Experiences of Transgender and Gender-Nonconforming Patients With Genitourinary and Gynecologic Cancers: A Qualitative Study.

Abstract

We hypothesized that transgender and gender-nonconforming (TGNC) patients diagnosed with genitourinary (GU) and gynecologic (GYN) cancers may experience unique challenges and barriers to care because of association of these organs with sex assigned at birth but not gender identity. We aimed to explore their experiences in this qualitative study. TGNC adults diagnosed with a GU/GYN cancer completed an anonymous survey probing experiences with cancer diagnosis, treatment, and clinicians, with the option to complete an additional interview. Participants were accrued to thematic saturation. Analysis included descriptive statistics, open coding, and development of themes. Twenty-one patients completed a survey, and 16 completed an interview. Qualitative analysis yielded six key themes: (1) clinician dismissal and assumptions about gender identity and preferences, (2) inadequate clinician knowledge about TGNC health, (3) avoidance of oncologic care due to dysphoria and fear of discrimination, (4) increased dysphoria associated with GU/GYN cancer, (5) importance of gender identity in patients' decision making, and desire to discuss gender-affirming goals, and (6) wide spectrum of reactions to GU/GYN cancer diagnosis, associated with charged feelings toward affected organ. For TGNC patients with GU/GYN cancers, gender identity matters, both for clinical decision making and patients' emotional experience. Clinicians can partner with patients through this challenging journey to ensure that patients feel safe and supported and can make treatment decisions that align with their gender-affirming goals.