon among those who identify as LGBTQ+.
The community experience with discrimination, perceived stigma and the aforementioned systematic barriers have decreased
the likelihood of having designated primary
care physicians and utilization of healthcare
services in comparison to their cisgender
and heterosexual counterparts. Distrust is
especially prevalent among racial and ethnic minority LGBTQ+ community members
due to experiencing racism, xenophobia and
language barriers with medical professionals
in addition to discrimination based on their
LGBTQ+ identity. 
With a lack of access to health insurance
and discrimination within our healthcare systems, LGBTQ+ individuals are at higher risk
for several different cancers (e.g., anal, penile
and oropharyngeal). LGBTQ+ individuals
also have a higher chance of being diagnosed
at a more advanced cancer stage than those
who are heterosexual and cisgender. And in
a survey published by the Journal of Clinical
Oncology, 45.6% of respondents being medical
oncologists, 53.1% of participants felt confident in their knowledge of healthcare needs
among lesbian, gay and bisexual patients,
and only 36.9% felt confident in their understanding of healthcare needs for transgender
patients. Though these numbers are relatively
low, 95.3% felt comfortable treating lesbian,
gay and bisexual patients, 82.5% felt comfortable with treating transgender patients,
and 70.2% of participants indicated a strong
interest in education on the unique healthcare
needs of LGBTQ+ patients. 
While there is a clear interest in LGBTQ+
health education among Oncology professionals, it has yet to be widely integrated into
the medical school curriculum and training.
Medical students are beginning to push for
the adoption of this education. This education
is crucial for medical professionals to receive
because, through being informed on LGBTQ+
care, the community will have greater access
to the healthcare they need. LGBTQ+ organizations, such as Escape and the Transgender
Cancer Patient Project, offer services to
provide general education on the community and how medical staff and


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Elephants And Tea - December 2020

Table of Contents for the Digital Edition of Elephants And Tea - December 2020

Contents
Elephants And Tea - December 2020 - Cover1
Elephants And Tea - December 2020 - Cover2
Elephants And Tea - December 2020 - 1
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