(110) A QUALITATIVE EXPLORATION OF THE EXPERIENCE OF TRANSGENDER AND GENDER NONCONFORMING PATIENTS WITH GENITOURINARY AND GYNECOLOGIC MALIGNANCIES
Authors: Brodsky C , Lesser-Lee B , Dryden K , Glick H , Ippolito G , Hadj-Moussa M 
Published: December 2024

Abstract

Introduction
Transgender and gender nonconforming (TGNC) patients experience substantial inequities in healthcare delivery and outcomes; barriers include discrimination and inadequate knowledge about TGNC health needs. Qualitative research into TGNC patient experiences, needs, and priorities is important to uncover ways we can improve care for this population; however, this research has lagged behind research regarding cis-gender patients. Little has been studied about TGNC patient experiences with cancer. We hypothesized that being diagnosed with genitourinary (GU) and gynecologic (GYN) cancers may be particularly challenging for TGNC patients who may have dysphoria regarding their pelvic organs.

Objective
This study aims to understand TGNC patient experiences with GU and GYN cancers. We explored (a) how gender identity impacts the emotional experience of cancer diagnosis and treatment, (b) how gender identity impacts treatment decision making, (c) how interactions with oncology providers have positively and negatively impacted patients’ experiences, and what we can do to better care for this population.

Methods
Adults identifying as TGNC, diagnosed with cancer of a pelvic organ, were recruited by electronic medical record search. Participants completed an anonymous online survey probing experiences with cancer diagnosis and treatment, the interplay between TGNC identity and GU/GYN cancer, and experiences with providers, with the option to complete an additional interview delving deeper into these topics. Participants were accrued to achieve thematic saturation. Analysis included descriptive statistics, open coding, development of themes, and mixed-methods integration.

Results
N = 19 patients completed a survey, and n = 15 completed an interview. Patient demographics and cancer details are shown in Table 1. Eleven patients (58%) reported that gender identity influenced their overall cancer journey, and 16 (84%) felt that having cancer in a pelvic organ caused more distress than if the cancer was in an organ unrelated to gender identity. Reasons for distress included fear of provider mistreatment and increased gender dysphoria. For example, an agender patient said that having ovarian cancer “put pressure on me to make quick decisions about my reproductive future that led to a significant increase in misgendering as I chose to have a child while I still could.” Ten patients (53%) reported that their gender identity influenced cancer treatment decisions. Transphobia and mistreatment were reported by six patients (32%); for example, a transmasculine patient with ovarian cancer said, “There was more than one doctor who speculated that my tumor, which produced testosterone, was the cause of my being transgender.” Regarding ways to improve care, patients want their oncologists to ask for pronouns, discuss ways in which cancer treatment may affect management of their gender-affirming therapy or vice versa, and listen to patients’ preferences and priorities.

Conclusions
For TGNC patients with pelvic-organ cancers, gender identity matters, both for clinical decision making and patients’ emotional experience. There is opportunity for oncology providers to partner with TGNC patients through this particularly challenging journey, to ensure that patients feel safe and supported and can make treatment decisions that align with their gender affirming goals.

Disclosure
No.