Lesbian and bisexual women's adjustment after a breast cancer diagnosis

Beyond Survival: A Scoping Review on the Sexual Health of Sexual and Gender Minority Women Following Curative Cancer Treatment

INTRODUCTION

To explore the existing research on sexual health experiences of sexual and gender minority women (SGMW) post-curative cancer treatment.

METHODOLOGY

This scoping review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Four articles that focused on sexual health experiences of SGMW post-curative cancer treatment were included.

RESULTS

Four themes were identified: (a) sexual function; (b) sexual orientation and gender identity, including disclosure and health care provider reactions; (c) relationship dynamics, such as relationship status and the quality of romantic relationships; and (d) body image.

DISCUSSIONS

The findings underscore substantial challenges faced by SGMW cancer survivors in achieving optimal sexual well-being, impacting their access to post-treatment care. This study advocates for more expansive research efforts involving diverse participant cohorts, extending beyond breast cancer, to gain deeper insights into these critical issues.

Experiences of discrimination in healthcare settings, trust in providers and disordered eating behaviors in LGBTQ+ college students

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals report more experiences of healthcare discrimination and disordered eating behaviors (DEBs), and less trust in physicians than their cisgender and heterosexual counterparts. Although research supports a link between discrimination and DEBs among LGBTQ+ populations, few studies have specifically investigated healthcare discrimination and DEBs in this population. This study examined whether LGBTQ+ status moderated the relation between negative healthcare experiences and DEBs in undergraduates. Undergraduates (n = 322) from a Southeastern (United States) university completed measures of healthcare discrimination, trust in physicians, and DEBs. Analyses investigated whether LGBTQ+ status moderated the relation between healthcare discrimination and DEBs; trust in physicians and DEBs. LGBTQ+ individuals (35% of sample), reported less trust in physicians (p < .001), and more body dissatisfaction (p = .007) and shape/weight overvaluation (p = .008). Among all undergraduates, experiences of healthcare discrimination were associated with higher body dissatisfaction (p = .003) and shape/weight overvaluation (p = .008). Less trust in physicians was associated with greater shape/weight overvaluation (p = .005). LGBTQ+ status did not moderate either relation. It is important to reduce healthcare discrimination and foster patient-provider trust for all young adults. Future research should examine factors influencing patient-provider trust among LGBTQ+ individuals.

Theory of health promotion for sexual and gender minority populations with cancer

BACKGROUND

Structural factors (e.g., cisheteronormativity) promote minority stressors, which generate healthcare disparities among sexual and gender minority (SGM) populations (also known as lesbian, gay, bisexual, transgender, queer, intersexual, asexual, and other sexual and gender-expansive persons--LGBTQIA+) with cancer. The individual's biological, behavioral, social, and psychological response to minority stressors will vary throughout their life course. However, there is a lack of empirical and theoretical guidance for conceptualizing health outcomes among SGM subgroups.

PURPOSE

To propose a nursing theory for the health promotion of SGM populations with cancer.

METHODS

Walker and Avant's strategies for theoretical derivation were followed.

RESULTS

I present the definition, theoretical assumptions, concepts, propositions, and implications for practice, education, research, and policy of the derived theory.

DISCUSSION AND CONCLUSION

The theory provides a nursing framework to understand and address the multilevel impact of minority stress on the health of SGM individuals throughout their cancer care continuum.

Clinical, psychosocial, and sociodemographic factors of sexual and gender minority groups with cancer: A systematic review

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.

The Role of Emotion-Related Abilities in the Quality of Life of Breast Cancer Survivors: A Systematic Review

Breast cancer survivors have to deal with notable challenges even after successful treatment, such as body image issues, depression and anxiety, the stress related to changes in lifestyle, and the continual challenges inherent to health management. The literature suggests that emotional abilities, such as emotional intelligence, emotion management, mood repair, and coping play a fundamental role in such challenges. We performed a systematic review to systematize the evidence available on the role of emotional abilities in quality of life and health management in breast cancer survivors. The search was performed on three scientific databases (Pubmed, Scopus, and PsycINFO) and, after applying exclusion criteria, yielded 33 studies, mainly of a cross-sectional nature. The results clearly support the hypothesis that emotional abilities play multiple important roles in breast cancer survivors' quality of life. Specifically, the review highlighted that coping/emotional management plays multiple roles in breast cancer survivors' well-being and health management, affecting vitality and general adjustment to cancer positivity and promoting benefit findings related to the cancer experience; however, rare negative results exist in the literature. This review highlights the relevance of emotional abilities to promoting quality of life in breast cancer survivors. Future review efforts may explore other breast cancer survivors' emotional abilities, aiming at assessing available instruments and proposing tailored psychological interventions.

LGBTQI cancer patients' quality of life and distress: A comparison by gender, sexuality, age, cancer type and geographical remoteness

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.

Câncer de mama e homossexualidade feminina

Devido aos avanços dos tratamentos oncológicos, a sobrevida das pacientes com neoplasias mamárias tem aumentado significativamente, o que impõe a necessidade de compreender seus aspectos psicossociais. Diferenças de gênero e orientação sexual favorecem a ocorrência de desigualdades dentro dos serviços de saúde. Este estudo teve por objetivo analisar a produção científica nacional e internacional sobre variáveis relacionadas à saúde de mulheres lésbicas com câncer de mama. O levantamento bibliográfico foi realizado a partir das bases LILACS, PubMed, CINAHL e PsycINFO. Foram selecionados 20 artigos publicados entre 2007 e 2017. A análise permitiu delinear os temas: repercussões físicas e psicológicas do tratamento, enfrentamento, riscos de morbidade e mortalidade, qualidade de vida, menopausa e estudos de base populacional. A literatura explora de que modo a doença e o tratamento impactam de forma diferenciada a qualidade de vida de mulheres lésbicas acometidas por câncer de mama. Esse conhecimento é fundamental para subsidiar um cuidado sensível às necessidades dos segmentos minoritários da população.

Health outcomes of sexual and gender minorities after cancer: a systematic review

PURPOSE

Cancer research on sexual and gender minority (SGM) populations is gaining momentum. The purpose of this systematic review was to examine what is currently known in the research literature regarding patient-reported health outcomes after cancer treatment among SGM populations.

METHODS

In March 2021, a medical librarian conducted a systematic keyword search on PubMed, Embase, Scopus, Web of Science, PsycINFO, ClinicalTrials.gov , and the Cochrane Central Register of Controlled Trials. The primary inclusion criterion was assessment of at least one physical, psychosocial, emotional, or functional patient-reported health outcome related to the impacts of cancer diagnosis and/or treatment. Articles that met inclusion criteria were reviewed in their entirety, charted in a Word Table, and assessed for quality. Quality considerations included study design, sampling approach, diversity of sample, measures used, and analytic procedures. Studies were synthesized based on type of cancer study participants experienced.

RESULTS

Sixty-four studies were included in the final analysis: most were quantitative, secondary analyses or cross-sectional studies with convenience samples, and focused on people with a history of breast or prostate cancer. Differences between sexual minority men and women in terms of coping and resilience were noted. Few studies reported on experiences of transgender persons and none reported on experiences of intersex persons.

CONCLUSIONS

A growing literature describes the patient-reported health outcomes of SGM people with a history of cancer. This study summarizes important between-group differences among SGM and heterosexual, cisgender counterparts that are critical for clinicians to consider when providing care.

IMPLICATIONS FOR CANCER SURVIVORS

Sexual orientation and gender identity are relevant to cancer survivors' health outcomes. Subgroups of SGM people have differential experiences and outcomes related to cancer and its impacts.

Health outcomes of sexual and gender minorities after cancer: a systematic review

PURPOSE

Cancer research on sexual and gender minority (SGM) populations is gaining momentum. The purpose of this systematic review was to examine what is currently known in the research literature regarding patient-reported health outcomes after cancer treatment among SGM populations.

METHODS

In March 2021, a medical librarian conducted a systematic keyword search on PubMed, Embase, Scopus, Web of Science, PsycINFO, ClinicalTrials.gov , and the Cochrane Central Register of Controlled Trials. The primary inclusion criterion was assessment of at least one physical, psychosocial, emotional, or functional patient-reported health outcome related to the impacts of cancer diagnosis and/or treatment. Articles that met inclusion criteria were reviewed in their entirety, charted in a Word Table, and assessed for quality. Quality considerations included study design, sampling approach, diversity of sample, measures used, and analytic procedures. Studies were synthesized based on type of cancer study participants experienced.

RESULTS

Sixty-four studies were included in the final analysis: most were quantitative, secondary analyses or cross-sectional studies with convenience samples, and focused on people with a history of breast or prostate cancer. Differences between sexual minority men and women in terms of coping and resilience were noted. Few studies reported on experiences of transgender persons and none reported on experiences of intersex persons.

CONCLUSIONS

A growing literature describes the patient-reported health outcomes of SGM people with a history of cancer. This study summarizes important between-group differences among SGM and heterosexual, cisgender counterparts that are critical for clinicians to consider when providing care.

IMPLICATIONS FOR CANCER SURVIVORS

Sexual orientation and gender identity are relevant to cancer survivors' health outcomes. Subgroups of SGM people have differential experiences and outcomes related to cancer and its impacts.

Online health community experiences of sexual minority women with cancer

OBJECTIVE

The study sought to explore online health communities (OHCs) for sexual minority women (SMW) with cancer by conducting computational text analysis on posts.

MATERIALS AND METHODS

Eight moderated OHCs were hosted by the National LGBT Cancer Network from 2013 to 2015. Forty-six SMW wrote a total of 885 posts across the OHCs, which were analyzed using Linguistic Inquiry and Word Count and latent Dirichlet allocation. Pearson correlation was calculated between Linguistic Inquiry and Word Count word categories and participant engagement in the OHCs. Latent Dirichlet allocation was used to derive main topics.

RESULTS

Participants (average age 46 years; 89% white/non-Hispanic) who used more sadness, female-reference, drives, and religion-related words were more likely to post in the OHCs. Ten topics emerged: coping, holidays and vacation, cancer diagnosis and treatment, structure of day-to-day life, self-care, loved ones, physical recovery, support systems, body image, and symptom management. Coping was the most common topic; symptom management was the least common topic.

DISCUSSION

Highly engaged SMW in the OHCs connected to others via their shared female gender identity. Topics discussed in these OHCs were similar to OHCs for heterosexual women, and sexual identity was not a dominant topic. The presence of OHC moderators may have driven participation. Formal comparison between sexual minority and heterosexual women's OHCs are needed.

CONCLUSIONS

Our findings contribute to a better understanding of the experiences of SMW cancer survivors and can inform the development of tailored OHC-based interventions for SMW who are survivors of cancer.

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

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.

"Sex Can Be a Great Medicine": Sexual Health in Oncology Care for Sexual and Gender Minority Cancer Patients

Purpose of review

Until recently, sexual and gender minority (SGM) people have been largely invisible in health care and health services research. However, understanding the needs and experiences of SGM cancer patients is critical to providing high-quality care, including needs and experiences related to sexual health. In this narrative review, we highlight that the literature on sexual health for SGM people with cancer is lacking, summarize existing literature on disparities affecting SGM patients with cancer, and discuss factors associated with these disparities. We conclude with recommendations and suggestions for future research in this area.

Recent Findings

Emerging evidence suggests that SGM people are at a higher risk for breast, cervical, endometrial, HPV-related, and lung cancers, as well as poor cancer outcomes, due to behavioral risk factors and health care system factors (e.g. lower access to health care insurance, discrimination in non-affirming care settings, negative health care interactions with providers). Additional research suggests that lack of clear guidelines for cancer screening in SGM patients, particularly for transgender and gender diverse patients, negatively impacts cancer screening uptake among SGM people. A growing number of studies have suggested greater sexual challenges following cancer treatment for sexual minority men with prostate cancer, while other studies highlight positive outcomes for sexual minority women following cancer treatment, such as benefit finding and resilience. Research on transgender and gender diverse patients is lacking.

Summary

Collection of sexual orientation and gender identity data across clinical enterprises and population-based surveys, mandatory health care provider training on cultural and clinical competency with SGM patients, and additional research inclusive of and focused on SGM cancer patients are key strategies to advance evidence-based clinical cancer care for diverse SGM populations.

The support that partners or caregivers provide sexual minority women who have cancer: A systematic review

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.

Care delivery, patient experiences, and health outcomes among sexual and gender minority patients with cancer and survivors: A scoping review

Sexual and gender minorities (SGMs) face a disproportionate burden of cancer, yet little is known about the experiences and specific needs of these underserved populations in cancer care delivery. The authors conducted a scoping review to characterize the literature on cancer care delivery, health outcomes, and health care experiences for patients with cancer and survivors identifying as SGM. In total, 1176 peer-reviewed citations were identified after a systematic search of the PubMed/Medline, PsycInfo, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Web of Sciences databases without restriction on publication date. The details captured included study aims, design, population, cancer site, and main findings. Thirty-seven studies published from 1998 to 2017 met the study criteria. Most studies were conducted in the post-treatment survivorship phase of the continuum (n = 30), and breast cancer was the most common cancer site (n = 20). There were only 2 intervention studies. The studies reviewed were classified under the following areas of focus: 1) disclosure of sexual orientation and gender identity, 2) quality of care, 3) psychosocial impact of/ adjustment to cancer, 4) social support, 5) sexual functioning, and 6) health risks/health behavior. Very little research reported an assessment of gender minority status or included a focus on gender minorities (n = 7). This review revealed substantial research gaps given a lack of population-based data and small sample sizes, likely related to the absence of systematic collection of sexual orientation and gender identity information in the cancer care context. Deficient research in this area likely perpetuates health disparities. Further research is needed to identify and remove the barriers to delivering high-quality care to SGM individuals with cancer.

"Waiting for breast reconstruction": An interpretative phenomenological analysis of heterosexual couples' experiences of mastectomy for breast cancer

PURPOSE

Treatment decisions, such as breast reconstruction is made by the dyad patient-physician, but close others can have an influence on the process. Shared decision-making models include close others but current studies generally investigate physician-patient interactions only. Moreover, little is known about couples' interactions throughout the breast cancer journey and treatment decision-making. Thus, the aim of the present study was to explore couples' experiences of mastectomy and breast reconstruction decision-making, the month following the mastectomy.

METHOD

Ten unstructured individual interviews, with five couples facing mastectomy for breast cancer, were conducted. A dyadic interpretative phenomenological analysis (IPA) was carried on the data set.

RESULTS

Eight super-ordinate themes emerged from the data. Couples' experiences were marked by the experience of the disease, the mastectomy and the impact they produced. The relationships with health professionals and partners were also important. Partners were not only supportive and protective, but directly (i.e., couples talk about treatments) and indirectly influenced (i.e., women make a decision taking into consideration how it will impact their couple) the women in their decision to have or not a breast reconstruction. The interpretative accounts underline how women and partners cope with the disease thinking about the aftertreatment.

CONCLUSIONS

This study explains for the first time how intimate partners influence breast reconstruction decision-making and how couples cope individually with the disease immediately after mastectomy. Health professionals need to involve partners more in the treatment decision-making process as the women consider and talks to them about the choices they have to make.

"Treat us with dignity": a qualitative study of the experiences and recommendations of lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients with cancer

PURPOSE

Despite indications that lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients have unique needs when seeking healthcare, the experiences of LGBTQ patients in the context of cancer care have not been fully explored. This qualitative study investigated recommendations offered by LGBTQ patients with cancer for improving cancer care.

METHODS

Two hundred seventy-three LGBTQ people across the USA who had been diagnosed with cancer completed an online survey that included open-ended questions. Using responses to these questions, two researchers independently conducted open coding. A code book was generated collaboratively and the data were coded independently. Codes were clustered and refined and the data were independently re-coded.

RESULTS

Five themes emerged. LGBTQ patients with cancer: (1) are affected by providers' LGBTQ-specific knowledge and skills, assumptions, and mistreatment; (2) negotiate disclosure of identities based on safety of clinical encounters; (3) have differing experiences based on multiple intersecting identities; (4) receive more effective care when members of their support networks are included; and (5) are self-advocates and undergo transformative experiences in the face of morbidity and marginalization.

CONCLUSIONS

LGBTQ cancer survivors report challenges accessing competent cancer treatment. To address this, cancer care providers should provide safe clinical encounters, inquire about and respond professionally to patients' identities and identifiers, include chosen support people, provide care relevant to patients' gender identities, and address treatments' effects on sexuality. Training providers about diverse LGBTQ communities and acknowledging the strengths of LGBTQ patients with cancer may improve provider/patient relationships. Provider training could be created based on these principles.

LGBT Populations' Barriers to Cancer Care

OBJECTIVE

To describe lesbian, gay, bisexual, and transgender (LGBT) individuals' barriers to accessing and receiving quality cancer care.

DATA SOURCES

Published data on cancer care and studies of LGBT individuals.

CONCLUSION

There is a clustering of barriers among LGBT individuals, which suggests multiple inequities exist in LGBT individuals' cancer care, although data on disparities along the cancer control continuum are not consistently available.

IMPLICATIONS FOR NURSING PRACTICE

Nurses can make a difference in LGBT individuals' cancer care by obtaining training on LGBT health and their cancer-related needs and by providing a welcoming and respectful relationship with LGBT patients.

Emotional distress and subjective impact of the disease in young women with breast cancer and their spouses

AIM

Evaluate the influence of emotional distress of young women with breast cancer and their spouses on their daily subjective experience of the disease, through application of the Actor-Partner Interdependence Model.

PATIENTS & METHODS

A total of 112 women under 45 years of age were diagnosed with nonmetastatic breast cancer and their spouses answered self-reported measures of anxiety, depression and subjective experience of the disease and its treatment.

RESULTS

The patient's emotional distress influenced more the subjective experience of her spouse than the spouse's emotional distress influenced the patient. The spouse's difficulties depended as much on his own distress level as on the patient's distress level.

CONCLUSION

These data confirm the importance of implementing couple-focused interventions.

Minority stress, psychosocial resources, and psychological distress among sexual minority breast cancer survivors

OBJECTIVE

Few studies have examined unique factors predicting psychological distress among sexual minority (i.e., lesbian and bisexual) women postbreast cancer diagnosis. The present study assessed the association of minority stress and psychosocial resource factors with depression and anxiety symptoms among sexual minority breast cancer survivors.

METHOD

Two hundred one sexual minority women who had ductal carcinoma in situ or Stage I-IV breast cancer participated in this study through the Love/Avon Army of Women. Self-report questionnaires were used to assess demographic and clinical factors, minority stress factors (discrimination, minority identity development, outness), psychosocial resources (resilience, social support), and psychological distress (anxiety and depression). These factors were included in a structural equation model, testing psychosocial resources as mediators between minority stress and psychological distress.

RESULTS

There were no significant differences noted between lesbian and bisexual women. The final structural equation model demonstrated acceptable fit across all sexual minority women, χ2 = 27.83, p > .05; confirmatory fit index = 0.97, root-mean-square error of approximation = 0.04, Tucker-Lewis index = 0.93. The model accounted for significant variance in psychological distress (56%). Examination of indirect effects confirmed that exposure to discrimination was associated with distress via association with resilience.

CONCLUSIONS

Factors unique to sexual minority populations, such as minority stress, may be associated with higher rates of psychological distress among sexual minority breast cancer survivors. However, presence of psychosocial resources may mediate relationships with distress in this population; enhancement of resilience, in particular, could be an aim of psychological intervention. (PsycINFO Database Record

Oncology healthcare providers' knowledge, attitudes, and practice behaviors regarding LGBT health

OBJECTIVE

There are limited data on lesbian, gay, bisexual, and transgender (LGBT) healthcare experiences and interactions with the providers. This study assessed knowledge, attitudes, and practice behaviors of oncology providers regarding LGBT health.

METHODS

A 32-item web-based survey was emailed to 388 oncology providers at a single institution. The survey assessed: demographics, knowledge, attitudes, and practice behaviors.

RESULTS

108 providers participated in the survey (28% response rate). <50% answered knowledge questions correctly. 94% stated they were comfortable treating this population. 26% actively inquired about a patient's sexual orientation when taking a history. 36% felt the need for mandatory education on LGBT cultural competency at the institution. Results from the open comments section identified multiple misconceptions.

CONCLUSION

This study revealed knowledge gaps about LGBT health risks. Cultural competency training may aid oncology providers to understand the need to inquire about patients' gender identity and sexual orientation.

PRACTICE IMPLICATIONS

Health care providers who incorporate the routine collection of gender identity and sexual orientation (SOGI) in their patient history taking may improve patient care by offering tailored education and referrals. While identifying as LGBT does not in itself increase risk for adverse health outcomes, this population tends to have increased risk behaviors.

A Dyadic Exercise Intervention to Reduce Psychological Distress Among Lesbian, Gay, and Heterosexual Cancer Survivors

PURPOSE

Studies have found disparities in psychological distress between lesbian and gay cancer survivors and their heterosexual counterparts. Exercise and partner support are shown to reduce distress. However, exercise interventions haven't been delivered to lesbian and gay survivors with support by caregivers included.

METHODS

In this pilot randomized controlled trial (RCT), ten lesbian and gay and twelve heterosexual survivors and their caregivers were randomized as dyads to: Arm 1, a survivor-only, 6-week, home-based, aerobic and resistance training program (EXCAP^©®); or Arm 2, a dyadic version of the same exercise program involving both the survivor and caregiver. Psychological distress, partner support, and exercise adherence, were measured at baseline and post-intervention (6 weeks later). We used t-tests to examine group differences between lesbian/gay and heterosexual survivors and between those randomized to survivor-only or dyadic exercise.

RESULTS

Twenty of the twenty-two recruited survivors were retained post-intervention. At baseline, lesbian and gay survivors reported significantly higher depressive symptoms (P = .03) and fewer average steps walked (P = .01) than heterosexual survivors. Post-intervention, these disparities were reduced and we detected no significant differences between lesbian/gay and heterosexual survivors. Participation in dyadic exercise resulted in a significantly greater reduction in depressive symptoms than participation in survivor-only exercise for all survivors (P = .03). No statistically significant differences emerged when looking across arm (survivor-only vs. dyadic) by subgroup (lesbian/gay vs. heterosexual).

CONCLUSION

Exercise may be efficacious in ameliorating disparities in psychological distress among lesbian and gay cancer survivors, and dyadic exercise may be efficacious for survivors of diverse sexual orientations. Larger trials are needed to replicate these findings.

Social support, self-rated health, and lesbian, gay, bisexual, and transgender identity disclosure to cancer care providers

PURPOSE/OBJECTIVES

To describe factors related to diagnosis, identity disclosure, and social support among lesbian, gay, bisexual, and transgender (LGBT) patients with cancer, and to explore associations between these factors and self-rated health.

DESIGN

Cross-sectional self-report survey design using descriptive and exploratory multivariate statistical approaches.

SETTING

Online, Internet-based.

SAMPLE

291 LGBT patients (89% Caucasian; 50% gay, 36% lesbian, 7% bisexual, 3% transgender) with mixed cancers.

METHODS

Participants completed a researcher-designed online survey assessing experiences of cancer diagnosis among LGBT patients at a single time point.

MAIN RESEARCH VARIABLES

Demographics, which provider(s) delivered the patients' cancer diagnoses, to whom patients had disclosed their LGBT identity, how they disclosed, who was on their social support team at the time of diagnosis, and current self-rated health.

FINDINGS

79% of participants reported disclosing their identities to more than one cancer care provider. Participants most commonly introduced the topic of LGBT identity themselves, sometimes as a way to correct heterosexual assumptions (34%). Friends were the most common members of LGBT patients' support teams (79%). Four disclosure and support factors were consistently associated with better self-rated health.

CONCLUSIONS

Disclosure of LGBT identity is a common experience in the context of cancer care, and disclosure and support factors are associated with better self-reported health among LGBT patients.

IMPLICATIONS FOR NURSING

Creating safe environments for LGBT patients to disclose could improve cancer care delivery to this underserved population. Nurses and other providers should acknowledge and include diverse support team members in LGBT patients' care.

Sexual Minority Women's Health Behaviors and Outcomes After Breast Cancer

PURPOSE

Sexual minority women (e.g., lesbians, bisexual women, and women who prefer a female partner) are a known risk population for overweight, obesity, and mental health problems. Our objective is to compare sexual minority women with breast cancer to a control sample of sexual minority women without cancer to identify differences in healthful lifestyle practices, weight, well-being and mental health.

METHODS

This is a cross-sectional study of 85 sexual minority women with a breast cancer history (cases) matched by age and partner status to 85 sexual minority controls without cancer. We compared self-reported physical activity, fruit and vegetable intake, weight, quality of life, anxiety, and depression.

RESULTS

Cases and controls had similar health behaviors, BMI, quality of life, anxiety, and depression. Of the weight-related behaviors, meeting the recommended guidelines of physical activity was significantly associated with lower likelihood of being overweight or obese, less depression, and better mental quality of life.

CONCLUSIONS

Sexual minority women with breast cancer are similar to sexual minority women without cancer with respect to healthful behaviors, body weight, anxiety, depression, and quality of life. Lifestyle interventions to reduce the risk of poor outcomes after cancer should be implemented in this population as well as in sexual minority women without cancer.

Sexual health as a survivorship issue for female cancer survivors

As more and more people are successfully treated for and live longer with cancer, greater attention is being directed toward the survivorship needs of this population. Women treated for cancer often experience issues related to sexual health and intimacy, which are frequently cited as areas of concern, even among long-term survivors. Unfortunately, data suggest that providers infrequently discuss these issues. We reviewed a contemporary understanding of sexual health of women and the impact of treatment on both sexual function and intimacy. We also provide a review of the diagnosis using the newest classification put forth by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, and potential treatments, including both endocrine and nonendocrine treatments that the general oncologist may be asked about when discussing sexual health with his or her patients.