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Brief Report
November 12, 2020

Clinical Characteristics, Experiences, and Outcomes of Transgender Patients With Cancer

Author Affiliations
  • 1Center for Biotechnology and Global Health Policy, University of California, Irvine School of Law, Irvine
  • 2Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
  • 3Division of Radiation Oncology, Boston Children's Hospital, Boston, Massachusetts
  • 4Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts
  • 5Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
JAMA Oncol. 2021;7(1):e205671. doi:10.1001/jamaoncol.2020.5671
Key Points

Question  What are the clinical characteristics, experiences, and outcomes of transgender patients with cancer?

Findings  In this case series study of 37 transgender patients with cancer, most required multimodal therapy, and 16 patients received gender-affirming hormone therapy or surgery after their cancer diagnosis. Pronouns used were documented by only 4 oncologic practitioners; the medical records of 5 patients contained documented discussion that acknowledged the interaction between cancer treatment and their gender-affirming care.

Meaning  Transgender patients develop a wide range of cancers, and many of them occur before gender-affirming care; however, documentation by oncologic practitioners suggests a need for acknowledgment of pronouns used by the patient and discussion surrounding the association of cancer treatment with gender-affirming care.

Abstract

Importance  More than 1 million people in the US identify as transgender; however, few studies have examined the experiences and outcomes of transgender patients with cancer.

Objective  To examine clinical characteristics, experiences, and outcomes of transgender patients with cancer.

Design, Setting, and Participants  This retrospective case series assessed transgender patients with at least 1 cancer diagnosis who were evaluated at Dana-Farber Cancer Institute or Brigham and Women’s Hospital in Boston, Massachusetts, between January 1, 2005, and December 31, 2019.

Main Outcomes and Measures  Demographic, clinical, and treatment characteristics for all patients and documentation by oncologic practitioners of important aspects of providing gender-affirming care, including pronouns used by the patient, were recorded.

Results  A total of 37 transgender patients with cancer were assessed (mean [SD] age, 38.9 [21.8] years at first cancer diagnosis). Fifteen patients (40.5%) had hematologic malignant cancers, and 25 patients (67.6%) had solid malignant tumors. Sixteen patients (43.2%) initiated gender-affirming hormone therapy or surgery after their cancer diagnosis. Cancer treatment was frequently multimodal, with 24 patients (64.9%) receiving systemic therapy, 24 (64.9%) receiving surgery, and 20 (54.1%) receiving radiation therapy along with other cancer-directed treatment, such as cryoablation. Five patients (13.5%) had documentation from an oncologic practitioner that addressed a potential interaction between their gender-affirming care and their cancer treatment. Thirty-three patients had follow-up visits with oncologic practitioners after starting their transition. Of those patients, pronouns used were documented by a member of the oncologic team for 4 patients (12.1%). However, for 3 of the 4 patients, documentation did not consistently use patient-reported information. At the last follow-up, 5 patients (13.5%) had died of their disease, and 26 (70.3%) were living without disease.

Conclusions and Relevance  This case series study found that transgender patients were diagnosed with diverse cancers, and many initiated gender-affirming hormone therapy or surgery after their diagnosis. Documentation by oncologic practitioners infrequently included pronouns used by the patient or discussion surrounding the interactions between cancer treatment and gender-affirming care, signifying that urgent improvements are needed in cancer care for transgender patients.

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