Jyoti Bajpai, MD, DM, an oncologist practicing in the Apollo Hospital network in India, is well versed in treating rare cancers, but when she encountered someone with prostate cancer who was undergoing gender-affirming hormone replacement therapy, she found surprisingly little data to inform her approach.
The realization spurred a survey of oncologists in the South Asian Association for Regional Cooperation, which includes Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri-Lanka. Alarmingly, only 19 percent reported feeling comfortable providing care to the LGBTQ+ community, and only five percent were confident they could provide good care. It came as little surprise, then, when only one percent of physicians reported that they collected sexual orientation and gender identity information.
Bajpai knew this couldn’t continue, especially in a country where one IPSOS survey reported that 2 percent of the adult population identifies as non-binary/non-conforming/gender-fluid or transgender. She planned to open the first ever oncology clinic in India that addresses the needs of LGBTQ+ people facing cancer.
But first she sought expertise abroad. At the 2024 American Society of Clinical Oncology conference, Bajpai encountered the work of Shail Maingi, MD, a community oncologist at Dana-Farber Brigham Cancer Center at South Shore Health and faculty member of the Cancer Care Equity Program at Dana-Farber.
There, Maingi presented data from two surveys she conducted in collaboration with PRIME Education and Moffitt Cancer Center on oncology providers and patients in the LGBTQ+ community across the United States.
She and her team had found that, for the most part, LGBTQ+ identifying patients still feel uncomfortable revealing information about their sexual orientation or gender identity when speaking with an oncology care provider. Only 24 percent reported feeling comfortable disclosing their LGBTQ+ status, and 4 percent reported that their care team treated their partner with respect. This information was used to create toolkits that cancer clinics could implement to better prepare providers to care for patients from this community as well as their families.
Excited by Maingi’s expertise and insight, Bajpai invited Maingi to speak at the Apollo Cancer Conclave, a large oncology conference in India. Almost immediately, Maingi accepted. She had not visited the country where her parents had emigrated from since before the COVID-19 pandemic, when she visited with her mother and brother to place her father’s ashes in the Ganges River. As an out and about member of the LGTBQ+ community, it also seemed fitting that Maingi would return once again to provide what guidance she could.
She did her best to brush up on her Hindi with Duolingo, and in December 2024 she boarded a flight bound for Mumbai. There, Maingi had the chance to visit LGBTQ+-centered HIV health centers and learned about Bajpai’s plan for a LGBTQ+ cancer clinic.
The oncologic landscape she encountered was very different than in the U.S. Some physicians reported to her that they felt unprepared to care for patients that identify as LGTBQ+, but there are some major cultural advantages. The existence of a third gender people is legally recognized, and they have been culturally visible and historically noted as far back as the 11th century at least.
“There’s no question there that trans people exist,” Maingi explains.
Maingi was reminded of the early days of her career when she worked in an HIV clinic. One patient she had during that time did not feel safe in the local nursing home because they would only admit her if “she changed her name, used a different voice, and wore different clothes,” Maingi explains.
“It was parallel to what I was hearing in India and had worked hard for 20 years to change. In palliative care, we’re supposed to provide dignity.”
At her Apollo Cancer Conclave panel, the room was crowded with physicians, politicians, and patients with pressing questions. One was worried that psoriasis meant they were going to get cancer, another told Maingi that their doctor said gender-affirming hormone treatments would cause cancer.
“I think it was valuable for the people there to see another Indian person come and talk about these issues as if it’s not something that’s external or rare,” she observes.
There was palpable optimism about changing things and increasing equity. “I was very impressed,” Maingi recalls.
Potential is high, according to Maingi, especially for furthering research in LGBTQ+-centered oncology screening, diagnosis, and treatment. India’s large LGBTQ+ community offers an immense opportunity for pushing the field forward.
The panel also broadened Maingi’s horizons.
“It expanded the way I was thinking about my career,” she explains. “I wasn’t thinking very international before, and I know my father would be proud that this work brought me back to India.”