A systematic review evaluated patient-reported outcomes after cancer treatment among patients who are sexual or gender minorities (SGM), including those who identify as lesbian, gay, bisexual, transgender, queer, and/or intersex (LGBTQI).
“LGBTQI populations…have been largely ignored in research until recently. While it is likely that these populations have been included in previous research, lack of data collection about sexual orientation and gender identity and lack of prioritizing the health of these populations has led to limited knowledge of their specific needs,” wrote the study authors. These findings were published in Systematic Reviews.
Defining Sexual or Gender Minorities
Regarding the use of the term SGM, the authors noted, “While ‘SGM’ is not a term typically used by LGBTQI people to describe themselves, and the authors do not wish to minoritize LGBTQI people, the authors use this acronym, which has been adopted by the NIH, to be inclusive of a wide range of people, including people who do not identify with the words represented in the acronym ‘LGBTQI.’”
For this study, the researchers conducted a literature review of PubMed, Embase, Scopus, Web of Science, PsycINFO, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials. Studies were eligible if they included outcomes of SGM people with a history of cancer and at least one assessment of physical, psychosocial, emotional, or functional patient-reported outcomes of cancer diagnosis and/or treatment.
In total, 64 studies met criteria and were included. Most studies were quantitative secondary analyses or cross-sectional studies with convenience samples and were from the U.S., Canada, and Australia. Breast and prostate cancer were the most studied diagnoses. Seven studies reported on experiences of transgender patients specifically, and no studies reported on intersex patients.
Health Differences of LGBTQI Cancer Survivors
According to the authors, several studies found worse cancer-related physical outcomes among SGM patients versus their heterosexual, cisgender counterparts. In studies comparing men who have sex with men (MSM) to heterosexual patients with a history of prostate cancer, MSM patients had higher rates of genitourinary complications, such as poor urinary and bowel function, sexual and erectile dysfunction, and pain. Transgender men were found to have higher likelihood of cancer diagnosis and increased comorbidities compared to cisgender men and women. Women who have sex with women (WSW) reported increased challenges to care access and more mastectomy- and radiation-related complications than their heterosexual peers.
A study of bisexual women with a history of cancer found these patients were three times more likely than other patients to report psychological distress. There were no significant differences in mental health between WSW with cancer compared to their heterosexual counterparts; however, several studies reported poorer mental health difficulties for MSM compared to heterosexual patients with cancer. Among patients who identified as sexual minorities, men had greater fear of cancer recurrence and were less likely to be partnered compared to women. Partner support was found to positively impact mental health challenges among this patient population, including a greater reduction in depression. This difference was particularly true for women, and less so for men.
Physician Knowledge of SGM Health Impacts Outcomes
The authors noted that physician “knowledge and competence of SGM health” was an important concern for patients. Patients reported greater unmet needs from oncologists who they felt were “not knowledgeable about SGM care.” Unmet care needs included depression, cancer-related fear, stress, and sexual dysfunction. These patients also reported being less likely to disclose their sexual orientation or gender identity to oncologists they felt were not knowledgeable about their care needs. Nearly 40% of WSW enrolled in one study said they were “assumed” to be heterosexual by their health care team.
Being “out” to one’s provider showed a range of benefit across studies. One study found that for male patients, disclosure of sexual orientation offered a self-esteem benefit, which was linked to improved mental health. Another study found men who disclosed their sexual orientation to their care team reported reduced anxiety and less illness intrusiveness.
“Collectively, these findings support past research that has demonstrated the importance of knowledgeable and unassuming providers in meeting the cancer care needs of SGM persons. Greater clinical and cultural knowledge of SGM concerns and SGM-affirming interventions for concerns are needed,” wrote the study authors.