Mandi L. Pratt-Chapman, PhD, on Oncology Care in the LGBTQI+ Community: Best Practices for Addressing Health Needs

NCCN 2023 Annual Conference


Mandi L. Pratt-Chapman, PhD, of the George Washington University Cancer Center, discusses the specific health-care needs for cancer screening, treatment, and survivorship among members of the LGBTQI+ community. Because clinical practices and research studies do not routinely collect sexual orientation and gender identity data, there is insufficient evidence to guide clinical care decision-making, Dr. Pratt-Chapman says.


Disclaimer: This video transcript has not been proofread or edited and may contain errors.
Dr. Pratt-Chapman: Lesbian, gay, bisexual, transgender, queer, and intersex people have unique cancer considerations from risk to screening, to treatment, to survivorship. And this also applies to policy. So, local jurisdiction issues, insurance coverage issues. So, as a researcher, I'm a queer identifying researcher that focuses on the health and healthcare quality of LGBTQI people. And my research really kind of spans the range of sexual orientation and gender identity data collection and use, including how do we ask these questions? What response options do patients want? When are these data collected? How are these data used? For example, I am leading a study that is looking at the wording of these questions as well as response options. I also led the development of cultural and clinical competency training for multidisciplinary teams to look at the range of unique issues for queer populations. Again, spanning from risk reduction through survivorship. And really, queer rights are human rights. And so as an advocate, I'm really encouraging clinicians and administrators to do what they can, where they are, where they live and work to make sure that patients are safe in disclosing their sexual orientation gender identity, that they support the appropriate collection of these data and use in clinical practice and research, that clinical trials are inclusive, that clinical settings are affirming, and that we're able to better gather data to guide clinical care decisions in the future. I recently wrapped up a study where I was collecting data from radiologists and radiation oncologists, and what was really clear was that transgender and intersex people in particular are facing clinical interactions and clinical care environments where at minimum they may be erased or invisible. And in many instances, providers don't feel clinically prepared or confident to care for the needs of these populations. And the vast majority of providers really want to provide good care. But there's a lack of systematic education and training for providers in kind of the differences in terms of, for example, anatomy that may or may not be present, or protections for individuals that may be seeking gender-affirming surgery at a later date and what that might mean for radiation treatment. And so just accounting for the values and preferences of care of patients across the care continuum and attending to anatomy as opposed to sex and gender markers. Considering endogenous and exogenous hormones when you're thinking about medical management and really trying to degender clinical settings so that they're inclusive and comfortable for all populations are some of the ways that providers can help to move the needle and provide more affirming care to these populations. NCCN and ASCO are committed to degendering guidelines. Coming soon, also are changes to HEDIS measures. So, there will be more anatomy driven cancer screening outcome measures in the future. So, administrators and clinicians can get ahead of this really by focusing on anatomy appropriate cancer screening as opposed to gendered cancer screening, and thinking about the whole person, the anatomy, the hormones, and the identity of people rather than kind of the binary sex markers that we've typically used in healthcare practice.

Related Videos

Hematologic Malignancies

Deborah M. Stephens, DO, on CLL/SLL: NCCN Clinical Practice Guidelines in Oncology® Update

Deborah M. Stephens, DO, of the Huntsman Cancer Institute at the University of Utah, discusses NCCN’s updates to treatment recommendations for patients with chronic lymphocytic leukemia/small lymphocytic lymphoma. Dr. Stephens details the key factors in selecting front-line and subsequent therapies, including IGHV status, del(17p)/TP53 mutation status, age, comorbidities, and resistance mutations.

CNS Cancers
Solid Tumors

Louis B. Nabors, MD, on NCCN Clinical Practice Guidelines in Oncology Updates for CNS Cancers in Adults

Louis B. Nabors, MD, of the O’Neal Comprehensive Cancer Center at UAB, discusses the three subtypes of adult gliomas classified by the World Health Organization, treatments influenced by IDH mutation status, the roles of radiotherapy and chemotherapy, molecular testing, and pseudoprogression and RANO (response assessment in neuro-oncology) criteria.

Elena Ratner, MD, MBA on Sexual Identity and Function in Cancer Survivors

Elena Ratner, MD, MBA, of Yale Cancer Center/Smilow Cancer Hospital, discusses sexuality, intimacy, fertility, and menopause as important aspects of women’s cancer survivorship and the many effects of treatment on these issues. They often go unacknowledged in the medical community, Dr. Ratner says, because of a lack of knowledge and resources. She describes interventions, including holistic, hormonal, behavioral, psychological, and interdisciplinary approaches.

Solid Tumors
Bladder Cancer

Arlene O. Siefker-Radtke, MD, on Urothelial Cancer: Emerging Therapies

Arlene O. Siefker-Radtke, MD, of The University of Texas MD Anderson Cancer Center, provides an overview of the emerging treatments for urothelial cancer, including several new agents in the antibody-drug conjugate and tyrosine kinase inhibitor classes. She describes the clinical activity and toxicities of enfortumab vedotin-ejfv, erdafitinib, and sacituzumab govitecan-hziy.

Solid Tumors

Mitesh J. Borad, MD, on Hepatobiliary Cancers: Management Updates

Mitesh J. Borad, MD, of the Mayo Clinic Comprehensive Cancer Center, discusses the expanding number of options in immunotherapies for patients with advanced hepatobiliary cancers, applying targeted treatments to this disease, and the importance of genomic profiling in patients with biliary tract cancers.