Caring for Transgender and Special Population Patients as an Oncologist

At the 2022 GDU Women’s Oncology virtual meeting, BJ Rimel, MD, Cedars-Sinai Medical Center, Los Angeles, CA, shared important tips and insights regarding the care for transgender and special population patients being treated for cancer.

In her presentation, Dr Rimel discussed the best practices and approaches to providing care to patients in the LGBTQ community, highlighting the considerations such as preferred pronouns, gendered information, and support for the patient.

Transcript

Hello. My name is BJ Rimel. I'm a gynecologic oncologist at Cedars-Sinai Medical Center in Los Angeles. It's my pleasure to talk to you today about care of transgender patients and care of patients of special populations. When asked initially to give this talk, I struggled a bit with what “special populations” mean, and I think it's important for us to set some definitions or terms around this. Care of special populations, in my mind, speaks to the sex and gender populations that we refer to as the lesbian, gay, bisexual, transgender, queer, or otherwise identified patients. Those patients require us to think about their gender and sexual orientation as a part of their intersectional personality, and it's important that we understand, to the best of our abilities, how to create safe spaces for the care of these patients.

Let me start first with a note on pronouns. It's important for yourself as a provider and for all your staff, including the people that answer your phones, to be able to acknowledge a person's preferred name and preferred pronoun. If you make a mistake, which anyone who speaks a second language has probably misgendered a chair or a lampshade at some point, you correct yourself politely and move on. It's important to give our patients the very best care that we can, and that starts by acknowledging their true selves.

What is care of a transgender patient when it comes to cancer care? It's important, as I mentioned, to start out with a proper name and proper pronoun. It's also important to provide a safe space where the patient feels that they are welcomed, which means avoiding specifically gendered signage, specifically gendered information, such as a handout or an H&P form. It means having the appropriate equipment present in the room, very small specula for most patients, especially those taking testosterone. It means being familiar with a patient's past medical history and asking the appropriate questions. It means including a patient's partner, if they wish to bring them.

It also means providing a distraction for a pelvic exam that may be vulnerable or uncomfortable. The patient should be allowed, in my opinion, to bring whatever distractions are necessary. Maybe they want to listen to music, or have their phone, or hold the hand of a loved one. Examinations should be careful, brief, and thoughtful. Some of the questions that we need answered can be avoided or answered with other imaging technology, that produces less dysphoria. It's important to note that all patients with a cervix need cervical cancer screening, which can be as simple as self-administered HPV testing, or a PAP test done by a provider.

It's important to offer our patients all the available options, which, as we know, includes high-risk HPV testing as a standalone test. If you have questions about care for a patient of a sex and gender minority, it's a great opportunity to reach out to colleagues who may be more familiar, or to reach out to other educational sources to make yourself more culturally aware. It's also important to make sure that your staff are aware that you're going to be seeing these patients in your office and you want to provide them the best possible care. From Los Angeles, thank you very much for listening. Keep an open heart and open mind. Take care.

Source

Rimel, B. Care for Transgender and Special Population Patients. Presented at: Great Debates & Updates in Women’s Oncology. Sep 21-23, 2022. Virtual.