Addressing the unique needs of LGBTQ+ cancer patients

June marked Pride Month when we celebrate the differences and resilience of the LGBTQ+ community. We at Apollo Proton Cancer Centre have pledged to offer person-centred care for our patients, in recognition of the particular challenges facing lesbian, gay, bisexual, and transgender communities (LGBTQ+). Here, we focus on peculiar concerns for persons suffering from cancer within this community and how hormone therapy is adapted during treatment.

American Cancer Society released a report saying that the prevalence of cancer-causing infections, such as human immunodeficiency virus (HIV), human papillomavirus (HPV), and hepatitis C virus (HCV) are considerably higher in some LGBTQ+ population groups. According to the CDC, for example, 70 per cent of HIV infections are attributed to male-to-male sexual contact (versus 22 per cent to heterosexual contact and 7 per cent to injection drug use). HIV-infected individuals are at a higher risk for at least 10 cancers.

Cancer diagnosis and treatment can be a daunting experience for anyone, but LGBTQ+ patients often face additional challenges, which include delays in seeking care, a lack of tailored support during treatment, and specific medical considerations that need to be addressed to ensure optimal outcomes. Creating an inclusive environment is the first step in treating LGBTQ cancer patients. The staff should be educated on LGBTQ+ awareness to ensure respectful and sensitive communication.  

Specific considerations in treatment:

SGM (Sexual and Gender Minority) people face unique challenges during treatment, particularly if they are undergoing hormone therapy. Therefore careful consideration and adjustments are required to ensure the treatment is effective and respectful of the patient’s gender identity. 

Hormone therapy adjustments:

During cancer treatment, hormone therapy adjustments may be needed for transgender patients.  Hormone therapy can interact with some types of cancer treatments such as chemotherapy and radiation. For instance, hormone therapy may need to be stopped or modified to avert the possibility of any side effects. To avoid adverse consequences and promote the effectiveness of cancer treatment, oncologists must monitor hormones closely.

In hormone-sensitive cancers like breast or prostate cancer, hormone therapy might affect how the disease advances. Therefore, it is important to weigh up their benefits to come up with a decision on whether they should be continued during treatment. Oncologists should work together with endocrinologists to strike a balance between treating.

Stopping or altering hormone therapy could result in profound mental health consequences for transgender patients. Mental health support is crucial during this stage for helping patients deal with distress or dysphoria. 

Radiation therapy:

Special considerations may have to be made when treating transgender patients who have already undergone gender-affirming surgeries. 

Transgender Women (Assigned male at birth): Transgender females who have had their breasts augmented will have to accommodate the presence of breast implants during radiation therapy. The effect that this can have on the distribution and absorption of radiation means that it requires special planning to target the cancerous tissues effectively and minimise the damage caused to the implants and surrounding healthy tissues. In these cases, radiation oncologists may need to use advanced imaging techniques and customised radiation dosages to achieve optimal outcomes.

Transgender Men (Assigned female at birth): Radiation therapy needs to be individualised for patients who underwent chest reconstruction through mastectomy. This accommodates changes that occur within tissue density, and structure after surgery including other aspects of modified anatomy so as not to compromise a reconstructed chest but to hit cancer cells with focused radiation. Adequate delineation is necessary so as not to irradiate organs or tissues around unnecessarily.

Addressing LGBTQ+ cancer patients, especially transgender individuals has necessitated a comprehensive approach that recognises their unique needs. At Apollo Proton Cancer Centre, we are dedicated to being at the forefront of inclusive cancer care, supporting our LGBTQ+ patients every step of the way. We believe that every patient deserves to be treated with dignity, respect, and compassion, regardless of their sexual orientation or gender identity.