1
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Arthur EK, Ridgway-Limle EA, Krok-Schoen JL, Boehmer U, Battle-Fisher M, Lee CN. Scoping review of experiences of sexual minority women treated for breast cancer. J Psychosoc Oncol 2024:1-24. [PMID: 38501984 DOI: 10.1080/07347332.2024.2323471] [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: 03/20/2024]
Abstract
PURPOSE To summarize and critique research on the experiences and outcomes of sexual minority women (SMW) treated with surgery for breast cancer through systematic literature review. METHODS A comprehensive literature search identified studies from the last 20 years addressing surgical experiences and outcomes of SMW breast cancer survivors. Authors performed a quality assessment and thematic content analysis to identify emergent themes. RESULTS The search yielded 121 records; eight qualitative studies were included in the final critical appraisal. Quality scores for included studies ranged 6-8 out of 10. Experiences and outcomes of SMW breast cancer survivors were organized by major themes: 1) Individual, 2) Interpersonal, 3) Healthcare System, and 4) Sociocultural and Discursive. CONCLUSIONS SMW breast cancer survivors have unique experiences of treatment access, decision-making, and quality of life in survivorship. SMW breast cancer survivors' personal values, preferences, and support network are critical considerations for researchers and clinicians.
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Affiliation(s)
- Elizabeth K Arthur
- Nursing Research, The James Comprehensive Cancer Center, The Ohio State Wexner Medical Center, Columbus, Ohio, USA
| | - Emily A Ridgway-Limle
- Nursing Research, The James Comprehensive Cancer Center, The Ohio State Wexner Medical Center, Columbus, Ohio, USA
| | - Jessica L Krok-Schoen
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Ulrike Boehmer
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Clara N Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Ohio State University, Columbus, Ohio, USA
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2
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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.
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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
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3
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Waters AR, Lyerly R, Scout NFN, Kent EE. The impact of employment loss on mentally unhealthy days among LGBTQ+ cancer survivors during the COVID-19 pandemic: Findings from the OUT National Survey. Psychooncology 2023; 32:1586-1597. [PMID: 37705150 PMCID: PMC10591952 DOI: 10.1002/pon.6210] [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: 03/30/2023] [Revised: 08/08/2023] [Accepted: 08/26/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE Lesbian, Gay, Bisexual, Transgender, Queer, and all other sexual and gender minority (LGBTQ+) populations made up 7.1% of the US population in 2021. LGBTQ+ cancer survivors face a variety of economic and mental health disparities; however, the determinants of poor mental health among LGBTQ+ cancer survivors are understudied. METHODS This analysis utilized the OUT National Survey which consists of N = 2233 LGBTQ+ cancer survivors (complete cases). Multivariable negative binomial and logit regression models were used to generate predicted values, predicted probabilities, and average marginal effects (AME) to assess the association between COVID-19 related employment loss and mentally unhealthy days (MUDs) and frequent mental distress among LGBTQ+ cancer survivors. Predicted values and marginal effects were generated with interaction terms (demographics interacted with employment loss) to explore the heterogeneity of the effect of employment loss among LGBTQ+ sub-populations. RESULTS In bivariate analyses employment loss was associated with a higher number of MUDs (10.3, SD = 9.9 vs. 8.4, SD = 9.6; p-value<0.001) and frequent mental distress (34% vs. 26%; p-value = 0.001). AME from a multivariable negative binomial model revealed that employment loss was associated with 1.42 more MUDs (95%CI: 0.33-2.86). Demographic factors such as some sexual orientations, cis-female and non-binary gender, younger age, and a current cancer diagnosis were also associated with significant expected increases in the number of MUDs. When assessing the heterogeneity of the effect of employment loss some sub-populations experienced changes in the number of MUDs that pushed them over the threshold of frequent mental distress while others did not. Furthermore, identifying with multiple sexual orientations (AME: 0.19, 95%CI: 0.11-0.27), cis-female and non-binary genders (AME: 0.07, 95%CI: 0.2-0.12; AME: 0.18, 95%CI: 0.07-0.28), American Indian and Alaska Native race (AME: 0.17, 95%CI: 0.03-0.31), and a current cancer diagnosis (AME: 0.14, 95%CI: 0.09-0.19) were associated with an increase in the probability of experiencing frequent mental distress. CONCLUSIONS COVID-19 related employment loss negatively impacted the mental health of LGBTQ+ cancer survivors. LGBTQ+ specific supportive services as well as equity-based employment and income interventions are needed.
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Affiliation(s)
- Austin R. Waters
- Department of Health Policy and Management, Gillings School
of Global Public Health, University of North Carolina Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North
Carolina Chapel Hill, NC, USA
| | - Reece Lyerly
- National LGBT Cancer Network, Providence, RI, USA
| | - NFN Scout
- National LGBT Cancer Network, Providence, RI, USA
| | - Erin E. Kent
- Department of Health Policy and Management, Gillings School
of Global Public Health, University of North Carolina Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North
Carolina Chapel Hill, NC, USA
- Cecil G. Sheps Health Services Research Center, University
of North Carolina Chapel Hill, NC, USA
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4
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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.
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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
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5
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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.
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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
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6
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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.
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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.
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Andersen BL, Lacchetti C, Ashing K, Berek JS, Berman BS, Bolte S, Dizon DS, Given B, Nekhlyudov L, Pirl W, Stanton AL, Rowland JH. Management of Anxiety and Depression in Adult Survivors of Cancer: ASCO Guideline Update. J Clin Oncol 2023:JCO2300293. [PMID: 37075262 DOI: 10.1200/jco.23.00293] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
PURPOSE To update the American Society of Clinical Oncology guideline on the management of anxiety and depression in adult cancer survivors. METHODS A multidisciplinary expert panel convened to update the guideline. A systematic review of evidence published from 2013-2021 was conducted. RESULTS The evidence base consisted of 17 systematic reviews ± meta analyses (nine for psychosocial interventions, four for physical exercise, three for mindfulness-based stress reduction [MBSR], and one for pharmacologic interventions), and an additional 44 randomized controlled trials. Psychological, educational, and psychosocial interventions led to improvements in depression and anxiety. Evidence for pharmacologic management of depression and anxiety in cancer survivors was inconsistent. The lack of inclusion of survivors from minoritized groups was noted and identified as an important consideration to provide high-quality care for ethnic minority populations. RECOMMENDATIONS It is recommended to use a stepped-care model, that is, provide the most effective and least resource-intensive intervention based on symptom severity. All oncology patients should be offered education regarding depression and anxiety. For patients with moderate symptoms of depression, clinicians should offer cognitive behavior therapy (CBT), behavioral activation (BA), MBSR, structured physical activity, or empirically supported psychosocial interventions. For patients with moderate symptoms of anxiety, clinicians should offer CBT, BA, structured physical activity, acceptance and commitment therapy, or psychosocial interventions. For patients with severe symptoms of depression or anxiety, clinicians should offer cognitive therapy, BA, CBT, MBSR, or interpersonal therapy. Treating clinicians may offer a pharmacologic regimen for depression or anxiety for patients who do not have access to first-line treatment, prefer pharmacotherapy, have previously responded well to pharmacotherapy, or have not improved following first-line psychological or behavioral management.Additional information is available at www.asco.org/survivorship-guidelines.
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Affiliation(s)
| | | | | | | | | | - Sage Bolte
- Inova Health Foundation, Falls Church, VA
| | - Don S Dizon
- Legorreta Cancer Center at Brown University and Lifespan Cancer Institute, Providence, RI
| | | | - Larissa Nekhlyudov
- Brigham and Women's Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
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Raque TL, Ross KV, Hangge AR, Gaines RC. A Meta-Ethnography on the Impact of Cancer for Lesbian and Queer Women and Their Partners. QUALITATIVE HEALTH RESEARCH 2023; 33:371-387. [PMID: 36802915 DOI: 10.1177/10497323231155403] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Lesbian and queer women face unique experiences navigating cancer care, including challenges in accessing services that incorporate their relational supports. Given the importance of social support for survivorship, this study examines the impact of cancer on lesbian/queer women in romantic relationships. We conducted the seven stages of Noblit and Hare's meta-ethnography. PubMed/MEDLINE, PsycINFO, SocINDEX, and Social Sciences Abstract databases were searched. Two hundred and ninety citations were initially identified, 179 abstracts were reviewed, and 20 articles were coded. Themes were (a) intersectionality of lesbian/queer identity in the cancer context; (b) institutional and systemic supports and barriers; (c) navigation of disclosure; (d) characteristics of affirmative cancer care; (e) survivors' critical reliance on their partner(s); and (f) shifts in connection after cancer. Findings indicate the importance of accounting for intrapersonal, interpersonal, institutional, and socio-cultural-political factors for understanding the impact of cancer for lesbian and queer women and their romantic partners. Affirmative cancer care for sexual minorities fully validates and integrates partners in care, removes heteronormative assumptions in services provided, and offers LGB+ patient and partner support services.
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Affiliation(s)
- Trisha L Raque
- Department of Counseling Psychology, University of Denver, Denver, CO, USA
| | - Kaitlin V Ross
- Department of Counseling Psychology, University of Denver, Denver, CO, USA
| | - Anna R Hangge
- Department of Counseling Psychology, University of Denver, Denver, CO, USA
| | - Rebecca C Gaines
- Department of Counseling Psychology, University of Denver, Denver, CO, USA
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9
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Conant KJ, Huynh HN, Chan J, Le J, Yee MJ, Anderson DJ, Kaye AD, Miller BC, Drinkard JD, Cornett EM, Gomelsky A, Urits I. Racial Disparities and Mental Health Effects Within Prostate Cancer. Health Psychol Res 2022; 10:39654. [PMID: 36425236 PMCID: PMC9680850 DOI: 10.52965/001c.39654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Disparities in prostate cancer (PCa) exist at all stages: screening, diagnosis, treatment, outcomes, and mortality. Although there are a multitude of complex biological (e.g., genetics, age at diagnosis, PSA levels, Gleason score) and nonbiological (e.g., socioeconomic status, education level, health literacy) factors that contribute to PCa disparities, nonbiological factors may play a more significant role. One understudied aspect influencing PCa patients is mental health related to the quality of life. Overall, PCa patients report poorer mental health than non-PCa patients and have a higher incidence of depression and anxiety. Racial disparities in mental health, specifically in PCa patients, and how poor mental health impacts overall PCa outcomes require further study.
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Affiliation(s)
- Kaylynn J Conant
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences
| | - Hanh N Huynh
- College of Osteopathic Medicine, Pacific Northwest University of Health Science
| | - Jolene Chan
- College of Osteopathic Medicine, Pacific Northwest University of Health Science
| | - John Le
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences
| | - Matthew J Yee
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco
| | | | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health
| | | | | | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Health
| | | | - Ivan Urits
- Department of Anesthesiology, Louisiana State University Health
- Southcoast Health, Southcoast Health Pain Management
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10
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Boehmer U, Clark MA, Winter M, Berklein F, Ozonoff A. Sexual minority-specific experiences of colorectal cancer survivors. Health Psychol 2022; 41:884-892. [PMID: 36074595 PMCID: PMC10367941 DOI: 10.1037/hea0001229] [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] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine how sexual minority-specific factors relate to colorectal cancer survivors' health-related quality of life, psychological adjustment, and quality of care. METHOD One hundred twenty-seven sexual minority survivors diagnosed with stage I, II, or III colorectal cancer were recruited from four cancer registries. An average of 3 years after diagnosis, eligible survivors participated in a telephone survey, which measured survivors' outcomes, consisting of physical and mental quality of life, anxiety, depression, self-rated fair or poor health, and quality of care. We considered sexual minority-specific factors (e.g., outness, discrimination) as correlates for each survivorship outcome using forward selection with generalized linear or logistic regression models. RESULTS After adjusting for confounders, accumulation of lifetime discrimination experiences had negative associations with survivors' physical and mental quality of life, anxiety, and depression. Sexual minority-specific discrimination experiences were negatively associated with perceived quality of care after adjusting for confounders. Sexual minority survivors' self-rated fair or poor health and their rating of care as excellent were independent of sexual minority-specific factors. CONCLUSION Addressing and counteracting sexual minority-specific and other lifetime discrimination experiences may be a pathway to improving sexual minority cancer survivors' quality of care, quality of life, and psychological adjustment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Ulrike Boehmer
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
| | - Melissa A Clark
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Michael Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA
| | - Flora Berklein
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA
| | - Al Ozonoff
- Harvard Medical School, Boston, MA
- Boston Children’s Hospital, Boston, MA
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11
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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.
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12
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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: 0] [Impact Index Per Article: 0] [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.
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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
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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.
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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
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14
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Lombardo J, Ko K, Shimada A, Nelson N, Wright C, Chen J, Maity A, Ruggiero ML, Richard S, Papanagnou D, Mitchell E, Leader A, Simone NL. Perceptions of and barriers to cancer screening by the sexual and gender minority community: a glimpse into the health care disparity. Cancer Causes Control 2022; 33:559-582. [PMID: 34984592 PMCID: PMC9076188 DOI: 10.1007/s10552-021-01549-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE A disparity exists in cancer screening rates for the Sexual and Gender Minority (SGM) community. We sought to understand the perceptions and baseline knowledge of cancer screening among SGM community members. METHODS Survey administered via social media from June 2018 to October 2018. We asked 31 questions focused on cancer screening, human papillomavirus, emotional distress, and experience with the health care system. Those included were 18 years or older. Cancer screening attitudes and knowledge, as well as perceptions of the health care system were investigated. RESULTS There were 422 respondents analyzed: 24.6% identified as female, 25.5% as male, 40.1% transgender, and 9.6% as other. 65.4% of the SGM community is not certain what cancer screening to do for themselves. Only 27.3% and 55.7% knew that HPV was a risk factor associated with head and neck cancer and anal cancer, respectively. Half stated their emotional distress prevents them from getting cancer screening. It was identified that process changes in making appointments, comforts during the visit, and formal training for physicians and nurses could increase cancer screening compliance for this community. The transgender population had a trend in more gaps in knowledge of appropriate cancer screening and significant excess emotional distress. CONCLUSION Gaps in cancer screening knowledge and emotional and financial distress may be responsible for the disparity of lower cancer screening rates for the SGM population and the transgender population may be most at risk. Appreciating the cancer screening concerns of the SGM population can help shape future clinical and institutional approaches to improve health care delivery.
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Affiliation(s)
- Joseph Lombardo
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Kevin Ko
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Ayako Shimada
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Nicolas Nelson
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher Wright
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jerry Chen
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Alisha Maity
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Marissa L Ruggiero
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Scott Richard
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Dimitrios Papanagnou
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Edith Mitchell
- Department of Medical Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Amy Leader
- Department of Medical Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Nicole L Simone
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
- Department of Radiation Oncology, Bodine Center for Cancer Treatment, Thomas Jefferson University, 111 S. 11th Street, Philadelphia, PA, 19107, USA.
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15
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Boehmer U, Jesdale BM, Streed CG, Agénor M. Intersectionality and cancer survivorship: Sexual orientation and racial/ethnic differences in physical and mental health outcomes among female and male cancer survivors. Cancer 2022; 128:284-291. [PMID: 34499367 PMCID: PMC8738152 DOI: 10.1002/cncr.33915] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Because of concerns about sexual minorities' poor cancer survivorship, this study compared cancer survivors' health outcomes in relation to multiple intersecting social positions, namely gender, sexual orientation, and race/ethnicity. METHODS This secondary data analysis used 2014-2019 Behavior Risk Factor Surveillance Survey data. The survey respondents consisted of 40,482 heterosexual and sexual minority men and 69,302 heterosexual and sexual minority women who identified as White, Black, or Hispanic. Logistic regression models compared White, Black, and Hispanic male and female cancer survivors' health status, depression, and health-related quality of life by sexual orientation. Models were adjusted for sociodemographic characteristics and access to care. RESULTS Mental health findings showed consistency, with sexual minority male and female cancer survivors having 2 to 3 times greater odds of depression and/or poor mental health among White, Black, and Hispanic survivors. Among White women, sexual minorities reported greater odds of fair or poor health, poor physical health, and poor activity days, whereas White sexual minority men showed similar odds in comparison with their heterosexual counterparts. Among Black and Hispanic sexual minority men and women, differences in the odds of fair or poor health, poor physical health, and poor activity days in comparison with their heterosexual counterparts were mostly explained by sociodemographic and access-to-care factors. CONCLUSIONS Physical and mental health outcomes vary in relation to sexual orientation and race/ethnicity among both female and male cancer survivors. Clinicians, researchers, and health care administrators must better understand and address the unique needs of cancer survivors in relation to multiple axes of social inequality to advance cancer equity.
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Affiliation(s)
- Ulrike Boehmer
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Bill M. Jesdale
- Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Carl G. Streed
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts;,Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, Massachusetts
| | - Madina Agénor
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island;,Fenway Institute, Fenway Health, Boston, Massachusetts
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16
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Boehmer U, Ozonoff A, Winter M, Berklein F, Potter J, Ceballos RM, Clark MA. Anxiety and depression in colorectal cancer survivors: Are there differences by sexual orientation? Psychooncology 2021; 31:521-531. [PMID: 34672050 DOI: 10.1002/pon.5837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine sexual minority compared to heterosexual survivors' health-related anxiety, anxiety, and depression. METHODS Four hundred and eighty eligible survivors participated in a telephone survey, which measured their anxiety and depression. These survivors were diagnosed with stage I, II, or III colorectal cancer an average of three years prior to the survey and were recruited from four cancer registries. As explanatory factors, we considered individual, social and contextual characteristics, prior psychological factors, psychological responses to cancer, and characteristics of cancer and its treatments. Using forward selection with generalized linear models or logistic regression models, we identified significant correlates for each outcome. RESULTS Prior to adjusting for covariates, depression was similar for all survivors, while sexual minority survivors had worse health-related anxiety and anxiety compared to heterosexual survivors. After adjustment, these differences were no longer statistically significant. Individual, social and contextual characteristics, characteristics of cancer, and psychological responses to cancer explained 44% of the variance in anxiety and 60% of the variance in depression. CONCLUSION There are modifiable factors associated with health-related and generalized anxiety as well as depression that can be changed to improve cancer survivorship among diverse survivors.
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Affiliation(s)
- Ulrike Boehmer
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Al Ozonoff
- Harvard Medical School, Boston, Massachusetts, USA.,Boston Children's Hospital, Boston, Massachusetts, USA
| | - Michael Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Flora Berklein
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jennifer Potter
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,The Fenway Institute, Boston, Massachusetts, USA
| | - Rachel M Ceballos
- Division of Public Health Sciences, Fred Hutch Cancer Research Center, Seattle, Washington, USA
| | - Melissa A Clark
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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17
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Thompson T, Ketcher D, Gray TF, Kent EE. The Dyadic Cancer Outcomes Framework: A general framework of the effects of cancer on patients and informal caregivers. Soc Sci Med 2021; 287:114357. [PMID: 34500320 DOI: 10.1016/j.socscimed.2021.114357] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 01/22/2023]
Abstract
It is widely acknowledged that cancer affects not only patients but also their friends and family members who provide informal, and typically unpaid, care. Given the dual impact that cancer often has on patients and their informal caregivers (i.e., family members, partners, or friends), an expanded dyadic framework that encompasses a range of health and psychosocial outcomes and includes primary caregivers with a range of relationships to the patients is critically needed. Moreover, an emphasis on the role of social and contextual factors may help the framework resonate with a broader range of patient-caregiver relationships and allow for the development of more effective dyadic interventions. This article describes the development of the Dyadic Cancer Outcomes Framework, which was created to guide future research and intervention development. Using an iterative process, we conducted a conceptual review of currently used dyadic and/or caregiving models and frameworks and developed our own novel dyadic framework. Our novel Dyadic Cancer Outcomes Framework highlights individual- and dyad-level predictors and outcomes, as well as incorporating the disease trajectory and the social context. This framework can be used in conjunction with statistical approaches including the Actor Partner Interdependence Model to evaluate outcomes for different kinds of partner-caregiver dyads. This flexible framework can be used to guide intervention development and evaluation for cancer patients and their primary caregivers, with the ultimate goal of improving health, psychosocial, and relationship outcomes for both patients and caregivers. Future research will provide valuable information about the framework's effectiveness for this purpose.
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Affiliation(s)
- Tess Thompson
- Washington University in St. Louis, Brown School of Social Work, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
| | - Dana Ketcher
- Moffitt Cancer Center, Department of Health Outcomes and Behavior, Tampa, FL, USA
| | - Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Institute, Boston, MA, USA; Phyllis F. Cantor Center for Research in Nursing & Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, USA
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18
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Boehmer U, Ozonoff A, Winter M, Berklein F, Potter J, Hartshorn KL, Ward KC, Ceballos RM, Clark MA. Health-related quality of life among colorectal cancer survivors of diverse sexual orientations. Cancer 2021; 127:3847-3855. [PMID: 34237147 DOI: 10.1002/cncr.33762] [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: 03/02/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The purpose of this study was to examine the health-related quality of life of sexual minority survivors in comparison with heterosexual survivors. METHODS Four hundred eighty eligible survivors participated in a telephone survey that measured survivors' outcomes, which consisted of physical and mental quality of life and self-rated fair or poor health. These survivors were diagnosed with stage I, II, or III colorectal cancer an average of 3 years before the survey and were recruited from 4 cancer registries. Using forward selection with generalized linear models or logistic regression models, the authors considered 4 domains-personal factors, environmental factors, health condition characteristics, and body function and structure-as correlates for each survivorship outcome. RESULTS The authors found that unadjusted physical quality of life and self-rated fair/poor health were similar for all survivors. Sexual minority survivors had poorer unadjusted mental quality of life in comparison with heterosexual survivors. After adjustments for covariates, this difference was no longer statistically significant. Three domains (personal factors, health condition characteristics, and body function and structure) explained colorectal cancer survivors' fair/poor health and 46% of the variance in physical quality of life, whereas 56% of the variance in mental quality of life was explained by personal factors, body function and structure, and environmental factors. CONCLUSIONS This study has identified modifiable factors that can be used to improve cancer survivors' quality of life and are, therefore, relevant to ongoing efforts to improve the survivorship experience.
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Affiliation(s)
- Ulrike Boehmer
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Al Ozonoff
- Harvard Medical School, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts
| | - Michael Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Flora Berklein
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Jennifer Potter
- Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Fenway Institute, Boston, Massachusetts
| | - Kevan L Hartshorn
- Section of Hematology Oncology, Boston University School of Medicine, Boston, Massachusetts
| | - Kevin C Ward
- Department of Epidemiology, Emory University, Atlanta, Georgia
| | - Rachel M Ceballos
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Melissa A Clark
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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Schefter A, Thomaier L, Jewett P, Brown K, Stenzel AE, Blaes A, Teoh D, Vogel RI. Cross-sectional study of psychosocial well-being among lesbian, gay, bisexual, and heterosexual gynecologic cancer survivors. Cancer Rep (Hoboken) 2021; 5:e1461. [PMID: 34057316 PMCID: PMC8842686 DOI: 10.1002/cnr2.1461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background Delays in care and increased risk for mental health diagnoses put individuals identifying as a sexual minority with cancer at risk for decreased quality of life. Aim To assess psychosocial health among sexual minority gynecologic cancer survivors, we compared self‐reported quality of life and psychosocial measures between individuals diagnosed with gynecologic cancers identifying as lesbian/gay/bisexual (LGB) and heterosexual. Methods and Results English‐speaking adults with gynecologic cancers were invited to participate in an ongoing cohort survey study. Quality of life and psychosocial measures included the Functional Assessment of Cancer Therapy‐General, Distress Thermometer (distress), Patient Health Questionnaire‐8 (depression), General Anxiety Disorder‐7 (anxiety), and Post‐traumatic Stress Disorder Checklist for DSM‐5 (post‐traumatic stress disorder; PTSD). Measures were compared by self‐reported sexual orientation (heterosexual vs. LGB) using descriptive statistics (frequencies and means) and linear and logistic regression models, adjusting for college education. Of 814 patients invited, 457 enrolled (56.1%) and 401 (92.6%) completed the survey and provided information on their sexuality. All but one self‐identified as cisgender women and 22 (5.5%) as LGB. LGB participants were more likely to have completed college (68.2% vs. 40.1%, p = .009) but were otherwise similar across demographic and clinical characteristics. Quality of life and distress scores were similar between groups. LGB participants, compared to heterosexual, reported higher rates of depression (31.8% vs. 10.6%, adjusted odds ratio [OR] = 4.1 [95% confidence interval [CI]: 1.6–11.0], p = .004), anxiety (25.0% vs. 7.1%, adjusted OR = 5.4 [95% CI: 1.7–16.7], p= .004), and PTSD (13.6% vs. 3.5%, adjusted OR = 4.2 [95% CI: 1.1–16.3], p = .04). Conclusion LGB participants reported poorer emotional health following a gynecologic cancer diagnosis than heterosexual participants. Our data suggest this population may need additional resources and support during and after their cancer diagnosis. Future work is needed to identify additional risk factors and the underlying sources of these disparities in order to improve patient care and wellness in this population.
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Affiliation(s)
- Alexandra Schefter
- Department of Obstetrics, Division of Gynecologic Oncology, Gynecology and Women's Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lauren Thomaier
- Department of Obstetrics, Division of Gynecologic Oncology, Gynecology and Women's Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Patricia Jewett
- Department of Medicine, Division of Hematology and Oncology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Katherine Brown
- Department of Obstetrics, Division of Gynecologic Oncology, Gynecology and Women's Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ashley E Stenzel
- Program in Health Disparities Research, Department of Family Medicine & Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Anne Blaes
- Department of Medicine, Division of Hematology and Oncology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Deanna Teoh
- Department of Obstetrics, Division of Gynecologic Oncology, Gynecology and Women's Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rachel I Vogel
- Department of Obstetrics, Division of Gynecologic Oncology, Gynecology and Women's Health, University of Minnesota, Minneapolis, Minnesota, USA
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20
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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.
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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
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21
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Thompson T, Heiden-Rootes K, Joseph M, Gilmore LA, Johnson L, Proulx CM, Albright EL, Brown M, McElroy JA. The support that partners or caregivers provide sexual minority women who have cancer: A systematic review. Soc Sci Med 2020; 261:113214. [PMID: 32738634 DOI: 10.1016/j.socscimed.2020.113214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/22/2020] [Accepted: 07/10/2020] [Indexed: 12/31/2022]
Abstract
RATIONALE Intimate partners and other informal caregivers provide unpaid tangible, emotional, and decision-making support for patients with cancer, but relatively little research has investigated the cancer experiences of sexual minority women (SMW) with cancer and their partners/caregivers. OBJECTIVE This review addressed 4 central questions: 1) What social support do SMW with cancer receive from partners/caregivers? 2) What effect does cancer have on intimate partnerships or caregiving relationships of SMW with cancer? 3) What effects does cancer have on partners/caregivers of SMW with cancer? 4) What interventions exist to support partners/caregivers of SMW or to strengthen the patient-caregiver relationship? METHOD This systematic review, conducted in 2018 and updated in 2020, was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent coders screened abstracts and articles. RESULTS In total, 550 unique records were screened; 42 articles were assessed for eligibility, and 18 were included in a qualitative synthesis. Most studies were U.S.-based, involved breast cancer, included intimate partners, had primarily white/Caucasian samples, and were cross-sectional. Sexual minority female participants reported that partners/caregivers often provide important social support, including emotional support, decision-making support, and tangible support. Effects of cancer on relationships with partners/caregivers were mixed, with some studies finding relationships remained stable and others finding cancer either increased closeness or disrupted relationships. Participants reported partners/caregivers often experience distress and may experience discrimination, discomfort disclosing sexual orientation, and a lack of sexual minority-friendly services. No studies involved an intervention targeting partners/caregivers or the dyadic relationship. CONCLUSIONS More work is needed to understand SMW with cancers other than breast cancer, and future work should include more racially, ethnically, and economically diverse samples. Longitudinal research will allow an examination of patterns of mutual influence and change in relationships. These steps will enable the development of interventions to support SMW with cancer and people close to them.
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22
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Desai MJ, Gold RS, Jones CK, Din H, Dietz AC, Shliakhtsitsava K, Martinez ME, Vaida F, Su HCI. Mental Health Outcomes in Adolescent and Young Adult Female Cancer Survivors of a Sexual Minority. J Adolesc Young Adult Oncol 2020; 10:148-155. [PMID: 32730111 DOI: 10.1089/jayao.2020.0082] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: Sexual minority (SM) individuals experience higher rates of anxiety and depression. Previous research on mental health disparities for SM cancer survivors has largely focused on adult survivors; however, studies are limited in the adolescent and young adult (AYA) population. This study's objective is to compare depression and anxiety symptoms between AYA, female cancer survivors who identify as an SM and those who identify as heterosexual. Methods: A cross-sectional analysis of 1025 AYA survivors aged 18-40 years (2015-2017) was performed. Patients self-reported SM identification and depression and anxiety symptoms, as measured by the Patient Health Questionnaire (PHQ8) and Generalized Anxiety Disorder Scale (GAD7), respectively. Multivariable logistic regression tested associations between SM identification and depression and anxiety. Results: Sixty-four participants (6%) identified as an SM. In adjusted analyses, SM participants had 1.88 higher odds of anxiety (odds ratio [OR] 1.88, confidence interval [95% CI] 1.05-3.35, p = 0.033) compared with heterosexual participants. SM participants did not have significantly higher odds of depression (OR 1.36, CI 0.75-2.47, p = 0.31). More social support was significantly associated with lower odds of depression (OR 0.91, CI 0.89-0.93, p < 0.001) and anxiety (OR 0.93, CI 0.91-0.94, p < 0.001). Conclusions: AYA cancer survivors identifying as an SM had nearly twice the odds of anxiety, with social support that is protective for both anxiety and depression. While mental health screening is recommended throughout the cancer care continuum, these data support the need for reliable screening, clinician awareness of increased vulnerability in the AYA, SM survivor population, and clinician training on culturally competent care and generation of evidence-based interventions.
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Affiliation(s)
- Milli J Desai
- School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Rebecca S Gold
- School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Chelsea K Jones
- School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Hena Din
- Department of Health Behavior, San Diego State University/University of California, San Diego, La Jolla, California, USA
| | - Andrew C Dietz
- Moores Cancer Center, University of California, San Diego, La Jolla, California, USA
| | - Ksenya Shliakhtsitsava
- Department of Pediatric Hematology/Oncology, University of Texas Southwestern, Dallas, Texas, USA
| | - Maria Elena Martinez
- Department of Family Medicine and Public Health and Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Florin Vaida
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, USA
| | - Hui-Chun Irene Su
- Department of Obstetrics, Gynecology, & Reproductive Science and Moores Cancer Center, University of California, San Diego, La Jolla, California, USA
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