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

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.