In a retrospective case series reported in JAMA Oncology, Burns et al described clinical characteristics, treatment, experiences, and outcomes among transgender patients with cancer.
As stated by the investigators, “Approximately 0.5% to 0.6% of the U.S. population identify as transgender, defined broadly as having a gender identity or expression that does not align with the sex assigned at birth. Several studies have characterized the incidence of cancers in transgender patients, but data regarding experiences and outcomes [in these patients] remain limited. Currently, some recommendations exist regarding the approach to delivering high-quality cancer care for transgender patients; however, improvements are needed from diagnosis to treatment and long-term follow-up.”
The study included 37 patients treated at Dana-Farber Cancer Institute or Brigham and Women’s Hospital between January 2005 and December 2019. Patients had a mean age of 38.9 years (standard deviation = 21.8 years). In total, 15 (40.5%) had hematologic malignancies and 25 (67.6%) had solid tumors.
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Overall, 28 patients (75.7%) received any gender-affirming hormone therapy, and 16 (43.2%) underwent at least one gender-affirming operation. Sixteen (43.2%) underwent gender-affirming care after their cancer diagnosis, and 14 (37.8%) received gender-affirming care during cancer treatment.
Cancer treatment frequently involved multiple modalities, with 24 patients (64.9%) receiving systemic therapy, 24 (64.9%) undergoing surgery, and 20 (54.1%) receiving radiation therapy. Only five patients (13.5%) had documentation from an oncologic practitioner addressing potential interaction between their gender-affirming care and cancer treatment.
Among 33 patients with follow-up visits with oncologic practitioners after starting their transition, pronouns used by the patients were documented by a member of the oncologic team for only 4 patients (12.1%), with patient-reported information being consistently used for only 1 patient. Only prior gender-affirming operation was significantly associated with documented pronoun use.
Among the 29 patients with no documentation regarding pronouns used, 7 (24.1%) had documentation by oncologic practitioners using only pronouns aligned with sex assigned at birth; 12 (41.4%) with a mixture of gender-specific pronoun usage; and 10 (35.5%) with only pronouns aligned with documented gender identity (woman, man, nonbinary).
At last follow-up, 5 patients (13.5%) had died from cancer, 6 (16.2%) were living with disease, and 26 (70.3%) were living without disease. One patient who died from their disease had prior gender-affirming bilateral mastectomies and subsequently noticed a chest wall mass; the patient was reportedly told by a physician outside Dana-Farber Cancer Institute and Brigham and Women’s Hospital that the mass was consistent with fat redistribution after surgery. Diagnosis was delayed by more than 1 year, with the patient subsequently presenting with metastatic breast cancer.
The investigators concluded, “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.”
Daphne A. Haas-Kogan, MD, and Kevin X. Liu, MD, DPhil, both of Brigham and Women’s Hospital/Dana-Farber Cancer Institute and Boston Children’s Hospital, are the corresponding authors for the JAMA Oncology article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.