Most oncologists are comfortable treating lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) patients with cancer, according to a survey of 149 oncologists from 45 National Cancer Institute–designated Comprehensive Cancer Centers, but not as confident in their knowledge of the health needs of these patients and interested in more education about these needs.1
Information technology can be used to bridge the education gap. “The minimum that should be provided to patients,” Matthew J. Loscalzo, LCSW, said in an interview with The ASCO Post, “is orienting them to what they should be concerned about; citing data, research, and experience with other patients and families; and then to provide them the resources on day 1 about issues that patients with their characteristics are likely to care about.”
He continued, “If you are a transgender person, or an intersex person, we can use technology to tailor the information to that particular person and provide links, send digital information, or print out materials for the patient right then and there. We can do that right now.” Prof. Loscalzo is Executive Director, Department of Supportive Care Medicine, and Liliane Elkins Professor in Supportive Care, City of Hope, Duarte, California.
Identify Patient’s Support System
Identification of the patient’s primary support system is an “essential element” of the initial patient screening, Prof. Loscalzo pointed out. “The partner is almost always the primary support system,” he noted. “Friends are great for the first couple of weeks. But when it comes to the serious issues—coming up with the money, cleaning a person, and driving that person back and forth for treatment—it is generally the partner who takes responsibility, whether the partner is of the same or opposite sex. That is what the research shows.”
It is also important to ask about the relationship between the partners. “We always ask about it,” Prof. Loscalzo said. “We ask, Do you feel controlled by your partner? Do you feel respected by your partner? Do you feel safe? Is there anything going on that we should know about that would in any way undermine you two working as a team?”
The Supportive Care Medicine team at City of Hope “was the first in the country to establish a couples program, now in operation for more than 10 years,” Prof. Loscalzo noted. Appointment schedulers “are scripted to say to the patient, ‘We expect you to bring your intimate partner with you.’ When people come into the center as couples, we not only welcome them to go to a support group, but we screen the partner and the patient for their emotional, psychological, and practical concerns,” he explained.
“Before patients and partners meet with the surgeon, before they meet with the oncologist, they meet with a social worker, who then talks to them about gender strengths,” he said, “and how they can get the best out of each other from a strength-based model.”
Couples Communication
Prof. Loscalzo, who has written and spoken about couples communication (including a video interview for The ASCO Post2 and a book, Gender in Psycho-Oncology3), said that there is “very little difference in how same-sex and opposite-sex couples communicate with each other. We thought there would be, but the more we see same-sex couples, it is people loving people. It is people struggling to say, ‘How do I show up for you? How can I be proud of being your partner?’ It is the patient not being treated like a victim and feeling that cancer is a permission slip to be depressed” and withdraw from life.
“No matter who these people are, no matter how they identify, no matter who they prefer to have sex with, no matter how they see themselves, they are human beings in the struggle of their lives, who need us to create a supportive and respectful environment, in which we are open to whatever they care about,” he said. ■
REFERENCES
1. Schabath MB, Blackburn CA, Sutter ME, et al: National survey of oncologists at National Cancer Institute–designated Comprehensive Cancer Centers: Attitudes, knowledge, and practice behaviors about LGBTQ patients with cancer. J Clin Oncol 37:547-558, 2019.
2. Loscalzo MJ: The effects of gender on patients’ coping strategies and stress management. 2015 IPOS APOS World Congress of Psycho-Oncology. Available at www.ascopost.com. Accessed March 6, 2019.
3. Kim Y, Loscalzo MJ (eds): Gender in Psycho-Oncology. New York, Oxford University Press, 2018.
