Sexual Harassment Rates Across Oncology Call for Improved Policies and Protections

Ishwaria M. Subbiah, MD, MS

Seventy percent of practicing oncologists had experienced sexual harassment by peers or superiors within 1 year, highlighting a substantial issue for both women and men, according to findings from a study that were published in the Journal of Clinical Oncology.

Out of 271 survey respondents, all of whom were cisgender oncology professionals, 189 had experienced sexual harassment, including 80% of women respondents and 56% of men respondents (P < .0001). Additionally, there were no significant correlations between respondent sexual harassment scores and gender, indicating that this issue affects people regardless of gender and that people of all genders experience similar downstream effects.

Sexual harassment has a negative effect on employee wellbeing and professional development and is an issue that has sparked the need for rigorous attention across industries, including clinical oncology, which has rarely before been studied in this context.

“Clinical oncology encompasses diverse clinicians from various practice settings, cultural backgrounds, and subspecialties,” lead study author Ishwaria M. Subbiah, MD, MS, and coauthors wrote in the study. “Understanding exactly what happens, where, when, and to whom is essential to inform efforts to transform culture and eradicate problematic behaviors.”

In order to standardize sexual harassment for the purposes of this study, organizational psychologists developed the Sexual Experiences Questionnaire (SEQ), a survey which includes the 3 dimensions of sexual harassment as defined by social scientists: unwanted sexual attention, sexual coercion, and gender harassment. This SEQ was created specifically for physicians to encompass behaviors perpetrated by patients, families of patients, and members of health care organizations.

For the purposes of this study, unwanted sexual attention was defined as sexual advances, such as touches or attempts to establish a sexual relationship that persisted despite discouragement. Sexual coercion was defined as coercing compliance with sexual demands through job-related threats or benefits. Gender harassment was defined as words or actions conveying objectification of, exclusion of, hostility toward, or second-class status about one gender.

From September to November 2020, this study was sent to 1,000 randomly selected members of the American Society of Clinical Oncology’s voluntary opt-in Research Survey Pool (RSP), as well as to oncologists solicited through social media. Those selected for outreach met study eligibility criteria, which included being attending physicians or physicians in training, practicing a clinical oncologic subspecialty, and having worked full-time at their current institution for at least 1 year.

The primary objective of this study was to determine the prevalence of sexual harassment experiences among practicing oncologists, characterize these experiences by gender, and classify them by type. Secondary objectives included evaluating links between harassment experiences and respondent consequences, including how respondents’ mental health, job satisfaction, sense of safety at work, and turnover intentions changed.

During the survey, participants completed questions based on demographics, constructs of interest, and unwanted behaviors from the previous year.

Subsequent survey analysis categorized responses based on whether respondents had experienced any form of sexual harassment in the past year and who had perpetrated the harassment, as well as respondent gender, oncology subspeciality, and career stage. This analysis then gave each respondent a sexual harassment score and examined correlations between scores and respondent consequences.

Of the 1,000 people invited to participate in the survey, 273 provided responses. Respondents and non-respondents displayed similar demographics in terms of gender, race, ethnicity, and geographic practice location. However, survey respondents were more likely to be in academic settings over training settings and were more likely to be in middle age groups rather than younger age groups.

Of the 273 respondents, 153 self-identified as cisgender women, and 118 self-identified as cisgender men. In addition, 2 respondents reported a noncisgender identity, although they were removed from the study because of the small sample size of noncisgender participants.

A total of 53% (n = 144) identified as White, 35% (n = 95) identified as Asian or Pacific Islander, and 11% (n = 30) identified as African American or Hispanic. Additionally, 94% (n = 256) identified as heterosexual, and 6% (n = 15) identified as a sexual or gender minority. In total, 250 respondents were physicians in practice, 21 were fellow or resident physicians, 62% (n = 168) practiced in academic settings, and 87% (n = 236) practiced medical oncology.

Additional results indicated that 79% of women and 55% of men experienced gender harassment (P < .0001), 22% of women and 9% of men experienced unwanted sexual attention (P = .005), and 3% of women and 2% of men experienced sexual coercion (P = .42). A total of 53% (n = 143) of respondents experienced sexual harassment by patients or their families, including 67% of women respondents and 35% of men respondents (P < .0001).

In terms of respondent consequences, previous-year sexual harassment by both institutional insiders and patients or their families were associated with decreased feelings of health and safety in the workplace. Previous-year sexual harassment by institutional insiders was associated with decreased mental health (β = –0.45; P = .004), sense of workplace safety (β = –0.98; P < .001), and increased turnover intentions (β = 0.93, P < .0001). Previous-year sexual harassment by patients or their families was associated with similar decreases in mental health (β = –0.41, P = .002) and sense of workplace safety (β = –0.42, P = .014), and increased turnover intentions (β = 0.58, P = .0004).

Although previous-year sexual harassment by institutional insiders was significantly associated with a decrease in job satisfaction (β = –0.69, P = .001), previous-year sexual harassment by patients or their families was not (P = .21). However, of the group that experienced sexual harassment by patients or their families, women oncologists did experience lower job satisfaction (β = –0.24, P = .026) and sense of workplace safety (β = –0.24, P = .034) than men.

None of the other participant outcomes were significantly associated with the demographics of gender, race, ethnicity, career stage, or oncologic subspecialty.

Overall, this study’s SEQ scoring system found that sexual harassment by peers, superiors, patients, and patient families significantly affects wellbeing, including mental health, job satisfaction, feelings of workplace safety, and turnover intentions. Additionally, although women were more likely to experience sexual harassment than men, people who had experienced harassment reported similar effects, regardless of gender.

The data gathered from this study highlight the need for effective protective and preventive workplace policies in the oncology field, especially as sexual harassment is more prevalent and more nuanced than is often recognized. Studies centered around sexual harassment in specific workplaces can help guide procedures and practices in certain fields, as well in workplaces more generally.

This study illuminates the need for continued and improved workplace approaches for preventing sexual harassment and offering effective reporting processes, supportive services, and evidence-based intervention. These findings can also guide further efforts specifically geared toward different responsible parties, such as institutional insiders, patients, and patient families.

Going forward, more research with larger participant populations is needed to further determine rates of workplace sexual harassment experienced among oncologists. Additionally, more broad participation from people in various oncologic subspecialties and historically marginalized groups is necessary to better understand how sexual harassment affects different identities.

Reference

Subbiah IM, Markham MJ, Graff SL, et al. Incidence, nature, and consequences of oncologists’ experiences with sexual harassment. J Clin Oncol. 2022;40(11):1186-1195. doi:10.1200/JCO.21.02574