Fighting Sexual Harassment Within Oncology Begins With Authentic, Actionable Conversations

Ishwaria M. Subbiah, MD, MS

Oncologists who have experienced sexual harassment can provide the necessary insight for policy and community reform, said Ishwaria M. Subbiah, MD, MS. She explained that sexual harassment is a behavioral issue deeply rooted in the ways oncology circles often function.

“Sexual harassment is a difficult topic to talk about. We were very meticulous about how we approached this area of study, because of how sensitive it is. The fact is, we now have solid data to show how impactful sexual harassment is in oncology,” Subbiah said. “We collectively, as an oncology community, need to take a deep breath, put aside any hesitations, any discomfort that we may feel about discussing sexual harassment, and sit at a table to see how we as a community at large can put solutions in place.”

In an interview with OncLive^®, Subbiah, medical oncologist, palliative care and integrative medicine physician, and director of Faculty and Academic Wellness in the Office of the Chief Academic Officer at The University of Texas MD Anderson Cancer Center, discussed the paper, “Incidence, Nature, and Consequences of Oncologists’ Experiences With Sexual Harassment.” She was a coauthor on the paper detailing findings from a study investigating the prevalence and types of workplace-related sexual harassment experienced by oncologists.

In this discussion, Subbiah brought attention to the perpetrators of sexual harassment, outlined the nuances of how these experiences affect personal wellbeing and job satisfaction, and highlighted the need for accountability as a first step toward systemic change across the oncology community.

OncLive^®: What was your rationale for conducting this study, and how does this information address a specific need within the oncology community?

Subbiah: The concept of the workplace experience is truly complex. We recognized that biases based on one’s gender do factor into the experience of oncologists. But we didn’t have the raw data from the oncology community that could truly capture the scope of the problem of sexual harassment within oncology.

Before we look to tackle any problem, we have to characterize it. Our study found a dearth of data that truly characterize the experience of oncologists when it comes to sexual harassment. To that end, we began by first characterizing the scope and depth of the problem [as a precursor to] possible solutions.

Why did you choose to use the Sexual Experiences Questionnaire (SEQ) to generate results?

When we first set out to characterize sexual harassment in oncology, it was important to us to use a methodologically rigorous approach. This is such a difficult topic. How we approached it had to be, in and of itself, driven by data and experience. We used the SEQ because it is an instrument that is psychometrically validated and developed for the study of sexual harassment.

One of the largest uses of this questionnaire was in the US military after the Tailhook scandal. It’s also been used in general medicine settings, as well as in settings outside of health care. The SEQ is designed in such a way that we could get information from the responses that helped us understand the types of sexual harassment. That was incredibly important to us, because there are different types of sexual harassment. By using the SEQ, an instrument that is psychometrically validated and has decades of use in other settings, we could get actionable information from our participants. That was a priority for us.

What were some of the most striking data that you found through this research?

When we first set out to do this study, we knew it was important to characterize the incidence and types of sexual harassment within oncology. What truly surprised us was just how high the incidence [rates were]. Overall, 70% of the oncologists who responded said they had experienced 1 or more episodes of sexual harassment in the previous year alone. That’s an important point to emphasize. Our study was specific only to experiences from the previous year. [This sexual harassment was] from peers and superiors, those institutional insiders in their workplaces.

The second part that was surprising to us was about interactions with patients. We didn’t want to [restrict occurrences] to peers alone, so we asked about patients and families. What we found was, over half of the oncologists who responded, 53% to be specific, had experienced sexual harassment from patients and/or families in the past year alone. This information becomes incredibly important because as we move toward systemic solutions, we have to be mindful that an oncologist’s workplace experience extends not just to their peers and their team members but to those that they care for as well.

What other important data did you collect?

We wanted to demonstrate the downstream effect of having experienced sexual harassment. We compared specific metrics of the workplace experience between those who said they had experienced sexual harassment in the previous year with those who responded that they hadn’t. We measured their mental health, sense of workplace safety, job satisfaction, and turnover intentions.

We found that those who had experienced sexual harassment from their peers or superiors in the previous year reported lower mental health scores, a lower sense of workplace safety, and lower job satisfaction, along with higher intentions to change jobs. Similarly, when we looked at those who experienced sexual harassment from patients or families, we found that there was a lower sense of mental wellbeing and workplace safety, as well as increased turnover intentions. The only difference was the job satisfaction wasn’t different [for this population].

One of the most interesting components of our findings is that this downstream effect of sexual harassment did not differ between the men and the women respondents. The incidence of sexual harassment was different between these 2 groups. But that downstream effect was no different. This becomes so important as we design solutions, because sexual harassment is not just a problem for women that women have to find a solution for. This is truly a problem for every person in the workplace, and the responsibility for the solution lies on the systemic level, with every person.

What are the next steps for this research? How are you hoping these data can create change within the oncology community, and what still needs to be studied?

When we think of the next steps, we can leverage the answers we received from our respondents. By using the SEQ, which is a validated instrument, we were able to find where the highest reports of sexual harassment incidences are, with gender harassment, unwanted sexual attention, and sexual coercion being the 3 most serious.

We found that the highest incidence was in the category of gender harassment. These are the workplace experiences where a colleague of a certain gender is treated or perceived differently by people of different genders.

When we look at solutions, we must first look at the subtype of sexual harassment that is the most prevalent. It’s almost never what we hear in the news. The incidents that make it out into community conversations are the most egregious of cases, the tip of the iceberg. Our study showed that the highest incidence, the bulk of the negative experiences, is in the gender harassment category, which is likely just under the waterline.

[Crafting solutions starts with acknowledging] the types of harassment that our oncologists have reported and looking at the factors that enable them. One of the components of our study that we’ve just completed is analysis on this data, which we’ll be reporting shortly. We asked: What were the experiences of the oncologists who chose to report what happened to them to their institutional entities? Those findings will be crucial as we design solutions because they will show us where the key flaws are in the current system that’s in place. How do we need to streamline reporting mechanisms? How do we need to streamline the approach, the investigation, and how these concerns are handled? And how do we do this in a way that is transparent enough to the oncologist reporting it, so they’re aware that their concerns are taken seriously?

Another component of our next steps involves looking at those cases that we hear about on the news or within oncology circles, those egregious examples that show years-long, or, in many cases, decades-long careers filled with concerning behaviors such as bullying, gender harassment, and other types of sexual harassment. This is where we as an oncology community need to step back and look at the environment that allows behaviors like this to continue and the persons behind those behaviors to, frankly, thrive.

When we look at that iceberg metaphor that the National Academies [of Sciences, Engineering, and Medicine] uses to describe sexual harassment, we see the most egregious cases that we hear about on the news at the tip of the iceberg, with many other behaviors and experiences under the water. We must pause to note that what keeps that iceberg of sexual harassment intact is the ocean. That iceberg would not exist had it not been for the water that keeps it intact. We in the oncology community are that water. We must find a way to turn up the heat so that the that iceberg is squashed at an early stage. We as an oncology community take responsibility for [these sexual harassment cases], and we also take ownership for developing the solutions.

What are the main implications of this study that you’d like colleagues and other readers to understand?

Our study showed, in a methodologically rigorous way, that sexual harassment has a high prevalence in oncology. Our study also showed that although the rates of sexual harassment were different between men and women oncologists, the downstream effect was not. Sexual harassment affected a sense of safety, individual wellbeing, job satisfaction and turnover intentions no differently between men and women oncologists.

Our study also showed that the perpetrators were not just peers and superiors within the institution but also patients and families. When we design a solution, we must be mindful to remove any blinders we may have and look at the workplace experience as a whole.

Another interesting finding from our study was that seniority wasn’t protected. [Whether they were early-career, mid-career, or late-career oncologists, respondents expressed] no differences in the downstream effects of having experienced previous-year sexual harassment. This is truly [an issue where we need to] look at our whole community of oncology providers and find a better way to take care of them.

What else would you like to add about this research?

These solutions will affect every oncology stakeholder. In this study, we chose to study oncology physicians. However, we know that our team is multidisciplinary. We know how many people are invaluable to the oncology team to provide care for our patients. It’s important for us to understand each stakeholder’s experience and design solutions that meet their needs. I fully suspect that the solutions will affect all the stakeholders who are in a multidisciplinary oncology clinic. We’re truly in this for every member of our team.