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Cancer services and the transgender population

By Mindo - 07th Feb 2019

Rrecently broadcast Prime Time programme on RTÉ put national attention on transgender issues. The health needs of the population are still not fully recognised, despite Ireland’s pioneers status in being one of the first countries to allow individuals self-declare their own gender identity.

The UK-based Gender Identity Research and Education Society has estimated that 1 per cent of individuals in a population experience some degree of gender non-conformity. This equates to approximately 48,000 people in Ireland. The incidence of cancer patients who consider themselves to be transgender in Ireland is currently unknown. The National Cancer Registry of Ireland does not hold demographics on this population. There is a deficit of information worldwide on cancer incidence and mortality for transgender people because of a lack of investigating large-scale prospective studies.

However, current literature indicates that transgender people face an increased cancer risk. The issue was the subject of a presentation at the recent ISMO Fellowship and Bursary Awards meeting, which was held in the Catherine McAuley Centre in the Mater Misericordiae University Hospital on 25 and 26 January. In her presentation entitled ‘Cancer doesn’t do labels’, Dr Carolyn Moloney, Cork University Hospital, discussed how the hospital’s oncology department was seeking to be more “trans-inclusive”.

Dr Moloney pointed out how transgender patients may avoid screening programmes for cancers, which are themselves gendered; for example, transgender men and cervical or breast screening. This can be due to fear of discrimination or emotional distress associated with revealing birth gender.

Research in south and south-west

In researching the subject, Dr Moloney and her colleagues identified four transgender patients under the care of medical oncology services in the south and south-west of Ireland. The research team analysed staging at diagnosis, family supports, smoking history, alcohol use and whether cancer treatment affected gender transitioning treatment and if this had documented effects on mental wellbeing. The team  also noted if medical records reflected a new name or change of gender.

The patients had stage IIIc high grade ovarian cancer, stage IV gastrointestinal tumour, stage IVb diffuse large B Cell and locally advanced extra-abdominal desmoid tumour, respectively. Of the four patients, three had a smoking history on diagnosis. All four patients’ recent medical correspondence reflected a name and gender change, but the medical records did not reflect this. Three patients had documented depression for which they were attending psychiatry services. It was noted that two patients had gender transitioning treatment postponed due to cancer care.

The team set out to identify how cancer services in Ireland can better meet transgender people’s needs, to improve patient experiences and clinical outcomes.

“To our knowledge, in Ireland, unlike in many other countries, there is no nationwide transgender oncology support group,” according to Dr Moloney.

“Transgender patients can often feel excluded from gender specific cancer support groups.”

She also pointed out how cancer treatments can delay gender transitioning therapies and have associated added negative effects on mental wellbeing, so extra support during a transgender patient’s cancer journey is necessary.

“We have developed a questionnaire, currently pending ethical approval, which will help us to identify how to develop our oncology department to be more trans-inclusive,” according to Dr Moloney.

The survey is based on the validated US National Transgender Discrimination Survey. Dr Moloney highlighted how ASCO published recommendations about how to improve cancer services for transgender patients in 2017. They include: The need to identify “gender minority” individuals in cancer clinics and report these data in the medical record in order to build much needed epidemiologic information; train staff on culturally sensitive approaches gender minorities with cancer; include transgender-friendly messages in cancer clinics; and individualise cancer care. Also in July 2018, Public Health England launched a new resource for people who are trans or non-binary as part of a commitment to make screening accessible for all eligible populations.

In conclusion, Dr Moloney pointed out that the transgender community is a growing population in Ireland that will continue to integrate into society.

“Areas that require further study include epidemiologic evaluations; cancer screening recommendations; cancer treatment; and survivorship,” she said.

“We should respect the words patients use to describe themselves.”

* World Cancer Day took place on 4 February. It was founded by the Union for International Cancer Control to support the goals of the World Cancer Declaration, written in 2008.

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