New laws that prohibit conversion therapy pose no material risk to evidence-based and clinically appropriate practice

Objective To examine the extent to which the Sexuality and Gender Identity Conversion Practices Act 2020 (ACT) and Change or Suppression (Conversion) Practices Prohibition Act 2021 (Vic) might pose a risk to evidence-based and clinically appropriate practice. Method Using a recent publication by Parkinson and Morris as a starting point, the provisions of the new legislation are carefully examined. Results The ACT and Victorian laws do not imperil psychiatrists undertaking evidence-based and clinically appropriate practice. Conclusions While it may be wise for psychiatrists to abandon this area of practice if they hold strong personal beliefs that the failure to identify with one’s natal gender is morally wrong, nothing in the new laws should deter psychiatrists from providing people with gender dysphoria with evidence-based and clinically appropriate care.

Downstaging Conversion Therapy in Patients With Initially Unresectable Advanced Hepatocellular Carcinoma: An Overview

The high mortality rate associated with hepatocellular carcinoma (HCC) is partly due to the high proportion of patients who present with advanced stage disease at diagnosis, for whom there are limited treatment options. For selected patients with initially unresectable HCC, locoregional and/or systemic treatments can result in tumor downstaging and consequently provide opportunities for surgical intervention and the potential for long-term survival. Therefore, the key aim of ‘conversion therapy’ is to reduce tumor burden so that patients become amenable to surgical resection. Various therapies have been investigated as candidates for downstaging patients with potentially resectable HCC including transarterial chemoembolization, transarterial radioembolization with yttrium-90 microspheres, radiotherapy, systemic therapies and combination or multimodality treatment approaches. However, downstaging conversion therapy remains controversial and there are several challenges such as defining the criteria used to identify the population of patients who are ‘potentially resectable’, the criteria used to define successful downstaging, and the optimum treatment approach to maximize the success of downstaging therapy. In this review article, we summarize clinical experience and evidence of downstaging conversion treatment in patients identified as having ‘potentially resectable’ HCC.

Details of "conversion therapy" practices and concordance with legislative definition: Findings from a non-probability community-based survey in Canada, 2020

Background: "Conversion therapy" practices (CTP) refer to a heterogeneous set of treatments and activities that share the common goal of suppressing, "repairing," or otherwise preventing expressions of transgender, lesbian, gay, bisexual, or queer identities. This study aimed to elicit details from those with direct experience and assess concordance between CTP experiences and the definition of CTP included in federal legislation aiming to deter CTP. Methods: We conducted an anonymous online survey of adults (>18 years) in Canada between August 18 and December 2, 2020. Participants were recruited through social media, CTP survivor networks, and word-of-mouth. Results: Of 51 respondents with direct experience of CTP, 16 were transgender, 34 were cisgender. Most respondents lived in Alberta, British Columbia, Ontario, or Quebec. 49% experienced CTP in a licensed healthcare provider office, 45% at a faith-based organization, and 36% at an unlicensed counselor office (categories not mutually exclusive). Age at first CTP experience ranged from 2 to 44 years of age (mean: 17.8 years; median: 17 years). Respondents experienced CTP for <1 year to 33 years (mean: 4.6 years; median: 2 years). Fifty percent of those with direct experience of CTP indicated that the proposed legislative definition of CTP did not fully encompass their personal experience. Interpretation: Results from this Canadian survey of adults with experience of CTP indicate that legislative attempts to ban CTP must be expanded (e.g., to include adults and practices that do not concord with previously drafted definitions) and paired with other prevention efforts.

Tislelizumab Combination With Chemotherapy Successfully Converted Unresectable Advanced Penile Cancer Into Complete Surgical Excision: a Case Report and Literature Review

Background: Locally advanced Penile squamous cell carcinoma (PSCC) with unresectable inguinal lymph nodes has a poor prognosis, and benefits from surgical treatment alone. Effective conversion therapy regimens are urgently needed.Case Presentation: We report a locally advanced PSCC patient with bulky, fixed inguinal lymph node metastasis complicated within genial skin ulcers, who completed inguinal lymph node dissection and achieved pathologically complete response via conversion therapy by immunotherapy plus chemotherapy.Conclusion: For unresectable locally advanced PSCC, neoadjuvant immunotherapy combined with chemotherapy is a potential treatment approach. Biomarkers of immune efficacy need to be explored. At the same time, clinical trials are needed to test the notions.