Creating Welcoming Spaces for LGBTQ+ Cancer Survivorship Care With Megan Mullins, PhD, MPH

Oncology Data Advisor: Welcome to Oncology Data Advisor. I'm Keira Smith. Today I'm joined by Dr. Megan Mullins, who is an Assistant Professor at UT Southwestern Medical Center. Dr. Mullins, thank you so much for coming on today. Would you like to introduce yourself and share what your work focuses on?

Megan Mullins, PhD, MPH: Sure. I'm Megan Mullins. I'm an Assistant Professor at UT Southwestern Medical Center's O'Donnell School of Public Health and also the Simmons Comprehensive Cancer Center. I am a cancer care delivery researcher, and my work is currently focused in two areas. One is goal-concordant cancer end-of-life care, and the other is understanding and improving equity of cancer care for LGBT folks.

Oncology Data Advisor: Awesome. At ONS, you presented a session called One Size Does Not Fit All: Cancer Survivorship in Diverse Populations. What are some of the unmet needs regarding cancer care survivorship for patients of sexual and gender minorities?

Dr. Mullins: I think it's an important question that is challenging to answer because we don't know actually a lot about many members of these populations. The last review that was done on the literature highlighted that a lot of our research is really focused in sexual and gender minority populations that are very white and cisgendered. We have big knowledge gaps in terms of intersectional identities and how those translate into care needs, as well as transgender populations and survivorship among cancers that aren't breast and prostate, where most of the research is centered.

We also know that a very important, unique aspect of care for these populations is minority stress—expecting to be discriminated against and experiencing stigma. A lot of the disparities that we do know of stem from that. Being able to address how we can provide more welcoming and accepting care could really address the disparities we know about.

Oncology Data Advisor: Along this line, what are some of the ongoing interventions that are investigating how to improve care for this population?

Dr. Mullins: Yes, so in terms of interventions, to my knowledge, there have only been two that are actually focused on cancer survivorship for LGBT folks. Those are both focused on physical activity in survivorship, because I think we know that on a population level, physical activity rates tend to be lower, and those can be really helpful with cancer outcomes. The other thing that I consider an important intervention is collecting sexual orientation and gender identity (SOGI) data. Right now, the National Cancer Institute (NCI) has funded administrative supplements to support that. That's a very big push of research that's happening right now.

Oncology Data Advisor: Oh, that's great. What are some of the changes within the health care system itself that are needed in order to improve care for this population?

Dr. Mullins: I think first and foremost is systematic collection of sexual orientation and gender identity data from all folks with cancer. Until we do that, we can't have that information abstracted into our cancer registries, so we don't really understand population-level estimates of risk where there are disparities and what we need to do to address those. So, that would really be the first thing.

The second, I would say, is thinking about how we can improve the trustworthiness of our health care systems for minoritized populations, which truly involves partnering with folks in those communities to understand their experiences and how we can do better. The third thing is starting to normalize sexuality in oncology care. I think that's not only critical for sexual and gender minorities, but it's a huge unmet need in survivorship across populations.

Oncology Data Advisor: Definitely. On the more individual level, how can nurses help to improve survivorship care for their patients?

Dr. Mullins: First and foremost, when patients come in, they're interacting with so many people. Of course, we want to do what we can as individuals. Wherever possible, if people can advocate for systemic change—promoting the importance of these things to your leadership and your hospital systems—I think that's really critical.

On a more individual level, I would say having a spirit of curiosity and humility is really key. I hear from so many clinical providers that they may get a sense that somebody has an identity that may be different, and they don't ask about it or bring it up in a visit because they don't want to make anyone uncomfortable. While that's coming from a good space, I think the way it's received is often not what people are intending. I think acknowledging that someone may be transgender or asking them about who's with them in the visit room rather than assuming or avoiding is always great.

Being willing to offer your own pronouns is a nice way to open the door and signal to somebody that you're curious about what identities they may have. And know that we all make mistakes, and that's okay. If you happen to misgender somebody and you are not doing it intentionally, generally that's not the end of the world for patients. They can recognize that. Just being able to quickly apologize and keep the conversation moving is all you have to do. You don't have to be afraid.

Oncology Data Advisor: Definitely, that's great advice. Are there any resources that nurses can consult to help improve their skills in this area?

Dr. Mullins: Yes, this is a very growing space, which is wonderful. In terms of existing things, I know the National LGBT Cancer Network has excellent resources. They partnered with the Society for Gynecologic Oncology to actually develop training modules for people who really want more in-depth training. They also have a lot of other resources there. There's SAGE, which focuses on LGBTQ aging and is a great resource. Then there is the National LGBTQIA+ Health Education Center, which also has some great resources and things like pamphlets that you can print out with responses to common questions.

Oncology Data Advisor: Awesome, that's great to know. This is so informative, so thank you for sharing all this today.

Dr. Mullins: Thanks. Thanks for having me.

About Dr. Mullins

Megan Mullins, PhD, MPH, is an Assistant Professor at UT Southwestern Medical Center's O'Donnell School of Public Health and Simmons Comprehensive Cancer Center. Her research is focused on improving equity and quality of cancer care for patients with advanced-stage cancers, particularly for older adults, racial/ethnic minorities, and sexual/gender minorities, and on providing goal-concordant end-of-life care. She is currently the Principal Investigator of a national NRG Oncology pilot study evaluating barriers and facilitators to SOGI data collection and developing a stakeholder-engaged implementation strategy to aid in SOGI data collection.

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Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.