Supporting LGBTQ+ Patients Through Cancer Diagnosis and Treatment 

A cancer diagnosis is often a frightening experience, negatively impacting an individual’s physical, mental, social, and spiritual well-being. Lesbian, gay, bisexual, transgender, queer/questioning, non-cisgender, and non-straight people, otherwise known as the LGBTQ+ community (and often referred to as sexual and gender minorities, or SGM, in health literature), face unique challenges when it comes to healthcare, particularly in the context of cancer diagnosis and treatment. Members of the community experience a disproportionate cancer burden due to a variety of unique cancer risks, needs, and challenges (Griggs et al., 2017). Most notably, a cancer diagnosis may profoundly impact a person’s physical, mental, social, and spiritual well-being, along with experiencing a disproportionate cancer burden due to distinct risks, needs, and challenges. 

In addition, discrimination, psychological challenges, and gaps in patient-provider communication can contribute to lower quality of care for LGBTQ+ cancer patients, who have lower rates of cancer screening due to challenges such as inadequate insurance coverage, exclusion from traditional screening campaigns, and apprehension due to previous experiences of discrimination when interacting with healthcare professionals. The fear of discrimination and stigmatization often leads LGBTQ+ patients to withhold information about their sexual orientation, creating additional barriers to obtaining appropriate care (Griggs et al., 2017). 

Let’s take some time to explore the unique challenges faced by LGBTQ+ patients, discuss how to create an inclusive healthcare environment, develop effective communication strategies, tailor support services, and offer valuable resources for both patients and healthcare providers. 

Understanding the Unique Challenges of LGBTQ+ Patients

Starting with cancer screening and diagnosis, many LGBTQ+ individuals face delayed diagnoses due to a combination of factors. Insurance coverage and cancer prevention screenings are biased in favor of heteronormative patients, and gendered terms like “well-woman examinations” are used throughout healthcare systems down to insurance coding, inadvertently excluding transgender patients.

There’s also often a lack of understanding among healthcare professionals about the unique risks of LGBTQ+ patients. Focusing on traditional risk factors for certain cancers can overshadow the specific risk factors that LGBTQ+ patients encounter, causing healthcare providers to ignore or miss relevant cancer risks, resulting in delayed diagnoses and more advanced cancers by the time they get diagnosed.

Compounding these challenges are higher rates of tobacco and alcohol use due to targeted alcohol and tobacco industry marketing, socialization historically centered around bars and clubs, and limited access to culturally competent healthcare. In addition, the lower rates of health insurance coverage among LGBTQ+ individuals also limit access to preventative screenings crucial to early cancer detection (Mapes, 2023).

Even more challenging is the fact that LGBTQ+ patients often don’t feel seen or understood within healthcare systems. It’s not uncommon for healthcare workers to assume to a patient’s spouse or partner being “just a friend” rather than their significant other. Transgender patients are frequently “deadnamed” (referred to by the birth name they no longer use) by healthcare staff and clinicians (Mapes, 2023), and the issue is often made worse due to missing or insufficient choices on medical forms related to gender and intimate partner classifications, increasing feelings of discomfort and alienation. Furthermore, up to 21% of LGBTQ+ people have past experiences of discrimination in the healthcare setting, leading to increased stress and delays in care (Mapes, 2023).

These negative experiences arise due to healthcare workers’ explicit or implicit biases or a lack of knowledge about the LGBTQ+ community (CancerCare, n.d.). Notably, one research study found that how healthcare professionals think and behave significantly impacts their patients. For example, inclusive and reflective healthcare workers made patients feel safe and respected, giving them the opportunity to disclose their sexual orientation and gender identity. Whereas healthcare professionals who believed they were treating all patients the same regardless of their sexual orientation or who expressed hostility about their sexual orientation made their patients feel invisible, dissatisfied, and excluded. These experiences can lead to feelings of judgment and erasure, further complicating an LGBTQ+ patient’s healthcare journey (Ussher et al., 2022).

Last but not least, the lack of adequate data on cancer diagnosis and treatment for LGBTQ+ individuals inhibits targeted and beneficial advancements in the field (Mapes, 2023).  

Creating an Inclusive Environment 

To support LGBTQ+ patients effectively, it’s essential to prioritize the development of an inclusive environment. Here are some strategies to consider. 

1. Ask and Use Chosen Pronouns: Always ask patients their preferred pronouns, document them, and use the correct pronouns consistently (Mapes, 2023). Providers should also introduce themselves with their pronouns to set a tone of inclusivity. 
2. Avoid Assumptions: Don’t make assumptions about a patient’s sexual orientation or gender identity. Instead, engage in open conversations that allow patients to share their identities in their own words (Mapes, 2023). Similarly, avoid assumptions about treatment phases. For example, not all patients undergoing a mastectomy want reconstructive surgery with implants.  
3. Degenderize Anatomy: When discussing body parts, use inclusive terminology that respects a patient’s identity. For example, ask your patient whether they prefer the term “chest” or “breast” when discussing surgeries or screenings (Mapes, 2023). 
4. Provide Inclusive Options on Medical Forms: Ensure that medical forms offer inclusive options that reflect diverse gender identities and sexual orientations (Mapes, 2023).  
5. Create Inclusive Facilities: Healthcare settings should include non-gendered restrooms and avoid gender-specific names for clinics such as “Women’s Health Clinic.”  
6. Cultural Competency Training: Healthcare professionals should seek cultural competency training to understand the unique needs of LGBTQ+ patients better (Griggs et al., 2017). 
7. Actively Develop Safe Environments: Create policies within your work settings that prohibit discrimination against patients and staff, ensuring that everyone feels safe and valued in the healthcare setting (Griggs et al., 2017). 

Communicating with LGBTQ+ Patients 

Effective communication is vital in ensuring that LGBTQ+ patients feel comfortable and understood during their cancer journey. Here are some essential communication strategies. 

1. Practice Active Listening: Encourage open dialogue and actively listen to patients to create a safe space where they can share their concerns, experiences, and preferences without fear of judgment. 
2. Use Inclusive Language: Avoid language that assumes a patient’s sexual orientation or gender identity. Instead, ask open-ended questions that allow patients to share their identities on their terms. 
3. Validate Experiences: Recognize the distinct challenges that LGBTQ+ patients encounter. Validation can go a long way in building trust and rapport. 
4. Encourage Disclosure: Cultivate an environment where patients feel safe to disclose their sexual orientation or gender identity by normalizing these discussions and emphasizing the importance of this information in providing tailored care. 
5. Be Mindful of Non-Verbal Cues: Pay attention to your body language and demeanor, such as maintaining eye contact and facing your patients when communicating. Non-verbal cues can significantly impact how comfortable a patient feels during the interaction. 
6. Respect Privacy: Understand that some patients may not be ready to disclose their sexual orientation or gender identity. Respect their privacy and allow them to share information at their own pace. 

Tailoring Support Services 

Addressing the unique needs of LGBTQ+ patients by tailoring support services can significantly enhance their care experience. Here are some helpful strategies for healthcare providers. 

1. Consider Treatment Interactions: Be aware that some gender-affirming hormone treatments may interfere with cancer treatments. For instance, gender-affirming testosterone therapy may interfere with anti-estrogen cancer therapy. Discuss these possibilities openly to determine a solution that works best for your patient (Mapes, 2023). 
2. Focus on Risk Factors: The presence or absence of specific anatomical characteristics should serve as the basis for cancer screening decisions rather than gender. One way to understand risk factors is to conduct an organ inventory. For transgender women, it’s crucial to document whether organs such as the prostate are removed during gender-affirming surgeries so that necessary routine checks (e.g., PSA tests) are a standard part of their healthcare plan. Similarly, transgender men may need HPV testing, Pap smears, and mammograms. Make sure to screen your patients for cancer risk factors, such as engaging in oral sex with a person who may have HPV, regardless of gender identity or sexual orientation (Mapes, 2023).  
3. Address Sexual Health Concerns: Cancer treatments can impact sexual function, leading to issues such as erectile dysfunction, loss of sensation, and vaginal dryness. Address these concerns sensitively and provide resources for sexual health support (Mapes, 2023). 
4. Clinical Trials Access: Ensure that LGBTQ+ patients have equal opportunities to enroll in clinical trials, which can help improve outcomes and provide valuable data about the effectiveness of treatments for diverse populations. 

Resources for Patients and Providers 

To further support LGBTQ+ patients and healthcare providers, several resources are available: 

1. National LGBT Cancer Network: This US organization provides a wealth of information and support for LGBTQ+ individuals coping with cancer, including resources for navigating the healthcare system and finding supportive services. 
2. Human Rights Campaign Foundation: HRC offers extensive resources related to LGBTQ+ health, including information on cancer care, preventive screenings, and advocacy for inclusive healthcare policies. 
3. Local LGBTQ+ Community Centers: Many community centers provide tailored support services, including counseling, support groups, and educational resources.  
4. Online Support Groups: Online forums and support groups offer LGBTQ+ individuals a platform to share experiences, seek advice, and connect with others facing similar challenges. 

Inclusive and Compassionate Cancer Care for LGBTQ+ Patients

Supporting LGBTQ+ patients through cancer diagnosis and treatment requires a multifaceted approach that addresses each person’s unique needs. By understanding the hurdles, actively creating an inclusive environment, employing effective communication strategies, and tailoring support services, healthcare providers can make a significant difference in patients’ lives. 

As we continue to improve the quality of healthcare for LGBTQ+ individuals, it’s essential to stay educated and aware of the potential barriers community members encounter. By fostering an environment of empathy, understanding, and respect, we can ensure that every patient, regardless of their sexual orientation or gender identity, receives the compassionate care they deserve. Through continued advocacy and education, we can work towards a healthcare system that’s truly inclusive and equitable for all. Education, awareness, and action are key to supporting our LGBTQ+ patients as they navigate the complexities of cancer care. 

Want to learn more about this topic? Here’s some of the latest research! https://ustranssurvey.org/

References 

• Mapes, D. (2023). Cancer and the LGBTQ+ Community: From structural barriers and binary patient forms to gendered diseases, ‘queer cancer’ can be fraught with bias and bad assumptions. Fred Hutch News Center. https://www.fredhutch.org/en/news/center-news/2023/08/cancer-and-the-lgbtq-community.html  
• Center for American Progress (2015). Discrimination Prevents LGBTQ People From Accessing Health Care
• LGBTQ+ adults more likely to delay, avoid care, Healthgrades survey finds
• LGBTQ+ health disparities and targeting by Big Tobacco and Alcohol
• Disparities in Experience with Culturally Competent Care and Satisfaction with Care by Sexual Orientation
• Griggs, J., Maingi, S., Blinder, V., Denduluri, N., Khorana, A. A., Norton, L., Francisco, M., Wollins, D. S., Rowland, J. H. (2017). American Society of Clinical Oncology Position Statement: Strategies for reducing cancer health disparities among sexual and gender minority populations. Journal of Clinical Oncology. 35 (19). https://doi.org/10.1200/JCO.2016.72.0441 
• CancerCare. (n.d.). Coping with cancer as an LGBTQ+ person. https://www.cancercare.org/publications/209-coping_with_cancer_as_an_lgbtq_person 
• Ussher, J. M., Power, R., Perz, J., Hawkey, A. J., Allison, K., & The Out with Cancer Study Team. (2022). LGBTQI inclusive cancer care: A discourse analytic study of health care professional, patient and carer perspectives. Frontiers in Oncology. 10 (12). https://doi.org/10.3389/fonc.2022.812348 

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