Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Achieving equity for all cancer patients - a prospective study of representation of LGBTQIA+ patients on early phase cancer clinical trials: results from a PEARLER sub-study (#322)

Rebecca H Nguyen 1 , Udit Nindra 1 , Christina Teng 2 , Joe Wei 2 3 , Andrew Killen 2 , Adam Cooper 1 , Kate Wilkinson 1 , Aflah Roohullah 1 , Charlotte Lemech 2 3 , Wei Chua 1 , Abhijit PAL 1
  1. Department of Medical Oncology, Liverpool Hospital, Liverpool, New South Wales, Australia
  2. Scientia Clinical Research, Randwick, New South Wales, Australia
  3. Prince of Wales Hospital, Randwick, New South Wales, Australia

Background

Patients identifying as LGBTQIA+ experience discrimination and structural stigma, leading to poorer engagement with healthcare and inequities with treatment, and as a consequence, poorer outcomes across the cancer care continuum1. Three to four percent of Australians identify as non-heterosexual2-3, and 1% as gender-diverse4. Despite this, there has been no research on representation of LGBTQIA+ patients in cancer early phase clinical trials (EP-CTs). We sought to prospectively examine the representation of LGBTQIA+ patients successfully recruited to EP-CTs.

Methods

All participants enrolling into EP-CTs across two major clinical trials units in NSW were recruited. Participants undertook a baseline demographic survey at commencement of their EP-CT. Details regarding EP-CT, participant background including demographics, cultural status, familial status, and gender and sexual identities were included. Currently, 84 patients have been prospectively recruited.

Results

The median age of patients was 64 years (IQR 55-71). Fifty-four patients (64%) were ECOG PS 0, and thirty patients (36%) were ECOG PS 1. Patients were located across NSW, including South-Western Sydney (n=13), South-Eastern Sydney (n=11), Southern NSW (n=6), Hunter/New England (n=6), and Illawarra/Shoalhaven (n=6) Local Health Districts. Eighteen patients (21%) were born outside Australia; the most common countries of birth apart from Australia were England (n=4), China (n=4), and Iraq (n=2). 

Forty patients identified as male, forty-four as female, and no patients self-identified as gender-diverse. All patients (n=84) self-identified their sexual orientation as heterosexual; no patients listed their sexual orientation as “same-sex” or “other”.

Conclusions

EP-CTs offer a valuable opportunity in cancer management, yet our study found that no LGBTQIA+ patients were successfully recruited. This may be a product of poor access for LGBTQIA+ patients to EP-CTs, or lack of willingness to identify as LGBTQIA+. Further work, including active demonstration of inclusivity, needs to be done to ensure equitable recruitment of cancer patients including LGBTQIA+ patients into EP-CTs.

  1. Leone, A. G., Trapani, D., Schabath, M. B., Safer, J. D., Scout, N. F. N., Lambertini, M., ... & Pietrantonio, F. (2023). Cancer in transgender and gender-diverse persons: a review. JAMA Oncology, 9(4), 556-563.
  2. Australian Bureau of Statistics (2020), General Social Survey: Summary Results, Australia, ABS Website, accessed 21 July 2024.
  3. Wilson, T., Temple, J., Lyons, A., & Shalley, F. (2020). What is the size of Australia’s sexual minority population?. BMC Research Notes, 13, 1-6.
  4. Higgins, D. J., Lawrence, D., Haslam, D. M., Mathews, B., Malacova, E., Erskine, H. E., ... & Scott, J. G. (2024). Prevalence of diverse genders and sexualities in Australia and associations with five forms of child maltreatment and multi-type maltreatment. Child maltreatment, 10775595231226331