1
|
Cheung CK, Lee H, Francis-Levin N, Choi E, Geng Y, Thomas BN, Roman VA, Roth ME. Provider preparedness to care for sexual and gender minority adolescent and young adult cancer patients: A scoping review. PEC INNOVATION 2024; 5:100343. [PMID: 39346774 PMCID: PMC11437872 DOI: 10.1016/j.pecinn.2024.100343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 07/30/2024] [Accepted: 09/10/2024] [Indexed: 10/01/2024]
Abstract
Objective The purpose of the current scoping review is to explore knowledge and gaps in the literature on the preparedness of health care providers (HCPs) to deliver cancer care that addresses the needs of sexual and gender minority (SGM) adolescent and young adult (AYA) patients diagnosed with cancer between ages 15-39 years. Methods We conducted two comprehensive searches on OVID MEDLINE, PsycINFO, and CINAHL in February 2022 and June 2024; examined the empirical literature on HCPs who treat SGM AYA cancer patients; characterized existing research; and evaluated each contribution. Results A total of thirteen articles were included in the final review. The reviewed studies varied widely in sample sizes (n = 6 to n = 1253), reflecting different methodological approaches: quantitative cross-sectional (n = 3), qualitative (n = 4), and mixed methods (n = 6). Innovation The current scoping review piloted an innovative Quality Assessment (QA) Tool of Foundational Progress for SGM AYA Research to assess the quality of evidence, providing a new framework for evaluating and guiding future research. Conclusion The existing literature on provider preparedness to care for SGM AYA cancer patients is limited. Future studies are critically needed to improve providers' ability to holistically respond to the unique health care needs and concerns of this population.
Collapse
Affiliation(s)
- Christabel K Cheung
- University of Maryland Greenebaum Comprehensive Cancer Center, United States
- University of Maryland School of Social Work, Baltimore, MD, USA
| | - Haelim Lee
- University of Maryland School of Social Work, Baltimore, MD, USA
| | - Nina Francis-Levin
- University of Michigan Division of Metabolism, Endocrinology, and Diabetes, Ann Arbor, MI, USA
| | - Eunju Choi
- University of Texas Department of Nursing and MD Anderson Cancer Center, Houston, TX, USA
| | - Yimin Geng
- Research Medical Library, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bria N Thomas
- Temple University School of Podiatric Medicine, Philadelphia, PA, USA
| | | | - Michael E Roth
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
2
|
Patel R, Chen E, Sun HH, Zaorsky NG. Caring for sexual and gender minority patients with genitourinary cancer: A primer for inclusive practices. Urol Oncol 2024; 42:337-344. [PMID: 38853055 DOI: 10.1016/j.urolonc.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/23/2024] [Accepted: 06/02/2024] [Indexed: 06/11/2024]
Abstract
Recognizing sexual orientation and gender identity (SOGI) is paramount in the management of genitourinary cancers, as sexual and gender minority (SGM) individuals encounter unique healthcare challenges leading to disparities. SGM patients often confront systemic barriers, provider biases, and scarcity of tailored resources, resulting in diminished satisfaction and adverse health outcomes. The evaluation and treatment of genitourinary cancers in SGM patients demand a nuanced, multidisciplinary approach that focuses on the unique health determinants often overlooked by the healthcare system. This review highlights recommendations for the inclusivity of SGM patients within the clinic, from inclusive signage to gender inclusive language. For the evaluation and treatment of SGM patients with genitourinary cancers, it is recommended to employ organ-based language, to utilize validated questionnaires encompassing mental health, sexual behavior, and patient-reported outcomes, and to provide timely referrals to social work and onco-fertility when appropriate. Ultimately, approaching inclusivity through education targeted at both SGM patients and healthcare providers is pivotal for centering care around the patient, improving the quality of life and outcomes for SGM patients facing genitourinary cancers.
Collapse
Affiliation(s)
- Rohan Patel
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH.
| | - Eric Chen
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Helen H Sun
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH.
| |
Collapse
|
3
|
Weideman BCD, McAlpine D. State LGBTQ policy environments and the cancer burden in sexual and gender minoritized communities in the United States. Cancer Med 2024; 13:e70097. [PMID: 39140345 PMCID: PMC11322825 DOI: 10.1002/cam4.70097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 07/10/2024] [Accepted: 07/16/2024] [Indexed: 08/15/2024] Open
Abstract
PURPOSE Our objective was to assess the association between state policies related to sexual orientation and gender identity (SOGI) and cancer prevalence and survivorship indicators in a sexual and gender minoritized (SGM) population in the United States. METHODS Data from the 2017-2021 Behavioral Risk Factor Surveillance System were used to measure cancer diagnosis, physical and mental health, and substance use for SGM adult cancer survivors. A state policy Z-score, ranging from most restrictive to most protective state policies related to SOGI, was computed from data available from the Movement Advancement Project. Survey-weighted logistic regression was used to test the relationship between state policies and cancer-related outcomes for SGM people. RESULTS More protective state policies were associated with lower odds of a cancer diagnosis (adjusted odds ratio [AOR]: 0.92; 95% confidence interval [CI]: 0.87-0.97). Among SGM cancer survivors, increasing protective state policies were associated with lower odds of poor physical health (AOR: 0.83; 95% CI: 0.74-0.94), lower odds of difficulty walking or climbing stairs (AOR: 0.90; 95% CI: 0.80-1.00), and lower odds of difficulty concentrating or remembering (AOR: 0.87; 95% CI: 0.78-0.98). No significant associations were found between state policies and mental health, depression, substance use, diabetes, or cardiovascular disease among SGM cancer survivors. CONCLUSION SGM people diagnosed with cancer are more likely to live in restrictive policy states, and survivors in those states have worse physical health and cognitive disability. Additional research should investigate potential causal relationships between state policies and SGM cancer outcomes.
Collapse
Affiliation(s)
- Ben C. D. Weideman
- Division of Health Policy and ManagementSchool of Public Health, University of MinnesotaMinneapolisMinnesotaUSA
| | - Donna McAlpine
- Division of Health Policy and ManagementSchool of Public Health, University of MinnesotaMinneapolisMinnesotaUSA
| |
Collapse
|
4
|
Ruiz S, Mintz R, Sijecic A, Eggers M, Hoffman AS, Woodard T, Bjornard KL, Hoefgen H, Sandheinrich T, Omurtag K, Housten AJ. Websites about, not for, adolescents? A systematic analysis of online fertility preservation information for adolescent and young adult cancer patients. J Cancer Surviv 2024; 18:1416-1425. [PMID: 37145331 DOI: 10.1007/s11764-023-01386-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/14/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE Fertility preservation is an increasingly important topic in adolescent and young adult cancer survivorship, yet treatments remain under-utilized, possibly due to lack of awareness and understanding. The internet is widely used by adolescents and young adults and has been proposed to fill knowledge gaps and advance high-quality, more equitable care. As a first step, this study analyzed the quality of current fertility preservation resources online and identified opportunities for improvement. METHODS We conducted a systematic analysis of 500 websites to assess the quality, readability, and desirability of website features, and the inclusion of clinically relevant topics. RESULTS The majority of the 68 eligible websites were low quality, written at college reading levels, and included few features that younger patients find desirable. Websites mentioned more common fertility preservation treatments than promising experimental treatments, and could be improved with cost information, socioemotional impacts, and other equity-related fertility topics. CONCLUSIONS Currently, the majority of fertility preservation websites are about, but not for, adolescent and young adult patients. High-quality educational websites are needed that address outcomes that matter to teens and young adults, with a priority on solutions that prioritize equity. IMPLICATIONS FOR CANCER SURVIVORS Adolescent and young adult survivors have limited access to high-quality fertility preservation websites that are designed for their needs. There is a need for the development of fertility preservation websites that are clinically comprehensive, written at appropriate reading levels, inclusive, and desirable. We include specific recommendations that future researchers can use to develop websites that could better address AYA populations and improve the fertility preservation decision making process.
Collapse
Affiliation(s)
- Sienna Ruiz
- Washington University in St. Louis, St. Louis, MO, USA
| | - Rachel Mintz
- Washington University in St. Louis, St. Louis, MO, USA
| | - Amela Sijecic
- Washington University in St. Louis, St. Louis, MO, USA
| | | | | | - Terri Woodard
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kari L Bjornard
- Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Holly Hoefgen
- Washington University in St. Louis, St. Louis, MO, USA
| | - Taryn Sandheinrich
- Washington University in St. Louis, St. Louis, MO, USA
- St. Louis Children's Hospital, St. Louis, MO, USA
| | - Kenan Omurtag
- Washington University in St. Louis, St. Louis, MO, USA
| | | |
Collapse
|
5
|
Franco-Rocha OY. Theory of health promotion for sexual and gender minority populations with cancer. Nurs Outlook 2024; 72:102237. [PMID: 38986293 DOI: 10.1016/j.outlook.2024.102237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/14/2024] [Accepted: 06/22/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Structural factors (e.g., cisheteronormativity) promote minority stressors, which generate healthcare disparities among sexual and gender minority (SGM) populations (also known as lesbian, gay, bisexual, transgender, queer, intersexual, asexual, and other sexual and gender-expansive persons--LGBTQIA+) with cancer. The individual's biological, behavioral, social, and psychological response to minority stressors will vary throughout their life course. However, there is a lack of empirical and theoretical guidance for conceptualizing health outcomes among SGM subgroups. PURPOSE To propose a nursing theory for the health promotion of SGM populations with cancer. METHODS Walker and Avant's strategies for theoretical derivation were followed. RESULTS I present the definition, theoretical assumptions, concepts, propositions, and implications for practice, education, research, and policy of the derived theory. DISCUSSION AND CONCLUSION The theory provides a nursing framework to understand and address the multilevel impact of minority stress on the health of SGM individuals throughout their cancer care continuum.
Collapse
Affiliation(s)
- Oscar Y Franco-Rocha
- School of Nursing, University of Texas at Austin, Austin, TX; Facultad de Enfermería, Universidad Nacional de Colombia, Bogota D.C., Colombia.
| |
Collapse
|
6
|
Shires DA, Kattari L, Hosea F, Hirsch J, Mulvaney M, Matthews AK, Thompson HS. Healthcare experiences among Black and White sexual and gender minority cancer survivors: a qualitative study. J Cancer Surviv 2023:10.1007/s11764-023-01504-z. [PMID: 38051422 DOI: 10.1007/s11764-023-01504-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE The purpose of this study was to explore healthcare experiences of Black and White sexual and gender minority (SGM) cancer survivors across the cancer care continuum. METHODS This was a qualitative analysis of two focus groups and eight individual interviews completed as part of a larger initiative using a community-engaged research approach to reduce cancer disparities in marginalized communities. There was a total of 16 participants in the study (9 were White, 7 were Black) and data were collected between 2019 and 2020. RESULTS Three main themes emerged from the thematic analysis: strategically coming out, provider preferences, and health system challenges. Participants noted that they often came out through their support system, decided to come out based on the relevance of their SGM identity that they perceived, and expressed a desire for privacy. Lack of an accessible and competent PCP was tied to delayed cancer diagnosis and many participants voiced a preference for consistency when they found a provider they liked. CONCLUSIONS Providers across specialties can address barriers for SGM patients by not making assumptions about patient sexual orientation or gender identity. Institutions should systematically collect sexual orientation and gender identity information. Primary care providers should be aware that due to resistance to switching from trusted providers, they may need to take greater initiative to facilitate cancer screenings for their patients when appropriate or take special care when making referrals to ensure they are using SGM-affirming providers. IMPLICATIONS FOR CANCER SURVIVORS SGM cancer survivors often benefit from a cultivating relationship with a trusted PCP or other provider.
Collapse
Affiliation(s)
- Deirdre A Shires
- School of Social Work, Michigan State University, 655 Auditorium Road, 122 Baker Hall, East Lansing, MI, 48824, USA.
| | - Leonardo Kattari
- Department of Health and Human Services, University of Michigan - Dearborn, Dearborn, MI, USA
| | - Forrest Hosea
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jen Hirsch
- School of Social Work, Michigan State University, 655 Auditorium Road, 122 Baker Hall, East Lansing, MI, 48824, USA
| | - Megan Mulvaney
- Indiana University School of Public Health, Bloomington, IN, USA
| | | | - Hayley S Thompson
- Office of Cancer Health Equity and Community Engagement, Karmanos Cancer Institute, Detroit, MI, USA
- Department of Oncology, School of Medicine, Wayne State University, Detroit, MI, USA
| |
Collapse
|
7
|
Rosser BS, Weideman BC, Rider GN, Jatoi A, Ecklund AM, Wheldon CW, Talley KM, Kulasingam S, Smith MK, Jacobs DR, Mitteldorf D, West W, Alley R, Ross MW. Sexual and Gender Minority Invisibility in Cancer Studies: A Call for Effective Recruitment Methods to Address Cancer Disparities. J Clin Oncol 2023; 41:5093-5098. [PMID: 37725780 PMCID: PMC10666979 DOI: 10.1200/jco.23.00655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/09/2023] [Accepted: 07/14/2023] [Indexed: 09/21/2023] Open
Abstract
#LGBTQ+ people with cancer are invisibilized: A call for #intersectional cancer research (link here) #healthequity
Collapse
Affiliation(s)
- B.R. Simon Rosser
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Ben C.D. Weideman
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - G. Nic Rider
- Department of Family Medicine and Community Health, Institute for Sexual and Gender Health, University of Minnesota Medical School, Minneapolis, MN
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, MN
| | - Alexandra M. Ecklund
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Christopher W. Wheldon
- Department of Social and Behavioural Sciences, College of Public Health, Temple University, Philadelphia, PA
| | - Kristine M.C. Talley
- Adult and Geriatric Health, University of Minnesota School of Nursing, Minneapolis, MN
| | - Shalini Kulasingam
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - M. Kumi Smith
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - David R. Jacobs
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | | | - William West
- Department of Writing Studies, University of Minnesota, Minneapolis, MN
| | - Rhea Alley
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Michael W. Ross
- Department of Family Medicine and Community Health, Institute for Sexual and Gender Health, University of Minnesota Medical School, Minneapolis, MN
| |
Collapse
|
8
|
Francis-Levin N, Ghazal LV, Francis-Levin J, Zebrack B, Chen M, Zhang A. Exploring the Relationship between Self-Rated Health and Unmet Cancer Needs among Sexual and Gender Minority Adolescents and Young Adults with Cancer. Curr Oncol 2023; 30:9291-9303. [PMID: 37887571 PMCID: PMC10605547 DOI: 10.3390/curroncol30100671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
This study evaluates the unmet needs of sexual and gender minority (SGM) adolescent and young adult (AYA) cancer survivors by comparing SGM AYA self-rated health (SRH) scores to their non-SGM (i.e., cisgender/heterosexual) counterparts. The Cancer Needs Questionnaire-Young People (CNQ-YP) and self-rated health measures were used to assess unmet needs in AYAs aged 15-39 who had been diagnosed with cancer in the previous ten years (n = 342). Participants were recruited from a National Cancer Institute (NCI) Comprehensive Cancer Center registry using the modified Dillman's method. Self-reported sexual orientation and gender identity (SO/GI) data were collected. Independent t-tests were used to test between-group differences in unmet needs and Pearson's chi-square test was used to determine the difference in SRH scores between SGM and non-SGM AYA cancer survivors. SGM AYA cancer survivors reported greater mean needs than their non-SGM counterparts across all six domains and reported significantly greater needs in the domains of Feelings and Relationships, t(314) = -2.111, p = 0.036, Information and Activities, t(314) = -2.594, p = 0.009, and Education, t(207) = -3.289, p < 0.001. SGM versus non-SGM SRH scores were significantly different, indicating that a higher percentage of SGM AYAs reported poor/fair health compared to those who were non-SGM. Unmet life and activities needs were negatively associated with AYA cancer survivors' SRH, whereas unmet work needs were positively associated with AYA cancer survivors' SRH. An AYA's gender identity (SGM versus non-SGM) was not a moderator. SGM AYAs are an understudied group within an already vulnerable patient population. Unmet psychosocial needs related to one's feelings and relationships, and information and activity needs merit further research to develop tailored interventions that reflect the experiences of SGM AYAs.
Collapse
Affiliation(s)
- Nina Francis-Levin
- Division of Endocrinology, Metabolism & Diabetes, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Lauren V. Ghazal
- School of Nursing, University of Rochester, Rochester, NY 14642, USA;
| | - Jess Francis-Levin
- Institute for Social Research, University of Michigan, Ann Arbor, MI 48104, USA;
| | - Bradley Zebrack
- School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA; (B.Z.); (M.C.)
| | - Meiyan Chen
- School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA; (B.Z.); (M.C.)
| | - Anao Zhang
- School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA; (B.Z.); (M.C.)
| |
Collapse
|
9
|
Boehmer U, Chang S, Sanchez NF, Jesdale BM, Schabath MB. Cancer survivors' health behaviors and outcomes: a population-based study of sexual and gender minorities. J Natl Cancer Inst 2023; 115:1164-1170. [PMID: 37421397 PMCID: PMC10560602 DOI: 10.1093/jnci/djad131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/15/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND Most case-control studies compare cancer survivors with general population controls without considering sexual orientation or gender identity. This case-control analysis compared health risk behaviors and health outcomes among sexual and gender minority cancer survivors to those of matched sexual and gender minority participants without cancer (controls). METHODS Using data from the 2014-2021 Behavioral Risk Factor Surveillance System, a population-based sample of 4507 cancer survivors who self-identified as transgender, gay men, bisexual men, lesbian women, or bisexual women were 1:1 propensity score matched, using age at survey, race and ethnicity, marital status, education, access to health care, and US census region. Within each sexual and gender minority group, behaviors and outcomes were compared between survivors and participants without cancer, and survivors' odds ratios and 95% confidence intervals calculated. RESULTS Gay male survivors had higher odds of depression, poor mental health, limited usual activities, difficulty concentrating, and fair or poor health. Few differences were observed between bisexual male survivors and participants without cancer. Compared with controls, lesbian female survivors had greater odds of overweight-obese status, depression, poor physical health, and fair or poor health. Bisexual female survivors had the highest rates of current smoking, depression, poor mental health, and difficulty concentrating across all sexual and gender minority groups. Statistically significantly different from transgender controls, transgender survivors had greater odds of heavy alcohol use, physical inactivity, and fair or poor health. CONCLUSIONS This analysis revealed an urgent need to address the high prevalence of engaging in multiple health risk behaviors and not following guidelines to avoid second cancers, additional adverse outcomes, and cancer recurrences among sexual and gender minority cancer survivors.
Collapse
Affiliation(s)
- Ulrike Boehmer
- Boston University School of Public Health, Boston, MA, USA
| | - Shine Chang
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Bill M Jesdale
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| |
Collapse
|
10
|
Mullins MA, Reber L, Washington A, Stasenko M, Rankin A, Friese CR, Cooley ME, Hudson MF, Wallner LP. Barriers, facilitators, and recommendations for sexual orientation and gender identity data collection in community oncology practices. Cancer Med 2023; 12:19203-19214. [PMID: 37732470 PMCID: PMC10557876 DOI: 10.1002/cam4.6517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Sexual orientation and gender identity (SOGI) data collection in community oncology practices is critical to identify and address cancer inequities, but less than 20% of NCI Community Oncology Research Program (NCORP)-affiliated practices regularly collect SOGI data despite widespread recommendations. We evaluated multilevel barriers and facilitators for SOGI data collection at NCORP practices. METHODS We conducted 14 semi-structured interviews at seven purposefully sampled NCORP oncology practices. We interviewed one clinician (oncologist, advanced practice provider) and one clinic staff member per practice. Thematic analysis informed by the Consolidated Framework for Implementation Research (CFIR) was conducted to identify barriers and facilitators. RESULTS Thematic saturation occurred after interviews at six practices and was confirmed with interviews at an additional practice. Participants highlighted multilevel barriers including low levels of understanding, information technology infrastructure, and perceived low relative priority. Not understanding the role of SOGI data in oncology care contributed to cis-heteronormative culture. At the clinic level, this culture coincided with a lack of processes and policies for collecting SOGI from all patients. At the care team level, perceived irrelevance to oncology care was related to discomfort asking SOGI, fear of patient discomfort, and limited awareness of SOGI in electronic health records. Suggested solutions included: normalizing asking SOGI questions, giving patients privacy to complete SOGI, and clarifying clinical relevance. CONCLUSIONS SOGI data collection barriers stemmed from perceptions that SOGI disclosure does not influence care quality. Oncology teams may benefit from training on culturally sensitive SOGI collection, education on SOGI data relevance to oncology practices, and support for implementing SOGI data collection policies.
Collapse
Affiliation(s)
- Megan A. Mullins
- Peter O'Donnell Jr. School of Public HealthUT Southwestern Medical CenterDallasTexasUSA
- Harold C. Simmons Comprehensive Cancer CenterUT Southwestern Medical CenterDallasTexasUSA
| | - Lisa Reber
- Peter O'Donnell Jr. School of Public HealthUT Southwestern Medical CenterDallasTexasUSA
| | - Ariel Washington
- Karmanos Cancer Institute, Department of OncologyWayne State University School of MedicineDetroitMichiganUSA
| | - Marina Stasenko
- Division of Gynecologic Oncology, Department of Obstetrics and GynecologyNYU Langone HealthNew YorkNew YorkUSA
| | - Aaron Rankin
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Christopher R. Friese
- Center for Improving Patient and Population HealthUniversity of MichiganAnn ArborMichiganUSA
- Rogel Cancer CenterUniversity of MichiganAnn ArborMichiganUSA
| | - Mary E. Cooley
- Phyllis F. Cantor Center, Research in Nursing and Patient Care ServicesDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - Matthew F. Hudson
- Prisma Health Cancer Institute Greenville South CarolinaGreenvilleSouth CarolinaUSA
| | - Lauren P. Wallner
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
- Rogel Cancer CenterUniversity of MichiganAnn ArborMichiganUSA
| |
Collapse
|
11
|
Yang MJ, Pérez-Morales J, Quinn GP, Miller JD, Simmons VN, Schabath MB. Psychosocial characteristics and quality of life among sexual and gender minority patients with cancer. JNCI Cancer Spectr 2023; 7:pkad061. [PMID: 37572311 PMCID: PMC10587999 DOI: 10.1093/jncics/pkad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/17/2023] [Accepted: 08/07/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Underserved and minoritized patients with cancer often experience more psychosocial concerns and inferior quality of life (QOL) compared with majority populations. This study compared patient-reported psychosocial characteristics and QOL among self-identified sexual and gender minority patients with cancer vs cisgender-heterosexual patients with cancer treated at a National Cancer Institute-designated comprehensive cancer center in the United States. METHODS Self-report data from 51 503 patients were obtained from an institutional standard-of-care electronic patient questionnaire that was completed prior to, or on the day of, the patient's initial visit. The electronic patient questionnaire collects demographic information, including sexual orientation and gender identity, psychosocial variables, and QOL using the validated Short Form Health Survey-12. Sexual orientation and gender identity information was used to identify self-identified sexual and gender minority and cisgender-heterosexual persons (ie, non-self-identified sexual and gender minority). Using parametric analyses, psychosocial variables and QOL measures were compared for self-identified sexual and gender minority vs non-self-identified sexual and gender minority patients with cancer. RESULTS Compared with non-self-identified sexual and gender minority patients (n = 50 116), self-identified sexual and gender minority patients (n = 1387, 2.7%) reported statistically significantly greater concerns regarding getting help during treatment (2.6% vs 4.3%, respectively; P = .001) and concerns with ability to seek care (16.7% vs 21.6%, respectively, P < .001). Self-identified sexual and gender minority patients reported statistically significantly elevated mental health concerns and daily emotional and pain interference (all P < .001), whereas there was no statistically significant difference in daily interference due to physical functioning. CONCLUSION These data reveal real-world disparities among self-identified sexual and gender minority patients with cancer, which can be used to develop psychosocial interventions tailored to address the unique psychosocial and QOL needs of this underserved and minoritized population and to ultimately improve cancer care.
Collapse
Affiliation(s)
- Min-Jeong Yang
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jaileene Pérez-Morales
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Gwendolyn P Quinn
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Jarred D Miller
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Vani N Simmons
- Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, FL, USA
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| |
Collapse
|
12
|
Cheung CK, Lee H, Levin NJ, Choi E, Ross VA, Geng Y, Thomas BN, Roth ME. Disparities in cancer care among sexual and gender minority adolescent and young adult patients: A scoping review. Cancer Med 2023; 12:14674-14693. [PMID: 37245227 PMCID: PMC10358240 DOI: 10.1002/cam4.6090] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/08/2023] [Accepted: 05/04/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Adolescent and young adult cancer patients (AYAs) who are sexual and gender minorities (SGM) are a rapidly increasing population that experiences unmet cancer-related needs. Despite emerging awareness, little is known about cancer care and outcomes for this vulnerable population. The purpose of this scoping review was to explore current knowledge and gaps in the literature on cancer care and outcomes for AYAs who identify as SGM. METHODS We reviewed empirical knowledge on SGM AYAs by identifying, describing, and critically appraising the literature to date. We conducted a comprehensive search on OVID MEDLINE, PsycINFO, and CINAHL in February 2022. Additionally, we developed and piloted a conceptual framework for appraising SGM AYA research. RESULTS A total of 37 articles were included in the final review. Most studies focused exclusively on SGM-related outcomes as the primary aim of the study (81.1%, n = 30), whereas others included some focus on SGM-related outcomes (18.9%, n = 7). The majority of studies included AYAs as part of a broader age range (86.0%, n = 32), and only a few studies examined exclusively AYA samples (14.0%, n = 5). Gaps in scientific evidence on SGM AYAs were seen across the cancer care continuum. CONCLUSION Numerous gaps in knowledge of cancer care and outcomes exist for SGM AYAs diagnosed with cancer. Future efforts should fill this void with high-quality empirical studies that reveal unknown disparities in care and outcomes and are inclusive of the intersectionality of SGM AYAs with other minoritized experiences, thereby advancing health equity in meaningful ways.
Collapse
Affiliation(s)
| | - Haelim Lee
- University of Maryland School of Social WorkBaltimoreMarylandUSA
| | - Nina Jackson Levin
- University of Michigan School of Social Work and Department of AnthropologyMichiganAnn ArborUSA
| | - Eunju Choi
- Department of Nursing and MD Anderson Cancer CenterUniversity of TexasHoustonTexasUSA
| | | | - Yimin Geng
- Research Medical LibraryUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Bria N. Thomas
- Geisinger Commonwealth School of MedicineScrantonPennsylvaniaUSA
| | - Michael E. Roth
- University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| |
Collapse
|
13
|
Hoyt MA, Darabos K, Llave K. Disparities in health-related quality of life among lesbian, gay, and bisexual cancer survivors. J Psychosoc Oncol 2023; 41:661-672. [PMID: 37183953 DOI: 10.1080/07347332.2023.2210548] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE This study compared health-related quality of life (HRQOL) among lesbian, gay, and bisexual (LGB) cancer survivors and their heterosexual counterparts in a US population-based sample of cancer survivors. METHODS The study utilized data from the All of Us research program. LGB survivors (n = 885) were matched for age, gender identity, marital status, income, education, and cancer site with heterosexual survivors (n = 885) using 1:1 propensity matching. Physical, mental, and social HRQOL were assessed with items from the Patient-Reported Outcomes Measurement Information System (PROMIS). RESULTS Relative to heterosexuals, LGB cancer survivors reported lower HRQOL in mental and social domains, but not in physical HRQOL. Older age was associated with higher HRQOL across domains. LGB survivors identifying as Black/African American were more likely to experience lower social HRQOL than White survivors. CONCLUSIONS This study highlights several disparities in HRQOL that exist between LGB and heterosexual cancer survivors.
Collapse
Affiliation(s)
- Michael A Hoyt
- Department of Population Health and Disease Prevention, University of California, Irvine, California, USA
| | - Katie Darabos
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Karen Llave
- Department of Population Health and Disease Prevention, University of California, Irvine, California, USA
| |
Collapse
|
14
|
Franco-Rocha OY, Wheldon CW, Trainum K, Kesler SR, Henneghan AM. Clinical, psychosocial, and sociodemographic factors of sexual and gender minority groups with cancer: A systematic review. Eur J Oncol Nurs 2023; 64:102343. [PMID: 37290162 DOI: 10.1016/j.ejon.2023.102343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/07/2023] [Accepted: 04/29/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Psychosocial health varies depending on demographic and clinical factors and the social context in which individuals grow and live. Sexual and gender minority (SGM) populations experience health disparities due to systemic factors that privilege cisgender and heterosexual identities. We reviewed the literature on the psychosocial, sociodemographic, and clinical factors in SGM groups with cancer and described the associations among these factors. METHODS We conducted a systematic review according to Fink's methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines in the PubMed, PsycInfo, Cumulative Index of Nursing and Allied Health Literature, and LGBTQ+ Life databases. Quantitative articles published in English or Spanish were included. Grey literature and studies with participants in hospice care were excluded. The quality of the publications was assessed with the Joanna Briggs Institute criticalappraisal tools. RESULTS The review included 25 publications. In SGM groups, systemic cancer treatment was associated with worse psychosocial outcomes; and older age, employment, and higher income were associated with better psychosocial outcomes. CONCLUSIONS SGM groups with cancer are different from their heterosexual cisgender peers in sociodemographic, psychosocial, and clinical factors. Clinical and sociodemographic factors are associated with psychosocial outcomes among SGM individuals with cancer.
Collapse
Affiliation(s)
- Oscar Y Franco-Rocha
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, 78712, USA.
| | - Christopher W Wheldon
- Department of Social & Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B, Moore Ave., Ritter Hall Annex 9th Floor, Room 955, Philadelphia, PA, 19122, USA.
| | - Katie Trainum
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, 78712, USA.
| | - Shelli R Kesler
- School of Nursing, Department of Diagnostic Medicine, Dell Medical School, The University of Texas at Austin, 1710 Red River St, Austin, TX, 78712, USA.
| | - Ashley M Henneghan
- School of Nursing, Department of Oncology, Dell Medical School, The University of Texas at Austin, 1710 Red River St, Austin, TX, 78712, USA.
| |
Collapse
|
15
|
Doucette C, Milano MT, Kamen C. Patient Perceptions of Sexual Orientation and Gender Identity Data Collection in an Outpatient Radiation Oncology Setting. Int J Radiat Oncol Biol Phys 2023; 116:68-78. [PMID: 36549346 DOI: 10.1016/j.ijrobp.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/14/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Sexual and gender minority patients with cancer experience significant health disparities requiring tailored care. Collecting sexual orientation and gender identity (SOGI) data in the electronic medical record (EMR) could allow care to be tailored and is in line with radiation oncology's mission to better serve diverse patients. This article describes a systematic method for collecting SOGI data for all patients starting radiation treatment in a department of radiation oncology (DRO). METHODS AND MATERIALS During a 3-month experimental period, DRO staff administered a demographic questionnaire and attitude survey to new adult patients. SOGI demographic data, entered into the EMR by nursing staff, were extracted and analyzed for all patients from the experimental period and from the 3 months prior (control period). Descriptive and categorical data completion rates were compared between the experimental and control periods using independent-samples t tests and Pearson χ2 tests. RESULTS A total of 788 patients were included in this analysis: 368 in the control period and 420 in the experimental period. Of the 420 patients enrolled in the experimental period, 267 (63.6%) were offered a survey, of whom 211 (79.0%) completed the survey. There were higher rates of sexual orientation responses entered into the EMR for the experimental group compared with the control group (56.9% vs 27.1%; P <.001), with the highest response rates for patients who completed a survey (82.9%). Ten patients (2.9%) identified as gay or lesbian and 100% identified as cisgender. The majority of patients were not upset by the form, with only 11 patients (5.2%) stating that any specific question caused them distress. CONCLUSIONS Collecting SOGI data via a demographic form is feasible in an outpatient DRO. This approach was well received by the majority of patients and could lead to provision of higher-quality, tailored care.
Collapse
Affiliation(s)
| | | | - Charles Kamen
- Surgery, University of Rochester Medical Center, Rochester, New York.
| |
Collapse
|
16
|
Ruiz S, Mintz R, Sijecic A, Eggers M, Hoffman A, Woodard T, Bjonard KL, Hoefgen H, Sandheinrich T, Omurtag K, Housten AJ. Websites about, not for, adolescents? A systematic analysis of online fertility preservation information for adolescent and young adult cancer patients. RESEARCH SQUARE 2023:rs.3.rs-2587513. [PMID: 36824765 PMCID: PMC9949230 DOI: 10.21203/rs.3.rs-2587513/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Purpose Fertility preservation is an increasingly important topic in adolescent and young adult cancer survivorship, yet treatments remain under-utilized, possibly due to lack of awareness and understanding. The internet is widely used by adolescents and young adults and has been proposed to fill knowledge gaps and advance high-quality, more equitable care. As a first step, this study analyzed the quality of current fertility preservation resources online and identified opportunities for improvement. Methods We conducted a systematic analysis of 500 websites to assess the quality, readability, and desirability of website features, and the inclusion of clinically relevant topics. Results The majority of the 68 eligible websites were low quality, written at college reading levels, and included few features that younger patients find desirable. Websites mentioned more common fertility preservation treatments than promising experimental treatments, and could be improved with cost information, socioemotional impacts, and other equity-related fertility topics. Conclusions Currently, the majority of fertility preservation websites are about, but not for, adolescent and young adult patients. High-quality educational websites are needed that address outcomes that matter to teens and young adults, with a priority on solutions that prioritize equity. Implications for Cancer Survivors: Adolescent and young adult survivors have limited access to high-quality fertility preservation websites that are designed for their needs. There is a need for the development of fertility preservation websites that are clinically comprehensive, written at appropriate reading levels, inclusive, and desirable. We include specific recommendations that future researchers can use to develop websites that could better address AYA populations and improve the fertility preservation decision making process.
Collapse
|
17
|
Ramsey I, Kennedy K, Sharplin G, Eckert M, Peters MDJ. Culturally safe, appropriate, and high-quality breast cancer screening for transgender people: A scoping review. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2023; 24:174-194. [PMID: 37114110 PMCID: PMC10128429 DOI: 10.1080/26895269.2022.2155289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Background There is a recognized need for evidence to inform breast cancer screening guidelines and services for transgender people, who face barriers to accessing appropriate and inclusive health care. Aims This review summarized evidence for breast cancer risk and screening guidelines in transgender individuals, including the potential impact of gender-affirming hormone therapy (GAHT); factors that may influence screening decision-making and behaviors; and considerations for providing culturally safe, high-quality screening services. Methods A protocol was developed based on the Joanna Briggs Institute scoping review methodology. Searches were performed in Medline, Emcare, Embase, Scopus, and the Cochrane Library for articles reporting information on the provision of culturally safe, high-quality breast cancer screening services for transgender people. Results We identified 57 sources for inclusion: 13 cross-sectional studies, 6 case reports, 2 case series, 28 review or opinion articles, 6 systematic reviews, 1 qualitative study, and 1 book chapter. Evidence on rates of breast cancer screening among transgender people and the association between GAHT and breast cancer risk was inconclusive. Factors negatively associated with cancer screening behaviors included socioeconomic barriers, stigma, and lack of health provider awareness of transgender health issues. Breast cancer screening recommendations varied and were generally based on expert opinion due to the lack of clear evidence. Considerations for providing culturally safe care to transgender people were identified and mapped to the areas of workplace policies and procedures, patient information, clinic environment, professional conduct, communication, and knowledge and competency. Discussion Screening recommendations for transgender individuals are complicated by the lack of robust epidemiological data and clear understanding of the role GAHT may play in breast cancer pathogenesis. Guidelines have been developed based on expert opinion and are subsequently not uniform or evidence based. Further work is required to clarify and consolidate recommendations.
Collapse
Affiliation(s)
- Imogen Ramsey
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Kate Kennedy
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Greg Sharplin
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Micah D. J. Peters
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
- Faculty of Health and Medical Sciences, Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
- The Centre for Evidence-based Practice South Australia (CEPSA): A JBI Centre of Excellence, Adelaide, Australia
| |
Collapse
|
18
|
Kamen CS, Reichelt M, Dadgostar P, Alpert AB, Doucette C, Vaughan P, Keuroghlian AS, Yousefi-Nooraie R. Sexual and gender minority cultural humility training for oncology settings: An example of iterative adaptation and implementation. FRONTIERS IN HEALTH SERVICES 2022; 2:958274. [PMID: 36925900 PMCID: PMC10012625 DOI: 10.3389/frhs.2022.958274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022]
Abstract
Background Multiple national organizations recommend that cancer care providers and oncology practices be responsive to the needs of sexual and gender minority (SGM) patients. Oncology practices have attempted to incorporate this recommendation through SGM-focused cultural humility training interventions. It is unclear how best to adapt and implement such training across practices. This manuscript outlines one process for adapting a widely-used SGM training from The Fenway Institute to the context of oncology settings using the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) model. Methods We conducted training sessions in two oncology care settings: a breast oncology center and a radiation oncology department. Subsequently, we conducted in-depth interviews with the three trainers involved in adapting The Fenway Institute's training to these two practices. Two independent investigators coded the interviews using components of the FRAME model as an analytic guide. Results Training team members described the mechanisms by which FRAME adaption occurred both proactively and reactively; the importance of involving SGM-identified trainers of diverse backgrounds as well as champions from within oncology practices in which trainings were conducted; the importance of adapting both the context and content of training to be relevant to oncology audiences; and the ways in which fidelity to the core principles of improving health care for SGM patients was maintained throughout the process. Discussion SGM cultural humility training for oncology providers and staff must undergo iterative adaptation to address the political and social context of specific practice environments and advocate for broader institutional culture change to achieve responsiveness to SGM health needs.
Collapse
Affiliation(s)
| | | | | | - Ash B. Alpert
- Brown University School of Public Health, Providence, RI, United States
| | | | | | | | | |
Collapse
|
19
|
Bybee S, Cloyes K, Mooney K, Supiano K, Baucom B, Ellington L. Posttraumatic growth and life course stress predict dyadic wellbeing among sexual and gender minority (SGM) and non-SGM couples facing cancer. Psychooncology 2022; 31:1860-1868. [PMID: 36151881 PMCID: PMC10550009 DOI: 10.1002/pon.6036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/27/2022] [Accepted: 07/18/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study examined: (1) Differences among sexual and gender minority (SGM) and non-SGM couples' life course stress, posttraumatic growth (PTG), individual, and dyadic wellbeing while facing cancer, (2) The predictive ability of PTG and life course stress on wellbeing for each dyad member, and (3) The predictive ability of dyad-level PTG and dyad-level life course stress on dyadic wellbeing. METHODS Thirty SGM and 30 non-SGM dyads (N = 60) completed measures assessing demographics, life course stress, PTG, individual, and dyadic wellbeing. Regression and multilevel models tested predictive hypotheses. RESULTS Participants were 56.3 years old on average (SD = 13.6) and were together for 24.2 (SD = 14.9) years. SGM participants reported greater life course stress and higher scores on the Depression, Anxiety, and Stress Scales (DASS-21) than non-SGM participants. A dyad members' higher PTG predicted their partners' higher DASS-21 score, dyad members' higher life course stress predicted their own higher DASS-21 score, and patients' higher life course stress predicted their partners' higher DASS-21 score. Greater dyadic PTG predicted greater dyadic wellbeing. CONCLUSIONS SGM and non-SGM couples experience PTG equally despite SGM couples' greater life course stress and higher DASS-21 scores. Future research is needed to explore how PTG may affect individuals and couples differently.
Collapse
Affiliation(s)
- S. Bybee
- The University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112
| | - K.G. Cloyes
- The University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112
| | - K. Mooney
- The University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112
| | - K.P. Supiano
- The University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112
| | - B.R.W. Baucom
- The University of Utah Department of Psychology, 380 S 1530 E, Salt Lake City, UT 84112
| | - L. Ellington
- The University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112
| |
Collapse
|
20
|
Van Poppel H, Battisti NML, Lawler M, Kolarova T, Daly J, Rizvi K, Greene R, Buyens G, Oliver K, Price R, Osmanovic N, Venegoni E. European Cancer Organisation's Inequalities Network: Putting Cancer Inequalities on the European Policy Map. JCO Glob Oncol 2022; 8:e2200233. [PMID: 36252165 PMCID: PMC9812450 DOI: 10.1200/go.22.00233] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Hendrik Van Poppel
- European Association of Urology, Arnhem, the Netherlands,Katholieke Universiteit Leuven, Leuven, Belgium
| | - Nicolò Matteo Luca Battisti
- International Society of Geriatric Oncology, Châtelaine, Switzerland,The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Mark Lawler
- Queens University Belfast, Belfast, Northern Ireland
| | | | | | | | - Robert Greene
- HungerNdThirst Foundation, Amsterdam, the Netherlands
| | | | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth Surrey, UK
| | | | | | - Enea Venegoni
- European Cancer Organisation, Brussels, Belgium,Enea Venegoni, Rue de la Science 41, 1000, Brussels, B-1040, Belgium; e-mail:
| |
Collapse
|
21
|
Romano H. [Transgender people and care]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2022; 67:39-43. [PMID: 36509498 DOI: 10.1016/j.soin.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Transgender people should be patients like any other. However, many testimonies describe how difficult, even painful, access to care is for them. Some health care providers react with incomprehension, rejection and discrimination, which can be perceived as violence towards transgender patients. A change in health policies and the implementation of training are fundamental to ending these inequalities in care.
Collapse
Affiliation(s)
- Hélène Romano
- c/o Soins, Elsevier Masson SAS, 65 rue Camille-Desmoulins, 92442 Issy-les-Moulineaux cedex, France.
| |
Collapse
|
22
|
Ussher JM, Allison K, Perz J, Power R. LGBTQI cancer patients' quality of life and distress: A comparison by gender, sexuality, age, cancer type and geographical remoteness. Front Oncol 2022; 12:873642. [PMID: 36203463 PMCID: PMC9530284 DOI: 10.3389/fonc.2022.873642] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background There is growing acknowledgement of the psycho-social vulnerability of lesbian, gay, bisexual, transgender, queer and/or intersex (LGBTQI) people with cancer. The majority of research to date has focused on cisgender adults with breast or prostate cancer. Study Aim This study examined psycho-social factors associated with distress and quality of life for LGBTQI cancer patients and survivors, across a range of sexualities and gender identities, intersex status, tumor types, ages and urban/rural/remote location using an intersectional theoretical framework. Method 430 LGBTQI people with cancer completed an online survey, measuring distress, quality of life (QOL), and a range of psycho-social variables. Participants included 216 (50.2%) cisgender women, 145 (33.7%) cisgender men, and 63 (14.7%) transgender and gender diverse (TGD) people. Thirty-one (7.2%) participants reported intersex variation and 90 (20%) were adolescents or young adults (AYA), aged 15-39. The majority lived in urban areas (54.4%) and identified as lesbian, gay or bisexual (73.7%), with 10.9% identifying as bisexual, and 10.5% as queer, including reproductive (32.4%) and non-reproductive (67.6%) cancers. Results Forty-one percent of participants reported high or very high distress levels, 3-6 times higher than previous non-LGBTQI cancer studies. Higher rates of distress and lower QOL were identified in TGD compared to cisgender people, AYAs compared to older people, those who identify as bisexual or queer, compared to those who identify as lesbian, gay or homosexual, and those who live in rural or regional areas, compared to urban areas. Elevated distress and lower QOL was associated with greater minority stress (discrimination in life and in cancer care, discomfort being LGBTQI, lower outness) and lower social support, in these subgroups. There were no differences between reproductive and non-reproductive cancers. For the whole sample, distress and poor QOL were associated with physical and sexual concerns, the impact of cancer on gender and LGBTQI identities, minority stress, and lack of social support. Conclusion LGBTQI people with cancer are at high risk of distress and impaired QOL. Research and oncology healthcare practice needs to recognize the diversity of LGBTQI communities, and the ways in which minority stress and lack of social support may affect wellbeing.
Collapse
|
23
|
Kamen CS, Hastert TA, Mulvaney M, Hosea F, VanBergen AM, Fakih A, Larkin K, Killingsworth E, Thompson HS. Community-Driven Identification and Adaptation of a Cancer Caregiving Intervention for LGBTQIA Populations. Front Oncol 2022; 12:873491. [PMID: 35800052 PMCID: PMC9253545 DOI: 10.3389/fonc.2022.873491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background Lesbian, gay, bisexual, transgender, and other LGBTQIA cancer patients experience significant disparities in cancer-related outcomes. Their relationships may not be acknowledged in care systems designed to serve primarily heterosexual and cisgender (H/C) patients, and resources for partners and caregivers of H/C patients may not address the needs of LGBTQIA caregivers. Tailored interventions are needed to address disparities in LGBTQIA patients and caregivers. Methods To address this gap, researchers from Karmanos Cancer Institute in Detroit, MI and Wilmot Cancer Institute in Rochester, NY worked with a cancer action council (CAC) of LGBTQIA stakeholders with lived experience of cancer in a community-academic partnership. This group used the ADAPT-ITT model to guide their process of assessing needs in this community, identifying evidence-based interventions that could be adapted to meet those needs, and beginning the process of adapting an existing intervention to meet the needs of a new population. Results In the Assessment phase of the model, CAC members shared their own experiences and concerns related to cancer and identified cancer caregiving as a priority area for intervention. In the Decision-Making phase of the model, researchers and CAC members performed a review of the literature on interventions that reported outcomes for cancer caregiver, identifying 13 promising interventions. Each of these interventions was evaluated over a series of meetings using a scoring rubric. Based on this rubric, the FOCUS intervention was established as an appropriate target for adaptation to the LGBTQIA population. In the first stage of the Adaptation phase, CAC members reacted to the intervention content and identified principal components for adaptation. Conclusion While the FOCUS intervention adaptation is still in process, this manuscript can serve as a guide for others establishing community-academic partnerships to adapt interventions, as well as those developing interventions and resources for LGBTQIA persons coping with cancer.
Collapse
Affiliation(s)
- Charles S. Kamen
- Cancer Control Unit, Department of Surgery, University of Rochester, Rochester, NY, United States
- *Correspondence: Charles S. Kamen,
| | - Theresa A. Hastert
- Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, MI, United States
| | - Megan Mulvaney
- Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, MI, United States
| | - Forrest Hosea
- Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, MI, United States
| | - Alexandra M. VanBergen
- Cancer Control Unit, Department of Surgery, University of Rochester, Rochester, NY, United States
| | - Ali Fakih
- Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, MI, United States
| | - Knoll Larkin
- National LGBT Cancer Network, New York, NY, United States
| | | | - Hayley S. Thompson
- Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, MI, United States
| |
Collapse
|
24
|
Simon Rosser BR, Wright M, Hoefer CJ, Polter EJ, Kohli N, Wheldon CW, Haggart R, Talley KM, Mitteldorf D, Kilian G, Konety BR, Ross MW, West W. Recruiting an underserved, difficult to reach population into a cancer trial: Strategies from the Restore-2 Rehabilitation Trial for gay and bisexual prostate cancer patients. Clin Trials 2022; 19:239-250. [PMID: 35232299 PMCID: PMC9232867 DOI: 10.1177/17407745221077678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND/AIMS Sexual minorities are small and under-researched populations that are at disproportionate risk for cancer and poor cancer outcomes. Described as a "hidden population," the principal research challenge has been to develop effective methods to identify and recruit such cancer patients into cancer studies. Online recruitment strategies, as well as targeted clinic recruitment using patient-entered sexual orientation and gender identity data from electronic medical records have potential to transform recruitment, but studies testing the effects of how to recruit using these have not been published. METHODS In 2019, we conducted a naturalistic, three-arm, stratified prospective study to compare three recruitment strategies: (a) clinic based recruitment of prostate cancer patients from gay health and urology clinics; (b) directly from the gay community; and (c) online recruitment (through cancer support, sex/dating, and social sites). For each strategy, we estimated time, workload, and direct costs involved. To study how recruitment strategy may affect sampling, we tested for retention rates, demographic and outcome differences across sites. Using these methods, we successfully recruited 401 gay and bisexual prostate cancer patients into a randomized, controlled, 24-month trial testing an online sexual and urinary rehabilitation curriculum tailored for this population. RESULTS There were seven key results. First, it is possible to recruit substantial numbers of sexual minority men into prostate cancer studies provided online recruitment methods are used. Second, we observed big differences in dropout during study onboarding by recruitment source. Third, within online recruitment, the online sex/dating application (app) was the most successful and efficient, followed by the cancer support site, and then the social networking site. Fourth, while clinics were the cheapest source of recruitment, they were time intensive and low in yield. Fifth, the cancer support site and sex/dating app recruits differed by several characteristics, with the former being more rehabilitation-focused while the latter were younger and more sexually active. Sixth, we found almost no differences in outcomes across the three online recruitment sites. Seventh, because retention in online studies has been a concern, we confirm very low attrition at 3- and 6 months into the trial. CONCLUSION For sexual minority cancer research, more research on how to use sexual orientation and gender identity electronic medical record data for clinic-based recruitment is needed. For other small or hard-to-reach populations, researchers should compare and publish online versus offline recruitment strategies.
Collapse
Affiliation(s)
- B R Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Morgan Wright
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Chris J Hoefer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Elizabeth J Polter
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Nidhi Kohli
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Christopher W Wheldon
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Ryan Haggart
- Department of Urology, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Kristine Mc Talley
- Adult and Gerontological Health Cooperative, School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | | | - Gunna Kilian
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Michael W Ross
- Department of Family Medicine and Community Health, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - William West
- Department of Writing Studies, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
25
|
Kano M, Jaffe SA, Rieder S, Kosich M, Guest DD, Burgess E, Hurwitz A, Pankratz VS, Rutledge TL, Dayao Z, Myaskovsky L. Improving Sexual and Gender Minority Cancer Care: Patient and Caregiver Perspectives From a Multi-Methods Pilot Study. Front Oncol 2022; 12:833195. [PMID: 35600396 PMCID: PMC9120769 DOI: 10.3389/fonc.2022.833195] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeUp to 1 million lesbian, gay, bisexual, and transgender (i.e., sexual and gender minority, SGM) individuals in the United States have histories of cancer. This medically underserved population is diverse, with complex sexualities and gender identities, and distinct health concerns. SGM persons experience disproportionate risks for, and rates of, anal, breast, cervical, colorectal, endometrial, lung, and prostate cancers, in addition to cancers affecting transgender persons who have undergone sex-reassignment. SGM individuals are linked by shared experiences of stigmatization as a minority population for which little cancer research has been conducted. SGM cancer patients frequently report reluctance to seek healthcare, have poorer outcomes following diagnosis, engage in elevated risk behaviors (i.e. smoking and alcohol use) even after cancer diagnosis, have difficulty making emotional adjustment to illness, and experience higher rates of psychological distress. They report less satisfaction with cancer care, deficiencies in patient-centeredness and shared decision-making, gaps in care, and social isolation. Minority stress resulting from experiences of anti-SGM sentiment and discrimination affects cancer patients and their informal cancer caregivers. Our paper presents findings from a pilot study to identify gaps and opportunities to improve cancer care for SGM patients and caregivers at the University of New Mexico Comprehensive Cancer Center.MethodsBetween June 2020 and July 2021, we used a multi-methods research design informed by ecological theory to collect qualitative and quantitative data regarding cancer patient and caregiver quality of life (QoL) and experiences of cancer and survivorship care. We used PROMIS measures distributed via REDCap to assess QoL (i.e., fatigue, pain interference, pain intensity, anxiety, depression, emotional support, social isolation, and companionship), and conducted in-depth semi-structured interviews. We recruited 10 SGM cancer patients and 8 heterosexual, cisgender (H/C) patient matches, and their self-identified informal cancer caregivers (n=36, dyad total n=18). Interviews ranged from 1 to 2 hours, were audio-recorded and transcribed for analysis. The study was approved by the University of New Mexico Human Research Protections Office Institutional Review Board.ResultsResults of the PROMIS QoL assessments indicated that SGM patients reported greater anxiety [mean (SD) = 54.5 (8.8)] and depression [mean (SD) = 49.3 (4.8)] than H/C patients [mean (SD)=51.6 (7.5) and 45.4 (6.8) respectively], while heterosexual, cisgender (H/C) patients reported higher fatigue [mean (SD) =52.04 (8.18)] and stronger pain intensity than SGM patients [mean (SD)=48.3 (9.1) and 37.8 (9.1) respectively]. SGM patients reported higher levels of social isolation [mean (SD) = 48.3 (7.3) vs. 42.1 (7.4) for H/C patients, whereas H/C patients reported more emotional support (mean (SD) =57.5 (9.3) vs. 53.0 (6.9)] and companionship [mean (SD) = 55.2 (8.6) vs. 51.5 (11.0)]. SGM and H/C differences in caregiver QoL were most notable with regards to higher levels of fatigue [mean (SD) = 47.1 (6.0) for SGM, and 42.4 (11.5) for H/C] and companionship [mean (SD) = 55.3 (6.0) for SGM, and 50.9 (5.5) for H/C]. Qualitative interviews supported our quantitative results. SGM patients and caregivers articulated experiences of anti-SGM stigma and discrimination contributing to minority stress that influenced their initial cancer care encounters. SGM dyads had more trepidation and/or medical mistrust during initial cancer care encounters when compared to H/C patients and caregivers. SGM patients questioned care that was not culturally responsive to SGM preferences, while H/C patients were more apt to identify gaps in communication and perceived lack of clarity regarding cancer care delivery. Although SGM patients experienced high satisfaction with their cancer care once they developed trust with their providers, they discussed desires to have more direct conversations with their oncologists about their sexual orientation and gender identities and sexual health. All patients and providers in the study (SGM and H/C) appreciated their oncology care teams. All patients and caregivers relied on social networks comprised of friends and family, although SGM patients and caregivers had smaller social networks and relied less on biological family, and single SGM individuals experienced challenges accessing cancer care and struggled with social isolation. We discovered too, that all caregivers, regardless of Sexual Orientation and Gender Identity (SOGI), perceived a lack of support and information pertaining to their loved one’s treatment, side effects and best way to provide care.ConclusionsThis study demonstrates that prior stigmatizing experiences contribute to minority stress and medical mistrust for SGM cancer patients and their informal caregivers across the cancer care experience. Findings point to specific gaps in SGM cancer patient care, including lack of conversation about patient SOGI, inadequate staff and oncology provider SGM specific knowledge and cultural competence/cultural humility training, and insufficient patient supports for those who lack social support during cancer care treatment. Further, this study reveals inadequacies in SGM specific support, and overall support services for informal cancer caregivers. Additional research is required to develop targeted interventions to address minority stress and clinic environment concerns to improve cancer care for SGM patients. Importantly, while there were differences between SGM and H/C experiences of cancer treatment, significant similarities also emerged. Caregiver expressed consensus about the current lack of support and guidance for informal caregivers of cancer patients. Future work should focus on providing caregiver-specific resources in the clinic setting and facilitating support groups for caregivers to network with one another, as well as for tailoring SGM specific caregiver support services. Our findings highlight areas for improving cancer care for the SGM community, as well as a broader population of patients and caregivers.
Collapse
Affiliation(s)
- Miria Kano
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, United States
- *Correspondence: Miria Kano,
| | - Shoshana Adler Jaffe
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, United States
| | - Stephanie Rieder
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, United States
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Mikaela Kosich
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, United States
| | - Dolores D. Guest
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, United States
| | - Ellen Burgess
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, United States
| | - Ariel Hurwitz
- University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Vernon Shane Pankratz
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, United States
| | - Teresa L. Rutledge
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, United States
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Zoneddy Dayao
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, United States
| | - Larissa Myaskovsky
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, United States
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| |
Collapse
|
26
|
Silveri G, Schimmenti S, Prina E, Gios L, Mirandola M, Converti M, Fiorillo A, Pinna F, Ventriglio A, Galeazzi GM, Sherriff N, Zeeman L, Amaddeo F, Paribello P, Pinna F, Giallanella D, Gaggiano C, Ventriglio A, Converti M, Fiorillo A, Galeazzi GM, Marchi M, Arcolin E, Fiore G, Mirandola M, Schimmenti S, Silveri G, Prina E, Amaddeo F, Bragazzi NL. Barriers in care pathways and unmet mental health needs in LGBTIQ + communities. Int Rev Psychiatry 2022; 34:215-229. [PMID: 36151825 DOI: 10.1080/09540261.2022.2075256] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Lesbian, gay, bisexual, transgender, intersex, queer people and minority gender identities and sexualities (LGBTIQ+) are often stigmatized and experience discrimination in health care settings, leading to poorer mental health outcomes and unmet needs compared to heterosexual and cisgendered peers. It is thus imperative that mental health providers consider and address structural challenges in order to reduce mental health inequalities of this population. This narrative review assessed the barriers that may prevent access to care and the pathways for care in LGBTIQ + communities. PubMed, PsycInfo, Embase, and Scopus were searched for papers published between December 2021 and February 2022. A total of 107 papers were included with studies reflecting five themes: (1) Unmet mental health needs; (2) Young people; (3) Substance abuse and addiction; (4) Barriers and pathways to care; and (5) Interventions. Findings demonstrate that LGBTIQ + people experience stigmatization and higher rates of substance misuse and mental ill health, which may lead to barriers in accessing health care services, and fewer tailored interventions being provided. These findings have implications for policy, health care screening, and how specialist services are structured. Substantial gaps in the evidence-base exist, and future research should examine how mental health care providers can challenge social issues that maintain discriminatory and stigmatizing practices, and support LGBTIQ + individuals to sustain their resilience.
Collapse
Affiliation(s)
- Giada Silveri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Simone Schimmenti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Massimo Mirandola
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy.,School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Federica Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Department of integrated activity of Mental Health and Pathological Dependencies, USL-IRCSS company of Reggio Emilia, Reggio Emilia, Italy
| | - Nigel Sherriff
- School of Sport and Health Sciences, University of Brighton, Brighton, UK.,Centre for Transforming Sexuality and Gender, University of Brighton, Brighton, UK
| | - Laetitia Zeeman
- School of Sport and Health Sciences, University of Brighton, Brighton, UK.,Centre for Transforming Sexuality and Gender, University of Brighton, Brighton, UK
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Pasquale Paribello
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Federica Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Daniela Giallanella
- Department of Clinical and Experimental, University di Foggia, Foggia, Italy
| | - Costanza Gaggiano
- Department of Clinical and Experimental, University di Foggia, Foggia, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental, University di Foggia, Foggia, Italy
| | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Arcolin
- Department of Mental Health and Drug Abuse, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gianluca Fiore
- Department of Mental Health and Drug Abuse, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Mirandola
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Simone Schimmenti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giada Silveri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
| | | |
Collapse
|
27
|
Berrahou IK, Snow A, Swanson M, Obedin-Maliver J. Representation of Sexual and Gender Minority People in Patient Nondiscrimination Policies of Cancer Centers in the United States. J Natl Compr Canc Netw 2022; 20:253-259. [PMID: 35168202 DOI: 10.6004/jnccn.2021.7078] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/21/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Sexual and gender minority (SGM) people are an underserved population who face high rates of discrimination in healthcare, including receipt of cancer treatment. Several national organizations have identified the importance of patient nondiscrimination policies that explicitly recognize SGM people in creating safe healthcare environments. METHODS We performed a web-based analysis of NCI-designated Cancer Centers to evaluate the landscape of patient nondiscrimination policies in major cancer centers with regard to representation of SGM people. RESULTS We found that 82% of cancer centers had a patient nondiscrimination policy on their website. The most commonly mentioned SGM-related term was "sex" (n=48; 89%), followed by "sexual orientation" (n=37; 69%) and "gender identity" (n=36; 67%). None of the policies included "sex assigned at birth" or "LGBTQ/SGM identity." Of the policies reviewed, 65% included protections for both sexual orientation and gender identity. Cancer centers with academic affiliations were significantly more likely to have policies that included both of these protections compared with nonacademic institutions (100% vs 79%; P=.005). CONCLUSIONS Our study shows that patient nondiscrimination policies across NCI-designated Cancer Centers are not always accessible to patients and their families online and do not consistently represent SGM people in their content. Because the SGM population is both at higher risk for cancer and for discrimination in the healthcare setting, it is crucial to create inclusive, safe, and equitable cancer care environments for this group. Administrators and clinicians should view the patient nondiscrimination policy as an opportunity to offer expansive protections to SGM people that extend beyond those offered in federal and state laws. Additionally, the patient nondiscrimination policy should be visible and accessible to patients seeking cancer care as a signal of safety and inclusion.
Collapse
Affiliation(s)
- Iman K Berrahou
- 1Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco
| | - Ava Snow
- 2Stanford University School of Humanities and Sciences, Stanford
| | - Megan Swanson
- 3Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Gynecologic Oncology, University of California San Francisco, San Francisco; and
| | - Juno Obedin-Maliver
- 4Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
28
|
Rosser BRS, Polter EJ, Talley KMC, Wheldon CW, Haggart R, Wright M, West W, Mitteldorf D, Ross MW, Konety BR, Kohli N. Health Disparities of Sexual Minority Patients Following Prostate Cancer Treatment: Results From the Restore-2 Study. Front Oncol 2022; 12:812117. [PMID: 35186749 PMCID: PMC8854183 DOI: 10.3389/fonc.2022.812117] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/13/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The NIH has identified sexual and gender minority persons as a health disparity population but little is known about cancer outcomes in these populations. The purpose of this study was to identify disparities in sexual minority prostate cancer patient-reported outcomes, to examine within group differences, and to test for alternative explanations for identified differences. MATERIALS AND METHODS In 2019, we recruited 401 gay and bisexual prostate cancer patients into the Restore-2 study, a randomized controlled trial of rehabilitation program tailored for sexual minority men. RESULTS Compared to the normative (heterosexual) EPIC sample, participants had significantly worse urinary, bowel and hormonal function, better sexual function, and no difference on bother scores. They also had worse depression and overall mental health, and worse physical, social/family, functional, prostate specific and overall well-being quality of life outcomes. Across measures, no differences by age, gay versus bisexual orientation, race/ethnicity, and relationship status were observed. Those who had hormonal treatment had worse sexual and hormonal function than those who had radiation or surgery only. Those with a longer time since treatment had better urinary function. Differences remained when participants were matched to normative samples on cancer stage and time since treatment. CONCLUSIONS This, the largest study of sexual minority prostate cancer patients to date, confirms health disparities in prostate cancer quality of life outcomes. Findings appear reliable and robust. To improve the clinical care of prostate cancer, it will be important to address the health disparities experienced by sexual minority prostate cancer patients.
Collapse
Affiliation(s)
- B. R. Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Elizabeth J. Polter
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Kristine M. C. Talley
- Adult and Gerontological Health Cooperative, University of Minnesota School of Nursing, Minneapolis, MN, United States
| | - Christopher W. Wheldon
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Ryan Haggart
- Department of Urology, University of Minnesota, Minneapolis, MN, United States
| | - Morgan Wright
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - William West
- Department of Writing Studies, University of Minnesota, Minneapolis, MN, United States
| | | | - Michael W. Ross
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
| | | | - Nidhi Kohli
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, United States
| |
Collapse
|
29
|
Gorman JR, Lyons KS, Reese JB, Acquati C, Smith E, Drizin JH, Salsman JM, Flexner LM, Hayes-Lattin B, Harvey SM. Adapting a Theory-Informed Intervention to Help Young Adult Couples Cope With Reproductive and Sexual Concerns After Cancer. Front Psychol 2022; 13:813548. [PMID: 35185733 PMCID: PMC8854289 DOI: 10.3389/fpsyg.2022.813548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveMost young adults diagnosed with breast or gynecologic cancers experience adverse reproductive or sexual health (RSH) outcomes due to cancer and its treatment. However, evidence-based interventions that specifically address the RSH concerns of young adult and/or LGBTQ+ survivor couples are lacking. Our goal is to develop a feasible and acceptable couple-based intervention to reduce reproductive and sexual distress experience by young adult breast and gynecologic cancer survivor couples with diverse backgrounds.MethodsWe systematically adapted an empirically supported, theoretically grounded couple-based intervention to address the RSH concerns of young couples coping with breast or gynecologic cancer through integration of stakeholder perspectives. We interviewed 11 couples (22 individuals) with a history of breast or gynecologic cancer to review and pretest intervention materials. Three of these couples were invited to review and comment on intervention modifications. Content experts in RSH and dyadic coping, clinicians, and community advisors (one heterosexual couple and one LGBTQ+ couple, both with cancer history) participated throughout the adaptation process.ResultsFindings confirmed the need for an online, couple-based intervention to support young couples experiencing RSH concerns after breast or gynecologic cancer. Qualitative themes suggested intervention preferences for: (1) A highly flexible intervention that can be tailored to couples’ specific RSH concerns; (2) Active steps to help members of a dyad “get on the same page” in their relationship and family building plans; (3) A specific focus on raising partners’ awareness about how cancer can affect body image and physical intimacy; and (4) Accessible, evidence-based information about RSH for both partners. These results, along with feedback from stakeholders, informed adaptation and finalization of the intervention content and format. The resulting virtual intervention, Opening the Conversation, includes five weekly sessions offering training to couples in communication and dyadic coping skills for addressing RSH concerns.ConclusionThe systematic adaptation process yielded a theory-informed intervention for young adult couples facing breast and gynecological cancers, which will be evaluated in a randomized controlled trial. The long-term goal is to implement and disseminate Opening the Conversation broadly to reach young adult couples with diverse backgrounds who are experiencing RSH concerns in cancer survivorship.
Collapse
Affiliation(s)
- Jessica R. Gorman
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
- *Correspondence: Jessica R. Gorman,
| | - Karen S. Lyons
- Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
| | - Jennifer Barsky Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Chiara Acquati
- Graduate College of Social Work, University of Houston, Houston, TX, United States
- Department of Clinical Sciences, College of Medicine, University of Houston, Houston, TX, United States
- Department of Health Disparities Research, The UT MD Anderson Cancer Center, Houston, TX, United States
| | - Ellie Smith
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Julia H. Drizin
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - John M. Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, United States
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
| | - Lisa M. Flexner
- Doctor of Physical Therapy Program, Oregon State University, Bend, OR, United States
| | - Brandon Hayes-Lattin
- School of Medicine, OHSU Knight Cancer Institute, Oregon Health and Sciences University, Portland, OR, United States
| | - S. Marie Harvey
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| |
Collapse
|
30
|
Tuman M, Roberts KE, Corner G, Beard C, Fadalla C, Coats T, Slivjak E, Schofield E, Lichtenthal WG. Interpretation Bias in Breast Cancer Survivors Experiencing Fear of Cancer Recurrence. Front Psychol 2021; 12:682174. [PMID: 34867579 PMCID: PMC8636426 DOI: 10.3389/fpsyg.2021.682174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Fear of cancer recurrence (FCR) is a prevalent and persistent challenge that many cancer survivors endure. While the role of interpretation bias, a tendency to perceive ambiguous situations as threatening, has been established in the onset and maintenance of FCR, few studies have examined cancer-related interpretation bias specifically. Grounded in the cognitive formulation of FCR, the current study aimed to fill this gap by investigating the relationship between cancer-related interpretation bias, FCR, and somatic symptoms, and examining whether bias mediates the relationship between somatic symptoms and FCR. Materials and Methods: This study used baseline data from a randomized controlled trial of a cognitive bias modification intervention. Breast cancer survivors (n = 110) provided demographic and medical background information as well as self-report measures of FCR and severity of somatic symptoms. A computer-based assessment of interpretation bias was used to measure cancer-related interpretation bias on several bias indices: percentage of cancer-related threat endorsement, and percentage of benign endorsement; mean reaction time (RT) for threat, and mean RT for benign endorsement. Results: Higher threat endorsement was linked to higher Overall Fear and emerged as a mediator of the relationship between overall somatic symptoms and Overall Fear. We also found that older age was related to longer benign endorsement RT. Conclusion: This study contributes understanding of factors related to cancer-related interpretation bias and provides evidence that bias may influence the relationship between somatic symptoms and FCR in cancer survivors.
Collapse
Affiliation(s)
- Malwina Tuman
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Kailey E Roberts
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, United States
| | - Geoffrey Corner
- Department of Psychology, University of Southern California, Los Angeles, CA, United States
| | - Courtney Beard
- McLean Hospital, Belmont, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Carol Fadalla
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Taylor Coats
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Elizabeth Slivjak
- Department of Psychology and Neuroscience, Boulder, CO, United States
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Wendy G Lichtenthal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| |
Collapse
|
31
|
Hawkey AJ, Ussher JM, Liamputtong P, Marjadi B, Sekar JA, Perz J, Ryan S, Schmied V, Brook E, Dune T. Trans Women's Responses to Sexual Violence: Vigilance, Resilience, and Need for Support. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3201-3222. [PMID: 34697692 DOI: 10.1007/s10508-021-01965-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 05/12/2023]
Abstract
Despite experiencing high rates of sexual violence, there is limited research that explores coping and support needs among trans women of color and those from migrant backgrounds. This article examines the impact of sexual violence, as well as responses and support needs in relation to sexual violence, among 31 trans women of color, aged between 18-54 years, living in Australia. Women were recruited using purposive and snowball sampling, local LGBTQI + networks, and social media. Study advertisements invited participation from people 18 years and older, who identified as a "trans woman of color" or "trans woman from a non-English speaking background," to take part in a study about their lives as trans women of color and experiences of sexual violence. In-depth interviews and photovoice took place between September 2018 and September 2019. Findings were analyzed through thematic analysis, drawing on intersectionality theory. Sexual violence was reported to be associated with fear, anxiety, and depression, and, for a minority of women, self-blame. While women reported hypervigilance and avoiding going out in public as measures to anticipate and protect themselves from sexual violence, they also demonstrated agency and resilience. This included putting time and effort into appearing as a cisgender woman, naming violence, seeking support, rejecting self-blame, and engaging in self-care practices to facilitate healing. Trans women highlighted the need for multi-faceted sexual violence prevention activities to encourage education, empowerment and cultural change across the general population and support services, in order to promote respect for gender, sexuality and cultural diversity.
Collapse
Affiliation(s)
- Alexandra J Hawkey
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia.
| | - Jane M Ussher
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Pranee Liamputtong
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Brahmaputra Marjadi
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Jessica Aasha Sekar
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Janette Perz
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Samantha Ryan
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Virginia Schmied
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | | | - Tinashe Dune
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| |
Collapse
|
32
|
Li Y, Theodoropoulos N, Fujiwara Y, Xie H, Wang Q. Self-assessment of health status among lesbian, gay, and bisexual cancer survivors in the United States. Cancer 2021; 127:4594-4601. [PMID: 34406650 DOI: 10.1002/cncr.33845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/13/2021] [Accepted: 07/19/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Research is lacking for understanding the health disparities in cancer survivorship in the lesbian, gay, and bisexual (LGB) population in the United States. Self-reported health status is used as a predictor of health disparities. METHODS This secondary data analysis study used 2018 Behavioral Risk Factor Surveillance System data to analyze cancer survivorship characteristics by sexual orientation and sex through the use of logistic regressions. RESULTS Overall, 17,656,329 US cancer survivors were included in this study after weighting, with percentage estimates of 1.52% for gays/lesbians and 1.41% for bisexuals. LGB participants were younger and more ethnically diverse. Significantly, bisexuals had current smoking (32.3% vs 13.6%) and binge drinking rates (17.1% vs 9.1%) twice those of heterosexuals; 16.6% of bisexuals versus 4.1% of heterosexuals reported no health insurance coverage (P < .0001). After adjustments for socioeconomic, health-related behavioral risk, and health care access factors, bisexual females reported poorer general health (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.31-1.36) as well as mental health (OR, 2.43; 95% CI, 2.39-2.46) than their heterosexual peers (P < .0001). Bisexual males were 5.14 times more likely to be told that they had depressive disorders than their heterosexual counterparts (95% CI, 5.05-5.23), whereas bisexual females were 3.23 times more likely for the same outcome (95% CI, 3.18-3.28). All LGB groups reported significantly more inadequate sleep than their heterosexual counterparts (especially lesbians: OR, 2.14; 95% CI, 2.10-2.18). CONCLUSIONS This study indicates that LGB cancer survivors have worse survivorship than their heterosexual peers with heterogeneity in subgroups. Future studies should use larger sample sizes, further investigate disparities, and promote survivorship in LGB populations. LAY SUMMARY It has been observed that lesbian, gay, and bisexual (LGB) cancer survivors may face challenges in cancer survivorship that are not as prevalent in the heterosexual community. This cross-sectional study has found that LGB cancer survivors, especially bisexuals, have overall poorer physical and mental health, are more likely to be told that they have depressive disorders, and have worse sleep quality in comparison with their heterosexual counterparts. These results also differ by sex, and this can provide rationales for future studies and guide interventions to relocate resources to better promote equality.
Collapse
Affiliation(s)
- Yannan Li
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Yu Fujiwara
- Department of Internal Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hui Xie
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | - Qian Wang
- Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
33
|
Rosser BRS, Rider GN, Kapoor A, Talley KMC, Haggart R, Kohli N, Konety BR, Mitteldorf D, Polter EJ, Ross MW, West W, Wheldon C, Wright M. Every urologist and oncologist should know about treating sexual and gender minority prostate cancer patients: translating research findings into clinical practice. Transl Androl Urol 2021; 10:3208-3225. [PMID: 34430423 PMCID: PMC8350223 DOI: 10.21037/tau-20-1052] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/19/2020] [Indexed: 11/22/2022] Open
Abstract
In 2016, the NIH designated sexual and gender minorities (SGM) a health disparity population. The next year, the American Society of Clinical Oncology highlighted the need to improve the suboptimal cancer and survivorship care received by SGM populations. There are currently no evidence-based training programs in culturally competent care of prostate cancer patients who are gay, bisexual and/or transgender. In this selective review, we summarize findings from the largest quantitative studies focused on sexual minority prostate cancer survivors and from 65 interviews with NIH staff, clinicians, and cancer clinics in 11 US cities. The report is divided into three parts and uses a question and answer format to address 21 questions relevant to clinicians providing care to SGM prostate cancer patients. First, we identify population-specific issues that are culturally relevant in the care of SGM patients with prostate cancer. While a body of research has emerged on sexual minority prostate cancer patients, the literature on gender minorities is limited to single case reports and inadequate to inform practice. This review covers definitions, population size, cultural and historical context, sexual behavior, population invisibility, sexual orientation and gender identity (SOGI) in the electronic medical record, disparities and evidence of discrimination in treatment provision. The second part focuses on promoting evidence-informed, patient-centered care. This includes current practices in assessing sexual orientation, management of disclosure of sexual orientation, how to address common problems sexual minority men experience post-treatment, common questions sexual minority patients have, management of urinary incontinence, HIV and STI risk during and post-treatment, and sub-groups of sexual minority patients with worse outcomes. It then identifies how male partners differ in prostate cancer support, current research on rehabilitation for sexual minority men, issues in advanced prostate cancer, and things to avoid with minority patients. Finally, we examine the cultural divide between provider and patient, advocating for cultural humility when working with minority patients. Training programs and continuing education can help providers both to become more aware of their own cultural assumptions, informed about health disparities, and able to provide quality care, and to make clinics more welcoming to SGM patients.
Collapse
Affiliation(s)
- B. R. Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - G. Nic Rider
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Aditya Kapoor
- Department of Radiology, Trinity Teleradiology Services, Vancouver, BC, Canada
| | - Kristine M. C. Talley
- Adult and Gerontological Health, University of Minnesota School of Nursing School, Minneapolis, MN, USA
| | - Ryan Haggart
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Nidhi Kohli
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
| | | | | | - Elizabeth J. Polter
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Michael W. Ross
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - William West
- Department of Writing Studies, University of Minnesota, Minneapolis, MN, USA
| | - Christopher Wheldon
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Morgan Wright
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
34
|
Pratt-Chapman ML, Alpert AB, Castillo DA. Health outcomes of sexual and gender minorities after cancer: a systematic review. Syst Rev 2021; 10:183. [PMID: 34154645 PMCID: PMC8218456 DOI: 10.1186/s13643-021-01707-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 05/18/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Cancer research on sexual and gender minority (SGM) populations is gaining momentum. The purpose of this systematic review was to examine what is currently known in the research literature regarding patient-reported health outcomes after cancer treatment among SGM populations. METHODS In March 2021, a medical librarian conducted a systematic keyword search on PubMed, Embase, Scopus, Web of Science, PsycINFO, ClinicalTrials.gov , and the Cochrane Central Register of Controlled Trials. The primary inclusion criterion was assessment of at least one physical, psychosocial, emotional, or functional patient-reported health outcome related to the impacts of cancer diagnosis and/or treatment. Articles that met inclusion criteria were reviewed in their entirety, charted in a Word Table, and assessed for quality. Quality considerations included study design, sampling approach, diversity of sample, measures used, and analytic procedures. Studies were synthesized based on type of cancer study participants experienced. RESULTS Sixty-four studies were included in the final analysis: most were quantitative, secondary analyses or cross-sectional studies with convenience samples, and focused on people with a history of breast or prostate cancer. Differences between sexual minority men and women in terms of coping and resilience were noted. Few studies reported on experiences of transgender persons and none reported on experiences of intersex persons. CONCLUSIONS A growing literature describes the patient-reported health outcomes of SGM people with a history of cancer. This study summarizes important between-group differences among SGM and heterosexual, cisgender counterparts that are critical for clinicians to consider when providing care. IMPLICATIONS FOR CANCER SURVIVORS Sexual orientation and gender identity are relevant to cancer survivors' health outcomes. Subgroups of SGM people have differential experiences and outcomes related to cancer and its impacts.
Collapse
Affiliation(s)
- Mandi L. Pratt-Chapman
- The George Washington University, School of Medicine and Health Sciences, Washington, DC USA
- The GW Cancer Center, The George Washington University, 2600 Virginia Avenue, Suite #324, Washington, DC 20037 USA
| | - Ash B. Alpert
- Wilmot Cancer Institute, Division of Hematology and Medical Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, USA
| | - Daniel A. Castillo
- Edward G. Miner Library, University of Rochester Medical Center, Rochester, USA
| |
Collapse
|
35
|
Abstract
PURPOSE Cancer research on sexual and gender minority (SGM) populations is gaining momentum. The purpose of this systematic review was to examine what is currently known in the research literature regarding patient-reported health outcomes after cancer treatment among SGM populations. METHODS In March 2021, a medical librarian conducted a systematic keyword search on PubMed, Embase, Scopus, Web of Science, PsycINFO, ClinicalTrials.gov , and the Cochrane Central Register of Controlled Trials. The primary inclusion criterion was assessment of at least one physical, psychosocial, emotional, or functional patient-reported health outcome related to the impacts of cancer diagnosis and/or treatment. Articles that met inclusion criteria were reviewed in their entirety, charted in a Word Table, and assessed for quality. Quality considerations included study design, sampling approach, diversity of sample, measures used, and analytic procedures. Studies were synthesized based on type of cancer study participants experienced. RESULTS Sixty-four studies were included in the final analysis: most were quantitative, secondary analyses or cross-sectional studies with convenience samples, and focused on people with a history of breast or prostate cancer. Differences between sexual minority men and women in terms of coping and resilience were noted. Few studies reported on experiences of transgender persons and none reported on experiences of intersex persons. CONCLUSIONS A growing literature describes the patient-reported health outcomes of SGM people with a history of cancer. This study summarizes important between-group differences among SGM and heterosexual, cisgender counterparts that are critical for clinicians to consider when providing care. IMPLICATIONS FOR CANCER SURVIVORS Sexual orientation and gender identity are relevant to cancer survivors' health outcomes. Subgroups of SGM people have differential experiences and outcomes related to cancer and its impacts.
Collapse
Affiliation(s)
- Mandi L Pratt-Chapman
- The George Washington University, School of Medicine and Health Sciences, Washington, DC, USA. .,The GW Cancer Center, The George Washington University, 2600 Virginia Avenue, Suite #324, Washington, DC, 20037, USA.
| | - Ash B Alpert
- Wilmot Cancer Institute, Division of Hematology and Medical Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, USA
| | - Daniel A Castillo
- Edward G. Miner Library, University of Rochester Medical Center, Rochester, USA
| |
Collapse
|
36
|
How can we meet the support needs of LGBT cancer patients in oncology? A systematic review. Radiography (Lond) 2021; 27:633-644. [DOI: 10.1016/j.radi.2020.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/05/2020] [Accepted: 07/10/2020] [Indexed: 12/19/2022]
|
37
|
Szoka N, Szoka S, Friedman K, Portenier D. Sexual and Gender Minority Bariatric Patients: An Unseen Population. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nova Szoka
- Department of Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Spring Szoka
- Department of Counseling Psychology, West Virginia University, Morgantown, West Virginia, USA
| | - Kelli Friedman
- Duke Center For Metabolic and Weight Loss Surgery, Duke University, Durham, North Carolina, USA
| | - Dana Portenier
- Duke Center For Metabolic and Weight Loss Surgery, Duke University, Durham, North Carolina, USA
| |
Collapse
|
38
|
Hutchcraft ML, Teferra AA, Montemorano L, Patterson JG. Differences in Health-Related Quality of Life and Health Behaviors Among Lesbian, Bisexual, and Heterosexual Women Surviving Cancer from the 2013 to 2018 National Health Interview Survey. LGBT Health 2021; 8:68-78. [PMID: 33325783 PMCID: PMC7826421 DOI: 10.1089/lgbt.2020.0185] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: Health-related quality of life (HRQoL) and health behaviors contribute to cancer morbidity and mortality, which are elevated in lesbian and bisexual women (LBW). The purpose of this study was to assess differences in HRQoL and health behaviors between heterosexual and lesbian women and heterosexual and bisexual women cancer survivors. Methods: We pooled 2013-2018 National Health Interview Survey data. HRQoL comprised physical, mental, financial, and social health domains. Health behaviors included tobacco and alcohol use, physical activity, and preventive health care. Weighted, multivariable logistic regression models estimated odds ratios (ORs) with 95% confidence intervals (CIs). Results: The sample included 10,830 heterosexual, 141 lesbian, and 95 bisexual cancer survivors. Lesbian women reported higher odds of fair/poor self-rated health (OR: 1.68, 95% CI 1.02-2.78), chronic obstructive pulmonary disease (OR: 1.98, 95% CI 1.09-3.56), and heart conditions (OR: 1.90, 95% CI 1.16-3.12) than heterosexual women. Bisexual women reported higher odds of severe psychological distress (OR: 3.03, 95% CI 1.36-6.76), heart conditions (OR: 1.98, 95% CI 1.12-3.53), and food insecurity (OR: 2.89, 95% CI 1.29-6.50) than heterosexual women. For health behaviors, lesbian women reported greater odds of current (OR: 2.34, 95% CI 1.26-4.34) and former tobacco use (OR: 1.89, 95% CI 1.21-2.96), and bisexual women had lower odds of a recent mammogram (OR: 0.42, 95% CI 0.23-0.78) than heterosexual women. Conclusions: LBW cancer survivors reported disparities in HRQoL and health behaviors. In cancer care settings, identification of LBW patients requiring physical and mental health promotion, financial services, and supported tobacco cessation may improve health and survival.
Collapse
Affiliation(s)
- Megan L. Hutchcraft
- Department of Obstetrics and Gynecology, Carle Illinois College of Medicine, Champaign, Illinois, USA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky Markey Cancer Center, Lexington, Kentucky, USA
| | - Andreas A. Teferra
- Department of Public Health, Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio, USA
| | - Lauren Montemorano
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | |
Collapse
|
39
|
"Sex Can Be a Great Medicine": Sexual Health in Oncology Care for Sexual and Gender Minority Cancer Patients. CURRENT SEXUAL HEALTH REPORTS 2020; 12:320-328. [PMID: 33776600 DOI: 10.1007/s11930-020-00285-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Purpose of review Until recently, sexual and gender minority (SGM) people have been largely invisible in health care and health services research. However, understanding the needs and experiences of SGM cancer patients is critical to providing high-quality care, including needs and experiences related to sexual health. In this narrative review, we highlight that the literature on sexual health for SGM people with cancer is lacking, summarize existing literature on disparities affecting SGM patients with cancer, and discuss factors associated with these disparities. We conclude with recommendations and suggestions for future research in this area. Recent Findings Emerging evidence suggests that SGM people are at a higher risk for breast, cervical, endometrial, HPV-related, and lung cancers, as well as poor cancer outcomes, due to behavioral risk factors and health care system factors (e.g. lower access to health care insurance, discrimination in non-affirming care settings, negative health care interactions with providers). Additional research suggests that lack of clear guidelines for cancer screening in SGM patients, particularly for transgender and gender diverse patients, negatively impacts cancer screening uptake among SGM people. A growing number of studies have suggested greater sexual challenges following cancer treatment for sexual minority men with prostate cancer, while other studies highlight positive outcomes for sexual minority women following cancer treatment, such as benefit finding and resilience. Research on transgender and gender diverse patients is lacking. Summary Collection of sexual orientation and gender identity data across clinical enterprises and population-based surveys, mandatory health care provider training on cultural and clinical competency with SGM patients, and additional research inclusive of and focused on SGM cancer patients are key strategies to advance evidence-based clinical cancer care for diverse SGM populations.
Collapse
|
40
|
Stenzel AE, Moysich KB, Ferrando CA, Starbuck KD. Clinical needs for transgender men in the gynecologic oncology setting. Gynecol Oncol 2020; 159:899-905. [PMID: 33004214 DOI: 10.1016/j.ygyno.2020.09.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/21/2020] [Indexed: 01/15/2023]
Abstract
Transgender men remain at risk for gynecologic malignancies, but are an underserved population. Members of the transgender community experience discrimination and have experiences that contribute to health disparities, including in gynecology and oncology. While efforts have been made within the United States to reduce inequalities experienced by members of this community, many needs in the clinical setting remain. Increased education and training among providers and healthcare professionals, and general improvements towards understanding barriers to health screening and health resource uptake may reduce some disparities. Additional research towards screening and cancer surveillance among this community will be necessary to understand any potential additional risks and survival disparities experienced by transgender men. This review focuses on barriers and clinical needs for transgender men in the gynecologic oncology setting, and suggestions for moving forward to improve care for this patient population.
Collapse
Affiliation(s)
- Ashley E Stenzel
- Program in Health Disparities Research, Department of Family Medicine & Community Health, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Kirsten B Moysich
- Department of Cancer Prevention & Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Cecile A Ferrando
- Center for Urogynecology & Pelvic Reconstructive Surgery, Center for LGBT Care, Subspecialty Care for Women's Health, Cleveland Clinic, Cleveland, OH, USA
| | - Kristen D Starbuck
- Department of Gynecologic Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| |
Collapse
|
41
|
Gordon JR, Baik SH, Schwartz KTG, Wells KJ. Comparing the Mental Health of Sexual Minority and Heterosexual Cancer Survivors: A Systematic Review. LGBT Health 2020. [PMID: 31314662 DOI: 10.1089/lgbt.2018.0204:10.1089/lgbt.2018.0204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
Purpose: Sexual minority (SM) individuals are more likely to experience mental health concerns than heterosexual individuals. However, little is known to date about the psychological needs of SM cancer survivors. The objective of this systematic review was to identify whether SM cancer survivors experience disparate psychological outcomes compared with heterosexual cancer survivors. Methods: PubMed/MEDLINE, PsycINFO, CINAHL, Web of Science, and ProQuest databases were searched systematically to identify studies that compared mental health outcomes between SM and heterosexual survivors. A standardized data extraction form was used to extract data from eligible articles. The Joanna Briggs Institute Checklist for Analytical Cross Sectional Studies was used to assess study quality. Results: Twelve studies met the inclusion criteria and assessed distress, depression, anxiety, perceived stress, and mental and emotional quality of life (QOL). Most studies enrolled survivors diagnosed either with female breast cancer or with prostate cancer. Most studies reporting on mental health among women found no differences between SM and heterosexual survivors. Studies conducted among men found that SM survivors experienced higher distress, depression, and anxiety, and lower emotional/mental QOL than heterosexual survivors. Conclusion: The findings of the present synthesis suggest that mental health disparities may exist among SM men diagnosed with cancer, particularly prostate cancer. More research is required to identify mental health disparities among SM survivors diagnosed with other cancers, as well as predisposing and protective factors. In addition, mental health screening and interventions are needed for SM men after cancer diagnosis.
Collapse
Affiliation(s)
- Janna R Gordon
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Sharon H Baik
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Karen T G Schwartz
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Kristen J Wells
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California.,Department of Psychology, San Diego State University, San Diego, California
| |
Collapse
|
42
|
Pampati S, Andrzejewski J, Sheremenko G, Johns M, Lesesne CA, Rasberry CN. School Climate Among Transgender High School Students: An Exploration of School Connectedness, Perceived Safety, Bullying, and Absenteeism. J Sch Nurs 2020; 36:293-303. [PMID: 32662358 PMCID: PMC8106508 DOI: 10.1177/1059840518818259] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
This study used self-administered survey data from seven high schools in Florida with a majority Black and/or Hispanic sample to examine transgender students' perceptions and experiences related to school climate in comparison to cisgender students. Using propensity score matching, a matched analytic sample was created of transgender and cisgender students (n = 542, including 186 transgender youth). Adjusted weighted logistic regression models indicated that transgender students were significantly more likely to report ever being bullied at school, being bullied in the past 3 months, and not going to school ≥3 days during the past 30 days. Transgender students were significantly less likely to report feeling safe at school and having positive perceptions of all five school connectedness items compared to cisgender students. Recent bullying experiences moderated the association between transgender status and past month absences. Findings can inform potential roles for school nurses in improving school climate for transgender youth.
Collapse
Affiliation(s)
| | | | | | - Michelle Johns
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Catherine N Rasberry
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
43
|
Martin CM, Greene D, Harrell JP, Mwendwa DT, Williams CD, Horton S, Cradle M, Hudson BD, Taylor TR. The impact of social constraints on insomnia among African-American breast cancer survivors: The mediating role of fear of recurrence. Psychooncology 2020; 29:1296-1302. [PMID: 32458549 DOI: 10.1002/pon.5435] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 04/25/2020] [Accepted: 05/05/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Insomnia is a significant concern among African-American breast cancer survivors (BCS). Social constraints (SC)-receiving unsupportive or critical responses when expressing trauma-related emotions-and fear of recurrence (FOR) have been associated with insomnia. We examined FOR as a mediator in the relationship between SC and insomnia in African-American BCS. We hypothesized a direct effect of SC on insomnia, and an indirect effect of SC on insomnia through FOR. METHODS Sixty-four African-American BCS completed a questionnaire assessing demographics, clinical characteristics, SC, FOR, and insomnia. Participants were an average of M = 8.41 (SD = 5.8) year survivors. The mediation was tested using PROCESS for SPSS. RESULTS The direct effect of SC on insomnia was significant (direct effect = .17, SE = .08, P = .04). Moreover, the indirect effect of SC on insomnia through FOR was significant (indirect effect = .19, SE = .10, 95% CI = .05, .41). CONCLUSIONS Experiencing SC from family and friends could produce cognitions that impact sleep for BCS, and FOR could be one of those cognitions. Family-based models of care that emphasize the emotional needs of survivors and families could be a relevant strategy to address the SC that impacts sleep.
Collapse
Affiliation(s)
- Chloé M Martin
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Danyella Greene
- Department of Psychology, Howard University, Washington, DC, USA.,College of Medicine, Howard University, Washington, DC, USA
| | - Jules P Harrell
- Department of Psychology, Howard University, Washington, DC, USA
| | | | | | - Sara Horton
- College of Medicine, Howard University, Washington, DC, USA
| | - Melanie Cradle
- Health Careers Opportunity Program, Howard University, Washington, DC, USA
| | - Briana D Hudson
- Health Careers Opportunity Program, Howard University, Washington, DC, USA
| | | |
Collapse
|
44
|
Perez GK, Salsman JM, Fladeboe K, Kirchhoff AC, Park ER, Rosenberg AR. Taboo Topics in Adolescent and Young Adult Oncology: Strategies for Managing Challenging but Important Conversations Central to Adolescent and Young Adult Cancer Survivorship. Am Soc Clin Oncol Educ Book 2020; 40:1-15. [PMID: 32324424 PMCID: PMC7328818 DOI: 10.1200/edbk_279787] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
Research on adolescents and young adults (AYAs) with cancer has flourished over the past decade, underscoring the unique medical and psychosocial needs of this vulnerable group. A cancer diagnosis during adolescence and young adulthood intersects with the developmental trajectory of AYAs, derailing critical physical, social, and emotional development. AYAs face these abrupt life changes needing age-appropriate information and resources to offset these challenges. Greater attention is needed to address AYA-specific concerns on reproductive and sexual health, financial security and independence, emotional well-being, social support, and end-of-life care. If these unique needs are unaddressed, this can adversely affect AYAs' health care engagement and overall quality of life, increasing their risk for cancer-related morbidity and early mortality. In particular, health care decisions made during treatment have important implications for AYA patients' future health. Oncology clinicians are well positioned to address AYA patients' concerns by anticipating and addressing the challenges this age group is likely to face. In this paper, we explore several core topics that affect AYAs' quality of life and that can be challenging to address. Starting from the moment of diagnosis, through cancer treatment and post-treatment survivorship, and into end of life, each section highlights critical developmental-centric life domains that are affected by the cancer experience. Specifically, we discuss resources, tools, and strategies to navigate these challenging conversations. Taking a risk-reduction approach that invites two-way communication and facilitates referral to age-appropriate resources would help destigmatize these experiences and, in turn, would support the provision of compassionate and effective age-concordant care to this vulnerable group.
Collapse
Affiliation(s)
- Giselle K. Perez
- Harvard Medical School/Massachusetts General Hospital, Boston, MA
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA
| | - John M. Salsman
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kaitlyn Fladeboe
- Seattle Children’s Research Institute, University of Washington, Seattle, WA
| | - Anne C. Kirchhoff
- Huntsman Cancer Institute and Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Elyse R. Park
- Harvard Medical School/Massachusetts General Hospital, Boston, MA
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA
| | - Abby R. Rosenberg
- Seattle Children’s Research Institute, University of Washington, Seattle, WA
| |
Collapse
|
45
|
Kent EE, Wheldon CW, Smith AW, Srinivasan S, Geiger AM. Care delivery, patient experiences, and health outcomes among sexual and gender minority patients with cancer and survivors: A scoping review. Cancer 2019; 125:4371-4379. [PMID: 31593319 DOI: 10.1002/cncr.32388] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 11/07/2022]
Abstract
Sexual and gender minorities (SGMs) face a disproportionate burden of cancer, yet little is known about the experiences and specific needs of these underserved populations in cancer care delivery. The authors conducted a scoping review to characterize the literature on cancer care delivery, health outcomes, and health care experiences for patients with cancer and survivors identifying as SGM. In total, 1176 peer-reviewed citations were identified after a systematic search of the PubMed/Medline, PsycInfo, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Web of Sciences databases without restriction on publication date. The details captured included study aims, design, population, cancer site, and main findings. Thirty-seven studies published from 1998 to 2017 met the study criteria. Most studies were conducted in the post-treatment survivorship phase of the continuum (n = 30), and breast cancer was the most common cancer site (n = 20). There were only 2 intervention studies. The studies reviewed were classified under the following areas of focus: 1) disclosure of sexual orientation and gender identity, 2) quality of care, 3) psychosocial impact of/ adjustment to cancer, 4) social support, 5) sexual functioning, and 6) health risks/health behavior. Very little research reported an assessment of gender minority status or included a focus on gender minorities (n = 7). This review revealed substantial research gaps given a lack of population-based data and small sample sizes, likely related to the absence of systematic collection of sexual orientation and gender identity information in the cancer care context. Deficient research in this area likely perpetuates health disparities. Further research is needed to identify and remove the barriers to delivering high-quality care to SGM individuals with cancer.
Collapse
Affiliation(s)
- Erin E Kent
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
- ICF, Inc, Fairfax, Virginia
| | - Christopher W Wheldon
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Ashley Wilder Smith
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Shobha Srinivasan
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Ann M Geiger
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| |
Collapse
|
46
|
Seay J, Hicks A, Markham MJ, Schlumbrecht M, Bowman‐Curci M, Woodard J, Duarte LF, Quinn GP, Schabath MB. Web‐based LGBT cultural competency training intervention for oncologists: Pilot study results. Cancer 2019; 126:112-120. [DOI: 10.1002/cncr.32491] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Julia Seay
- Sylvester Comprehensive Cancer Center Miami Florida
| | - Amanda Hicks
- University of Florida Health Cancer Center Gainesville Florida
| | | | | | | | | | - Luisa F. Duarte
- H. Lee Moffitt Cancer Center & Research Institute Tampa Florida
| | | | | |
Collapse
|
47
|
Gordon JR, Baik SH, Schwartz KTG, Wells KJ. Comparing the Mental Health of Sexual Minority and Heterosexual Cancer Survivors: A Systematic Review. LGBT Health 2019; 6:271-288. [PMID: 31314662 DOI: 10.1089/lgbt.2018.0204] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose: Sexual minority (SM) individuals are more likely to experience mental health concerns than heterosexual individuals. However, little is known to date about the psychological needs of SM cancer survivors. The objective of this systematic review was to identify whether SM cancer survivors experience disparate psychological outcomes compared with heterosexual cancer survivors. Methods: PubMed/MEDLINE, PsycINFO, CINAHL, Web of Science, and ProQuest databases were searched systematically to identify studies that compared mental health outcomes between SM and heterosexual survivors. A standardized data extraction form was used to extract data from eligible articles. The Joanna Briggs Institute Checklist for Analytical Cross Sectional Studies was used to assess study quality. Results: Twelve studies met the inclusion criteria and assessed distress, depression, anxiety, perceived stress, and mental and emotional quality of life (QOL). Most studies enrolled survivors diagnosed either with female breast cancer or with prostate cancer. Most studies reporting on mental health among women found no differences between SM and heterosexual survivors. Studies conducted among men found that SM survivors experienced higher distress, depression, and anxiety, and lower emotional/mental QOL than heterosexual survivors. Conclusion: The findings of the present synthesis suggest that mental health disparities may exist among SM men diagnosed with cancer, particularly prostate cancer. More research is required to identify mental health disparities among SM survivors diagnosed with other cancers, as well as predisposing and protective factors. In addition, mental health screening and interventions are needed for SM men after cancer diagnosis.
Collapse
Affiliation(s)
- Janna R Gordon
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Sharon H Baik
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Karen T G Schwartz
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Kristen J Wells
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
- Department of Psychology, San Diego State University, San Diego, California
| |
Collapse
|
48
|
Seay J, Hicks A, Markham MJ, Schlumbrecht M, Bowman M, Woodard J, Kollefrath A, Diego D, Quinn GP, Schabath MB. Developing a web-based LGBT cultural competency training for oncologists: The COLORS training. PATIENT EDUCATION AND COUNSELING 2019; 102:984-989. [PMID: 30642714 DOI: 10.1016/j.pec.2019.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/09/2018] [Accepted: 01/05/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Despite substantial LGBT cancer health disparities, there are no LGBT cultural competency trainings tailored for oncologists. Here we describe the systematic development of a web-based, oncology-focused LGBT cultural competency training. METHODS A literature review regarding LGBT cancer outcomes and competency training was conducted to identify potential training content. An expert panel meeting, including LGBT cancer survivors, cultural competency experts, oncologists, a web designer, and an instructional designer, was held to solidify the training content focus. Following the panel, the training was developed in collaboration with an instructional designer, a web designer, and LGBT community members. RESULTS The training modules include: 1) LGBT Basics; 2) Inclusive Environments; 3) Initiating Oncology Care with LGBT Patients; and 4) Issues in Cancer Survivorship among LGBT Patients. Module content is interactive, and models effective communication. CONCLUSION The process of collaboration with a diverse group of stakeholders and three cancer centers in Florida has resulted in a practical and efficient web-based resource for LGBT cultural competency training for oncologists. PRACTICE IMPLICATIONS Feedback from stakeholders indicates that training in this area is needed and will be well-received by oncologists. We are currently conducting an evaluation of this training among oncologists and LGBT community members.
Collapse
Affiliation(s)
- Julia Seay
- Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL 33136, United States.
| | - Amanda Hicks
- University of Florida Health Cancer Center, 2033 Mowry Rd, Gainesville, FL 32610, United States
| | - Merry Jennifer Markham
- University of Florida Health Cancer Center, 2033 Mowry Rd, Gainesville, FL 32610, United States
| | - Matthew Schlumbrecht
- Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL 33136, United States
| | - Meghan Bowman
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States
| | - Jennifer Woodard
- University of Florida Health Cancer Center, 2033 Mowry Rd, Gainesville, FL 32610, United States
| | - Austin Kollefrath
- Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL 33136, United States
| | - Daniela Diego
- Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL 33136, United States
| | - Gwendolyn P Quinn
- New York University School of Medicine, 550 First Ave, New York, NY 10016, United States
| | - Matthew B Schabath
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States
| |
Collapse
|
49
|
Scime S. Inequities in cancer care among transgender people: Recommendations for change. Can Oncol Nurs J 2019; 29:87-91. [PMID: 31148748 DOI: 10.5737/236880762928791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Owing to a shift in social attitudes and human rights standards, health inequities experienced by gender minorities are gaining an increasing spotlight globally. Transgender (trans) is an umbrella term used to describe individuals who have a dissimilar sex, gender identity and/or gender expression than what was designated at birth. Recently, studies have sought to identify health disparities and barriers to care among this population. While oncology-focused research remains limited, the social determinants of trans health elicits a significant impact on transgender people across the cancer continuum and, thus, requires further examination. The purpose of this paper is to explore the issue of trans health inequity in the context of Canadian cancer care highlighting current clinical practice, as well as gaps in research, provider education and health care policy. The paper will conclude with recommendations for policy development and a reflection on the oncology nurse's role in advocating for change.
Collapse
Affiliation(s)
- Samantha Scime
- St. Michael's Hospital, 282 Roxton Road, Toronto ON, M6G 3P9, 437-999-6017,
| |
Collapse
|
50
|
Scime S. Inégalités des soins aux personnes transgenres atteintes du cancer : Recommandations en faveur de changements. Can Oncol Nurs J 2019; 29:92-96. [PMID: 31148779 PMCID: PMC6516343 DOI: 10.5737/236880762929296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Avec l'évolution des attitudes sociales et des normes relatives aux droits de la personne, les inégalités que connaissent les minorités de genre en matière de santé attirent de plus en plus l'attention, partout dans le monde. L'appellation transgenre (ou trans) est un terme générique servant à décrire les individus qui adoptent un sexe, une identité ou une expression de genre différent de celui qui leur avait été attribué à la naissance. Récemment, des études ont cherché à identifier les disparités et les obstacles liés aux soins de santé chez cette population. La recherche en oncologie demeure limitée, et puisque les déterminants sociaux de la santé des personnes transgenres touchent assez fortement cette population tout au long du continuum du cancer, la question doit être approfondie. Cet article a pour but d'explorer la question des inégalités en santé vécues par les personnes transgenres dans le contexte de soins du cancer au Canada. Il traite de la pratique clinique actuelle, des lacunes en recherche, de l'éducation des fournisseurs et des politiques de soins de santé. L'article se termine sur des recommandations en faveur du développement des politiques et propose une réflexion sur le rôle de l'infirmière en oncologie dans la promotion du changement.
Collapse
|