Jun 24, 2019

LGBTQIA+ cancer survivors report worse health post-treatment than heterosexual survivors; gap in unique survivorship care

LGBTQIA+ cancers survivors report worse health post-treatment compared with heterosexual survivors, and their partners report a lack of customized support options. Can oncology care meet the growing needs of this patient population?

With advances in our understanding of immune complexities and the commercialization of targeted therapies, cancer survivorship (those currently fighting cancer and those who have been cured) is at an all-time high.1 As of January 2019, there are an estimated 16.9 million cancer survivors in the US, 1 million of whom identify as LGBT.1-3 Previous blogs have discussed the communication and knowledge disparity that exists between oncologists and LGBTQIA+ patients they treat.4 Unfortunately, this gap continues post-treatment and into survivorship.

Traditionally, survivorship data are cataloged by the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. However, SEER does not capture sexual orientation data. The National Health and Nutrition Examination Survey (NHANES) currently provides the best national data available to explore issues of sexual minority status, cancer survivorship, and their health behaviors. Each year, NHANES surveys ~5,000 individuals using interviews, laboratory measures, and physical exams to assess the health and nutrition of adults and children in the United States. Since LGBTQIA+ survivorship is widely understudied, Jabson et al analyzed NHANES data of 602 self-identified cancer survivors between 2001-2010 who were eligible for the sexual behavior interview and provided their sexual orientation. Jabson et al hypothesized that since this population often has a history of engaging in cancer-related behaviors (eg, tobacco use, alcohol use, substance use), LGBTQIA+ survivors would report poorer health, cancer reoccurrence, and cancer-related mortality at higher levels than their heterosexual counterparts.5

Of the 602 cancer survivors surveyed, 4.3% (n=26) were identified as sexual minorities (ie, lesbian, gay, bisexual, or “something else”). These individuals were 60% less likely to report their current health status as good compared to heterosexuals.5

Almost all cancer survivors experience distress. However, LGBTQIA+ cancer survivors are more likely to report being unhappy with their health or feeling negatively about their future.6 Poor health outcomes may be compounded by the stress associated with being a sexual minority in addition to the emotional/physical stress of the cancer treatment and the perceived discrimination faced during the cancer treatment process.5

Almost all cancer treatments affect sexual function. Yet, the cancer care team (eg, oncologists, nurses, social workers) may not have the appropriate knowledge or understanding of LGBTIA+ sexuality to properly address the long-term impact of cancer treatments on sexual function.7,8 Traditional support groups can also add stress; female partners of breast cancer survivors or male partners of prostate cancer survivors attending support groups may be the solo female/male care partner in the room.7

As the number of cancer survivors continues to increase1, oncologists need to be better prepared to care for LGBTQIA+ patients and their unique needs. Oncologists should have open, honest conversations about what to expect post-treatment, inclusive of their patients’ sexuality and needs of their partners. Reducing post-treatment anxiety may help to reduce unhealthy habits (eg, recreational drug use, tobacco use), improve health, and guard against cancer-related mortality.5

 

References:

1.

Bluethmann SM, et al. Anticipating the “silver tsunami”: prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiol Biomarkers Prev. 2016;25(7):1029-1036.

2.

The LGBT community’s disproportionate cancer burden. Cancer Network website. https://cancer-network.org/cancer-information/cancer-and-the-lgbt-community/the-lgbt-communitys-disproportionate-cancer-burden/. Accessed June 6, 2019.

3.

National Institute of Health website. https://cancercontrol.cancer.gov/ocs/statistics/statistics.html. Last updated February 8, 2019. Accessed June 11, 2019.

4.

Schabath MB, et al. National survey of oncologists at National Cancer Institute—designated Comprehensive Cancer Centers: attitudes, knowledge, and practice behaviors about LGBTQ patients with cancer. J Clin Oncol. 2019;37(7):epub.

5.

Jabson M, et al. Health behaviors and self-reported health among cancer survivors by sexual orientation. LGBT Health. 2015;2(1):41-47.

6.

Cancer survivorship in the LGBT community. LGBT Healthlink website. https://www.lgbthealthlink.org/Assets/U/Documents/FactSheets/lgbtcancersurvivorshipfactsheet_final.pdf. Accessed June 7, 2019.

7.

Cancer survivorship issues. Cancer Network website. https://cancer-network.org/cancer-information/cancer-and-the-lgbt-community/cancer-survivorship-issues/. Accessed June 7, 2019.

8.

Kamen C. Lesbian, gay, bisexual, and transgender (LGBT) survivorship. Semin Oncol Nurs. 2018;34(1):52-59.