About the Editor
Lisa E. Davis, PharmD, FCCP, BCPS, BCOP, is the editor in chief of Pharmacy Practice in Focus: Oncology. Davis holds positions as a clinical pharmacist in early-phase clinical trial and breast cancer programs at the University of Arizona Cancer Center in Tucson and as a clinical professor of pharmacy practice and science at the University of Arizona R. Ken Coit College of Pharmacy. Davis also sits on the Hematology/Oncology Pharmacy Association Board of Directors and is a member of the Cancer Prevention and Control Program and scientific review committee at the University of Arizona Cancer Center.
Strategies to advance sex and gender equality nationally and globally in oncology have been initiated in recent years, which has helped to highlight ongoing inequalities in oncology care for sexual and gender minority (SGM) populations. In the US, social determinants of health affect women and SGM populations disproportionately in all areas of health care, including oncology.
The Lancet Commission on women, power, and cancer identifies and releases key findings that can inform quality cancer care, awareness, and policies that not only impact patients but also their caregivers and the oncology workforce.1 As cancer health care professionals, we can incorporate some of the commission’s recommendations regarding gender competencies into curricula, research, and practice, particularly as they relate to the provision of care. Two examples identified by the commission are sex-specific toxicity and treatment response, and patient-reported outcomes monitoring of toxicity or psychosocial stresses of cancer treatment.1
Women with cancer experience disparities across the entire cancer spectrum, including incidence, diagnosis, treatment, and adverse effects. Female sex is an established risk factor for severe symptomatic, hematologic, and nonhematologic toxicities associated with immunotherapy and certain anticancer agents and classes of drugs. Broadly, women also experience higher rates of toxicity, as reported in clinical trials for esophageal, gastric, lung, and colorectal cancers, as well as sarcomas and lymphomas; however, exceptions can be seen in trials of EGFR inhibitors for lung cancer and rituximab (Rituxan; Genentech) for non-Hodgkin lymphoma. Despite higher rates of toxicity, women also often have better reported response rates or survival outcomes compared with men in many but not all oncology clinical trials. These inconsistencies highlight highlight opportunities to improve the quality of demographic sex/gender reporting and analysis in clinical research.
Sex differences in outcomes and toxicities could be attributable to sex-related differences in drug pharmacokinetics and/or pharmacodynamics, metabolism, microbiome, tumor biology, or sex hormones, among other factors such as drug adherence, relative doses, symptom differences, or differences in symptom reporting. Sex-specific dosing recommendations for oncologic agents, however, are uncommon. As oncology pharmacists, we consider individual patient characteristics to optimize their oncolytic and supportive regimens and incorporate risk-based strategies into treatment and monitoring plans. For example, we may recommend triple-drug emetic prophylaxis for young women receiving moderately emetogenic chemotherapy as compared with 2-drug emetic prophylaxis for a man with no additional risk factors receiving the same chemotherapy.
In routine practice, we can see examples where standard-of-care therapies differ between men and women. Despite similar rates of annual incidence and mortality for prostate and breast cancer in the US, hormonal therapeutic options are not comparative. Luteinizing hormone–releasing hormone (LHRH) agonists are typically given as depot injections every 3 months for prostate cancer whereas ovarian suppression for patients with breast cancer is more frequently managed with monthly injections. Further, an oral LHRH treatment alternative (relugolix [Orgovyx; Myovant Sciences]) became available in 2020 but is approved only for prostate cancer.
The scope of sex differences in cancer care is wide and complex, and often underinvestigated. The better we can understand and learn about these differences, the more we can improve the quality of care for our patients.
