Targeting cancer prevention and screening interventions to LGBTQ communities: A scoping review

Suicidal thoughts and behaviors among gender and sexual minorities: Adults ages 25-44 show highest rates of past month suicidal thoughts

INTRODUCTION

Sexual and gender minority (SGM) people are at increased risk for suicidal thoughts and behaviors relative to their cisgender heterosexual peers. However, most research in this area has focused on youth, limiting our understanding of suicide risk among SGM adults.

METHODS

To address this gap in the literature, the present study examined suicidal thoughts and behaviors among SGM adults across different age groups using a sample of 10,620 US adults.

RESULTS

Consistent with the literature on youth, SGM adults showed higher rates of suicidal thoughts and behaviors than cisgender heterosexual adults. When examining prevalence rates across various age groups, young adults (18-25) showed greater suicidal thoughts and behaviors relative to adults ages 45+. However, adults ages 25-44 actually showed the highest rate of past month suicidal thoughts compared to adults ages 18-25.

CONCLUSION

These findings suggest that suicide risk for SGM extends beyond youth and highlights the need for more research on middle-age SGM adults. Additional resources for SGM adults that are not only tailored toward youth and young adults are warranted.

Improving cervical screening rates among sexual minorities: Insights from Aotearoa New Zealand

ISSUE ADDRESSED

Sexual minority women (SMW) experience inequities in health outcomes. The extant literature consistently suggests that SMW are much less likely than their heterosexual peers to engage in cervical screening. Using participant's voices, the focus of this study was to explore the ways in which cervical screening rates for SMW might be improved.

METHODS

An online survey was completed by SMW (N = 177) aged 25-69 based in Aotearoa New Zealand and representing a range of sexual identities, ethnicities, and geographical regions. The analysis presented here was derived from open-ended qualitative responses to a single survey item: What do you think could be done to encourage more SMW (lesbians, wahine takatāpui, bisexual women, etc.) to engage in smear testing?

RESULTS

Analysis of the data generated three main themes around how public health services could encourage more SMW to engage in cervical screening: Inclusive health services, clarity of information, and targeted health promotion.

CONCLUSION

The analysis showed that the inherent heteronormativity among health care professionals and the lack of clear and consistent information specific to SMW may be key factors contributing to lower rates of engagement in screening. SO WHAT?: Given that not engaging in screening is the main risk factor for cervical cancer, it is imperative that active consideration is given to these issues with a view to increasing participation rates among SMW.

A Content Analysis of Cancer-Related Changes in Perceptions of Self, Relationships, and Health Among LGBTQI+ Cancer Survivors Across the Life Course: Findings From OUT: The National Cancer Survey

BACKGROUND

The LGBTQI+ population makes up at least 7.6% of the US population. LGBTQI+ populations are at increased risk of experiencing LGBTQI+-related discrimination and cis-heteronormativity in healthcare leading to poorer health outcomes throughout the cancer care continuum. We aimed to explore LGBTQI+ cancer survivors' perspectives of how cancer has changed their perceptions of self and relationships using data from OUT: The National Cancer Survey.

METHODS

We conducted an inductive qualitative content analysis of responses to four open-ended questions from OUT: The National Cancer Survey. Data were collected from September 2020 to April 2021. Eligible participants were 18 years of age or older at time of survey, had been previously diagnosed with cancer, identified as LGBTQI+, and currently lived in the US. Open-ended survey questions asked about the impact of cancer on LGBTQI+ cancer survivors' perceptions of self and relationships. To maximize inter-rater reliability, 20% of the survey responses were double coded. Chi-squared tests assessed differences in changes across the life-course.

RESULTS

Of the participants in the OUT survey (N = 2382), 86.9% (N = 2069) provided responses to at least one of the four open-ended questions. The content analysis sample participants were primarily aged 40-59 (39.3%) and 60-79 (49.4%), gay (54.7%), cisgender men (59.4), White (89.7%), and not on active treatment (77.4%). A total of 5179 codes were applied to the 2069 responses. A total of 5 overarching categories and 18 sub-categories were identified. Themes included: (1) changes in perceptions of self; (2) changes to relationships; (3) changes to health and (4) LGBTQI+ specific unmet needs. The most commonly reported categories were changes in perceptions of self (77%, n = 1593) and changes to health (47%, n = 972). Most cancer-related changes were more frequently reported by young adult survivors.

CONCLUSIONS

This content analysis illuminates the unique challenges that the LGBTQI+ population faces while navigating through the cancer care continuum.

Suicidal thoughts and behaviors among gender and sexual minorities: Adults ages 18-24 show highest rates of past month suicidal thoughts

INTRODUCTION

Sexual and gender minority (SGM) people are at increased risk for suicidal thoughts and behaviors relative to their cisgender heterosexual peers. However, most research in this area has focused on youth, limiting our understanding of suicide risk among SGM adults.

METHODS

To address this gap in the literature, the present study examined suicidal thoughts and behaviors among SGM adults across different age groups using a sample of 10,620 US adults.

RESULTS

Consistent with the literature on youth, SGM adults showed higher rates of suicidal thoughts and behaviors than cisgender heterosexual adults. When examining prevalence rates across various age groups, young adults (18-24) showed greater lifetime and past month suicidal thoughts and behaviors relative to adults ages 45+. Adults ages 18-24 also showed greater past month suicidal ideation than adults ages 25-44; however, there were no group differences in lifetime suicidal thoughts and behaviors and past month suicidal behavior between adults ages 18-24 and 25-44.

CONCLUSIONS

Although suicidal thoughts and behaviors are most common among young SGM adults, other age groups do still show concerning rates of suicidal thoughts and behaviors, suggesting that this risk might extend to later years of life. Additional resources for SGM adults that are not only tailored toward youth and young adults are warranted.

Inclusive language in health policy - a timely case (study) of cervical screening in Australia

Language is important in health policy development. Policy changes in Australia to increase cervical screening offers a timely case example to explore the function of inclusive language in health policy. Gender and sexuality diverse people with a cervix have been largely invisible within health promotion programs, which has led to reduced awareness of, and access to, cervical screening. Twenty-eight semi-structured interviews were conducted with 29 key informants between April and October 2022 about the role of inclusive language in cervical screening policy, promotion, and delivery in the context of a national program to promote cervical screening. Three themes were identified from what key informants believed to be the role of inclusive language: (1) the common goal of inclusive language as policy advocacy for broader inclusivity; (2) the inevitable partiality of inclusive language in policy as an opportunity to start conversation; and (3) policy as a bridge between essential but diffuse components of the health sector with multidirectional influences. Inclusive language was seen to operationalise equity in health policy within the broader aim of eliminating cervical cancer among under-screened populations.

"Sorry, no results found": evaluating LGBTQIA + inclusivity of U.S. cancer centers' websites

PURPOSE

Cancer care for lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexuality and gender diverse (LGBTQIA +) individuals is marked by disparities stemming from a history of discrimination, stigma, and systemic inequities. For LGBTQIA + individuals seeking cancer care, cancer center websites may be a first point of contact with healthcare. Two complementary studies sought to evaluate the LGBTQIA + inclusivity of cancer centers' websites.

METHODS

The authors conducted two studies in 2022-2023, reviewing the websites of National Cancer Institute (NCI)-designated cancer centers and Children's Oncology Group (COG)-designated health systems and cancer centers. Reviewers manually searched websites and coded several Yes/No criteria for LGBTQIA + inclusivity.

RESULTS

Among the 65 NCI cancer centers' websites in 2023, 66% included a nondiscrimination statement, 71% mentioned LGBTQIA + health disparities, 65% included LGBTQIA + tailored resources, and 66% had articles about LGBTQIA + health. There was a trend of increased inclusivity across categories from 2022 to 2023. Among the 204 COG-designated health system websites in 2023, there were 60 pediatric care websites and 144 lifespan care websites. A total of 79.9% of COG health system websites referenced LGBTQIA + patients (80.0% of pediatric and 79.9% of lifespan sites), 16.7% of COG cancer center websites referenced LGBTQIA + patients in the context of cancer care (6.7% of pediatric and 20.8% of lifespan sites), and 82.4% yielded results when search terms were input (83.3% of pediatric and 81.9% of lifespan sites).

CONCLUSIONS

Adult and pediatric cancer centers' websites have varying levels of LGBTQIA + inclusivity based on nondiscrimination statements, articles, and the availability of LGBTQIA + resources. While there have been some improvements in inclusivity on the NCI-designated cancer centers' websites between 2022 and 2023, there is a need for further improvement.

Come for the Tobacco, Stay for the Flavor: Flavored Cigarillo-Use Trajectories Among Young Adult Sexual Gender Minority Women

INTRODUCTION

The purpose of this research was to identify how young adult sexual gender minority (SGM) women who use cigarillos may respond to cigar flavor restrictions.

AIMS AND METHODS

Young adults aged 21-28 years in the United States who currently use cigarillos were recruited between October 2020 and April 2021 to participate in an online survey. Due to high prevalence of cigarillo use among individuals who identify as sexual and/or gender minority (SGM) women, their (n = 192) flavored tobacco-use behaviors and anticipated responses to cigarillo flavor restrictions were compared to cisgender heterosexual (CisHet) women (n = 110). Logistic regression was used to model cigarillo cessation and product-switching behaviors (flavored and unflavored).

RESULTS

SGM women were significantly less likely to report the use of flavor at the initiation of cigarillo use (61.7% vs. 86.1%) but were no different in current flavor use compared to CisHet women, with more than 80% of all women using any flavor. SGM women were 2.36 times as likely to say they would discontinue using cigarillos if flavors were unavailable. Among those who would continue using cigarillos, SGM women were 4.53 times as likely to endorse switching to an unflavored tobacco product but had the same likelihood of saying they would switch to flavored product compared to CisHet women.

CONCLUSIONS

Flavor restriction policies may not reduce the initiation of cigarillos among SGM women and may elicit differential cigarillo use and tobacco product substitution by SGM identity. Flavor restriction policies should be coupled with targeted cessation resources to address potential remaining disparities.

IMPLICATIONS

SGM US women have a unique cigarillo-use trajectory. These women are more likely to initiate cigarillos without flavor and then later integrate it into their behavior. National cigar flavor restrictions are expected to have a greater impact decreasing cigarillo initiation among CisHet women and decreasing current cigarillo use among SGM women. However, for those who would continue using unflavored cigarillos, SGM women may remain at risk for nicotine dependence due to increased product substitution. SGM women should be prioritized for cessation resources to reduce tobacco-use disparities leading up to and following the implementation of cigar flavor restrictions.

Approaching sexuality in LGBTQIAP + patients with cancer: scoping review

BACKGROUND

When individuals in the SGM group are diagnosed with cancer and undergo treatment, they experience changes in physical, mental, sexual and spiritual dimensions, which can negatively impact sexual desire, as well as satisfaction and sexual health as a whole. This study aims to examine the existing scientific literature on how healthcare professionals approach sexuality in cancer patients who belong to the SGM group. The SGM group is particularly vulnerable, and the challenges they face in terms of psychosocial and emotional health are further exacerbated by the oncological treatment they receive. Therefore, specialized attention and support are necessary to address their unique needs.

METHOD

To conduct this study, a scoping review was performed following the guidelines established by the Joanna Briggs Institute. By synthesizing the available evidence, this study aims to provide insights and recommendations for healthcare professionals to improve the care and support provided to SGM individuals with cancer. Guiding question: "how do health professionals approach sexuality in cancer patients in a minority group?". The search was carried out in PubMed, Science Direct, Scopus, Web of Science, Virtual Health Library, Embase databases and Google Scholar in addition. Specific criteria were used for Evidence source selection, Data mapping, assurance, analysis, and presentation.

RESULTS

Fourteen publications were included in this review for the final synthesis, which indicated that the approach to the sexuality of sexual and gender minority groups is based on research whose character is limited in terms of producing care and health care that is congruent in gender and sexuality. The analysis of scientific articles showed that one of the biggest challenges and priorities of health services today is to reduce disparities and promote equity in health for SGM people.

CONCLUSIONS

This study reveals a significant gap in addressing the sexuality of SGM groups within cancer care. Inadequate research impedes the provision of consistent and inclusive care for SGM individuals, which has a negative impact on their overall wellbeing. Reducing disparities and promoting healthcare equity for SGM individuals must be a top priority for health services.

Participation, barriers, and facilitators of cancer screening among LGBTQ+ populations: A review of the literature

The LGBTQ+ community is at higher risk of certain cancers but is less likely to participate in screening programs or engage with preventive healthcare. Despite this, the barriers and facilitators to cancer screening are not well understood in this population. We conducted a literature review of research related to LGBTQ+ participation in cancer screening, as well as barriers and facilitators to participation. Following abstract and full-text screening, 50 studies were included in the final synthesis. Compared to their heterosexual counterparts, lesbian and bisexual women were less likely to participate in cervical cancer screening and mammography, but gay and bisexual men were more likely to participate in anal and colorectal cancer screening. Transgender individuals had lower rates of screening than cisgender individuals for all cancer types. Barriers to participation were found at the individual-, provider-, and administrator-level, and good communication with a healthcare provider was the strongest facilitator. These results provide reasonable first steps toward improving participation rates for LGBTQ+ populations in cancer screening. Patient-centered approaches should draw on core guiding principles to inform the provision of care, including anticipating LGBTQ+ patients, improving knowledge about care for these patients, and confronting individually-held biases that may affect care, in order to improve care experiences and participation rates in preventive services.

Impacts of psychological wellbeing with HIV/AIDS and cancer among sexual and gender minorities: A systematic review and meta-analysis

Background

The agony and economic strain of cancer and HIV/AIDS therapies severely impact patients' psychological wellbeing. Meanwhile, sexual minorities experience discrimination and mental illness. LGBT individuals with cancer and HIV/AIDS play two roles. It is important to understand and examine this groups mental wellbeing.

Objective

The purpose of this study is to synthesize current studies on the impact of HIV/AIDS and cancer on LGBT patients' psychological wellbeing.

Methods

This research uses a systematic literature review at first and later stage a meta-analysis was run on the same review. In this study, data from Google academic and Web of Science has been used to filter literature. PRISMA 2020 Flow Diagram seeks research on LGBT cancer and HIV/AIDS patients. The above sites yielded 370 related papers, some of which were removed due to age or inaccuracy. Finally, meta-analyses was done on 27 HIV/AIDS and 33 cancer patients's analyse.

Results

The research included 9,898 LGBT cancer sufferers with AIDS and 14,465 cancer sufferers with HIV/AIDS. Using meta-analysis, we discovered the gap in psychological wellbeing scores between HIV/AIDS LGBT and non-LGBT groups ranged from -10.86 to 15.63. The overall score disparity between the HIV/AIDS LGBT and non-LGBT groups was 1.270 (95% CI = 0.990-1.560, Z = 86.58, P < 0.1). The disparity in psychological wellbeing scores between cancer LGBT group and general group varies from -8.77 to 20.94 in the 34 papers examined in this study. Overall, the psychological wellbeing score disparity between the cancer LGBT subset and the general group was 12.48 (95% CI was 10.05-14.92, Test Z-value was 268.40, P-value was <0.1).

Conclusion

Inflammation and fibrosis in HIV/AIDS and cancer sufferers adversely affect their psychological wellbeing.

Emotions and lung cancer screening: Prioritising a humanistic approach to care

Low-dose computed tomography lung cancer screening has mortality benefits. Yet, uptake has been low. To inform strategies to better deliver and promote screening, in 2018, we interviewed 27 long-term smokers immediately following lung cancer screening in Australia, prior to receiving scan results. Existing lung screening studies employ the Health Belief Model. Reflecting growing acknowledgement of the centrality of emotions to screening uptake, we draw on psychological and sociological theories on emotions to thematically and abductively analyse the emotional dimensions of lung cancer screening, with implications for screening promotion and delivery. As smokers, interviewees described feeling stigmatised, with female participants internalising and male participants resisting stigma. Guilt and fear related to lung cancer were described as screening motivators. The screening itself elicited mild positive emotions. Notably, interviewees expressed gratitude for the care implicitly shown through lung screening to smokers. More than individual risk assessment, findings suggest lung screening campaigns should prioritise emotions. Peer workers have been found to increase cancer screening uptake in marginalised communities, however the risk to confidentiality-especially for female smokers-limits its feasibility in lung cancer screening. Instead, we suggest involving peer consultants in developing targeted screening strategies that foreground emotions. Furthermore, findings suggest prioritising humanistic care in lung screening delivery. Such an approach may be especially important for smokers from low socioeconomic backgrounds, who perceive lung cancer screening and smoking as sources of stigma and face a higher risk of dying from lung cancer and lower engagement with screening.

Health-related quality of life among colorectal cancer survivors of diverse sexual orientations

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.