Transgender Cancer Survivors Need Complex Survivorship Care

According to a study published in Cancer, transgender cancer survivors have complex medical needs that would be best addressed by a multidisciplinary team of providers in order to tackle transgender survivorship care, specifically within the context of diabetes, cardiovascular disease, and depression.

Researchers also indicated that clinicians should be aware of the higher prevalence of cancer among transgender men and a potential survivorship bias among transgender individuals. Given these findings, clinicians and health services should target gender nonconforming survivor’s depression and health behaviors in order to improve survival and should also focus on the complex comorbidities of transgender men and transgender women. 

“This study speaks directly to the previously identified need to conduct more research concerning transgender cancer survivors’ needs and addresses oncologists’ interest in gaining more knowledge regarding the health of transgender survivors,” the authors wrote. “Because of the increasing volume of cancer survivors who require survivorship care, discussions currently are ongoing regarding which cancer survivors need to be followed by oncologists versus primary care physicians.”

Using Behavioral Risk Factor Surveillance System data from 95,800 cisgender and transgender individuals who self-reported a cancer diagnoses, the researchers estimated cancer prevalence and calculated odds ratios with 95% confidence intervals of physical, psychological, overall health, and health behaviors of transgender survivors versus cisgender survivors.

After adjusting for confounders, transgender men were found to have a significantly higher (>2-fold) number of cancer diagnoses compared to cisgender men, but not cisgender women. Cancer prevalence among gender nonconforming individuals and transgender women was not significantly different from that of both cisgender men and women. 

Moreover, gender nonconforming survivors had significantly greater physical inactivity, heavy episodic alcohol use, and depression than the cisgender men and women. Transgender men survivors were also significantly more likely to report poor physical health and greater medical comorbidities and were less likely to report smoking compared to cisgender men and cisgender women. 

Additionally, transgender women survivors were significantly more likely to report diabetes compared with cisgender men and cisgender women and were also more likely to report cardiovascular disease compared with cisgender women.

“Consistently, research has pointed to associations between depression and unhealthy lifestyle behaviors, especially physical activity and alcohol use, suggesting that gender nonconforming survivors are an at-risk group in urgent need of complex interventions to reduce alcohol use, physical inactivity, and depression,” the authors wrote.

Notably, because the surveyed transgender survivors were alive, capturing the healthiest survivors only, this could point to a healthy survivor bias. Further, the researchers lacked certain relevant knowledge, such as use of hormone therapy and gender reassignment surgery status, which could change cancer risks as well as overall physical health risks in this population.

“The absence of comprehensive surveillance data regarding transgender individuals severely hinders research within this population group,” the authors wrote. “Moreover, because of the size of the transgender population, there are too few transgender patients at cancer centers or in most health care systems to conduct transgender survivorship studies.”

According to the study, a recent estimate of the size of the transgender population in the US suggested that 1.4 million adults self-report as transgender. Transgender individuals also have lifestyle factors that put them at a higher risk for cancer. For example, there is a higher prevalence of human papillomavirus and HIV infections among transgender individuals, which are linked to approximately 15.4% of all cancers worldwide.

Reference:

Boehmer U, Gereige J, Winter M, Ozonoff A, Scout N. Transgender Individuals’ Cancer Survivorship: Results of a Cross-Sectional Study. Cancer. doi:10.1002/cncr.32784.