Table 1.
Recommendations on the theme ‘Healthcare organisation’ with relevance assessment
| Recommendations extracted from the selected studies on the theme ‘Healthcare organisation’ with relevance assessment. | |
|---|---|
| Statementa | Assessment |
| Health care providers should engage in shared medical decision making, particularly in settings where patient priorities differ from guidelines or when discussing gender-related treatments (e.g. hormones or surgery) in the context of cancer treatment.10 | 9 |
| Patient-reported symptomatic AEs should be included in routine monitoring to shed further light on potential sex-related differences.5 | 9 |
| There should be pooling among clinical trial databases to enhance statistical power to identify trends in AEs by sex.5 | 9 |
| Oncology institutions should ensure clinical trial criteria do not exclude participants based on gender, hormones, or human immunodeficiency virus (HIV) status unless clinically indicated.10 | 9 |
| Oncology institutions should ensure SGM cultural humility training is required for all staff and clinicians.10 | 8.5 |
| Curricula should be required to train oncologists in SGM health care needs and affirmative communication skills to facilitate patient-centred care for SGM individuals with cancer.11 | 8 |
| Oncology institutions should ensure clear and accessible grievance policies for patients who experience discrimination.10 | 8 |
| A comprehensive clinical evaluation of patients, encompassing the functional assessment and the comorbidity profile as well as chronological age, together with the potential predicted risk of treatment-related toxicity, should always be carried out before the start of a first-line treatment to guide the therapeutic choice and to maximise the risk–benefit profile.12 | 8 |
| To promote more equitable research and care for SGM populations, SOGI data should be included in cancer registries and clinical trials. Funding opportunities to train the next generation of researchers should also be increased to raise awareness of health issues among SGM people.13 | 8 |
| More education and research are required to bridge knowledge gaps among radiation therapists about LGBTQ2SPIA+ patients with cancer to provide inclusive patient care.14 | 8 |
| The underlying problems of cancer screening in the SGM populations should be understood to define future clinical and institutional approaches so as to improve health care.15 | 8 |
| Population-based studies or meta-analyses should be conducted to encourage discussion about the inclusion of sex and gender characteristics in the decision making for the personalised treatment of patients with brain metastases.16 | 8 |
| Patients should be provided with different avenues for disclosing SOGI information such as in hospital forms (both written and online) and verbal questioning from HCPs as a routine part of sociodemographic and history-taking.17 | 7 |
| During hospital admissions, assessing patient comfort in sharing rooms with someone of a different SO or GI may be helpful in determining hospital policies and communicating the same to patients upon admission.17 | 7 |
| Oncology institutions should ensure the availability of all-gender restrooms.10 | 7 |
| Oncology institutions should ensure intake forms have a language that does not make presumptions about anatomy based on gender (e.g. ‘for women only: when was your last period?’).10 | 7 |
| Oncology institutions should ensure intake forms are inclusive of SGM people by including answer options inclusive of SGM identities (e.g. questions about gender include nonbinary, agender, genderfluid, genderqueer, and/or other options).10 | 7 |
| Oncology institutions should engage in comprehensive data collection, including querying sexual orientation, gender identity (including whether someone is transgender), and anatomy and consider checking hormone levels.10 | 7 |
| Oncology institutions should ensure gowns and other clothing items provided are gender-neutral and/or that multiple options exist from which to choose.10 | 5 |
| Recommendations promoted by the panel of experts on the theme ‘Health care organisation’ with relevance assessment. | |
|---|---|
| Statement | Assessment |
| It is important to promote preclinical, clinical, and translational research in oncology that takes into account a gender perspective. | 9 |
| More training of health care professionals in the field of gender medicine and gender oncology is needed. | 9 |
| In preclinical and clinical research in oncology it is essential to disaggregate data by sex and gender, in accordance with the guidelines for the application of gender medicine in research, drawn up by the observatories for monitoring the application of gender medicine in the NHS and this information should also be available on their website.18 | 9 |
| It is essential in the predisposition of integrated care pathways that care dedicated to oncological pathologies takes into account the biological differences between men and women in various types of neoplasms and pays attention to the social and economic factors that affect the state of health, to define management paths in the perspective of gender that can be so facilitated and customised for the patients.18 | 9 |
| Given the gender differences observed in oncology, sex should be an important stratification factor to be included in all randomised clinical trials to better understand the biological differences between men and women to improve biological therapies.19 | 9 |
| Evidence of gender differences in lung cancer may justify a change in screening programmes: different selection criteria for screening programmes for lung cancer by gender should be evaluated, to guarantee equal opportunities for participation, allowing both genders to benefit.20 | 8 |
| A review of the literature shows evidence of gender inequality in patients with lung cancer in access to health care services and treatments in developed countries. However, evidence is not available in developing countries, so further studies are needed to understand gender inequalities in these contexts and design interventions to improve the survival of patients with lung cancer.21 | 8 |
| More training and research are needed to fill gaps in health care professionals’ knowledge (oncologists, other specialists, nurses, etc.) about LGBTQ2SPIA+ patients with cancer to provide inclusive care to these patients. | 8 |
| Clinical trials in oncology should report extensively the outcomes of safety, quality of life, efficacy, and activity by gender, as ancillary publications or as additional material. | 8 |
AE, adverse event; GI, gender identity; GPPs, good practice points; HCP, health care professional; HIV, human immunodeficiency virus; LGBTQ2SPIA+, lesbian, gay, bisexual, trans, queer, two-spirit, pansexual, intersex, asexual, plus; NHS, National Health System; SGM, sexual and gender minority; SO, sexual orientation; SOGI, sexual orientation and gender identity.
a
Statements without a bibliographic reference are GPPs.