In 2016, the NIH designated sexual and gender minorities (SGM) a health disparity population. The next year, the American Society of Clinical Oncology highlighted the need to improve the suboptimal cancer and survivorship care received by SGM populations. There are currently no evidence-based training programs in culturally competent care of prostate cancer patients who are gay, bisexual and/or transgender. In this selective review, we summarize findings from the largest quantitative studies focused on sexual minority prostate cancer survivors and from 65 interviews with NIH staff, clinicians, and cancer clinics in 11 US cities. The report is divided into three parts and uses a question and answer format to address 21 questions relevant to clinicians providing care to SGM prostate cancer patients. First, we identify population-specific issues that are culturally relevant in the care of SGM patients with prostate cancer. While a body of research has emerged on sexual minority prostate cancer patients, the literature on gender minorities is limited to single case reports and inadequate to inform practice. This review covers definitions, population size, cultural and historical context, sexual behavior, population invisibility, sexual orientation and gender identity (SOGI) in the electronic medical record, disparities and evidence of discrimination in treatment provision. The second part focuses on promoting evidence-informed, patient-centered care. This includes current practices in assessing sexual orientation, management of disclosure of sexual orientation, how to address common problems sexual minority men experience post-treatment, common questions sexual minority patients have, management of urinary incontinence, HIV and STI risk during and post-treatment, and sub-groups of sexual minority patients with worse outcomes. It then identifies how male partners differ in prostate cancer support, current research on rehabilitation for sexual minority men, issues in advanced prostate cancer, and things to avoid with minority patients. Finally, we examine the cultural divide between provider and patient, advocating for cultural humility when working with minority patients. Training programs and continuing education can help providers both to become more aware of their own cultural assumptions, informed about health disparities, and able to provide quality care, and to make clinics more welcoming to SGM patients.
Translational andrology and urology. 2021 Jul [Epub]
B R Simon Rosser, G Nic Rider, Aditya Kapoor, Kristine M C Talley, Ryan Haggart, Nidhi Kohli, Badrinath R Konety, Darryl Mitteldorf, Elizabeth J Polter, Michael W Ross, William West, Christopher Wheldon, Morgan Wright
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA., Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA., Department of Radiology, Trinity Teleradiology Services, Vancouver, BC, Canada., Adult and Gerontological Health, University of Minnesota School of Nursing School, Minneapolis, MN, USA., Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA., Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA., Department of Urology, Rush Medical College, Chicago, IL, USA., Malecare Cancer Support, New York, NY, USA., Department of Writing Studies, University of Minnesota, Minneapolis, MN, USA., Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA.