Addressing Disparities: Practicing Inclusion for LGBTQ+ Patients With Cancer
Medical providers should strive to make all patients feel welcome and safe.
Cancer health disparities affect a number of populations, including racial and ethnic minorities, low socioeconomic status groups, and sexual and gender minorities. The lesbian, gay, bisexual, transgender, queer+ community (LGBTQ+) is one which faces disparities that are often unrecognized.1
Identifying and acknowledging disparities helps us work together to improve access to care and treatment and reduce the cancer risks.2 Among individuals in the LGBTQ+ community there is less access to care because of a lack of inclusive health care, underrepresentation and exclusions in clinical trials, and lack of coverage for appropriate screenings. LGBTQ+ individuals often have poor access to cancer prevention screenings and high-quality cancer care. Further, LGBTQ+ individuals who receive a diagnosis of cancer often experience disparities in cancer survivorship, including poorer quality-of-life outcomes. For LGBTQ+ cancer survivors there are reports of more difficult relationships, lower satisfaction with cancer care and treatment, and poorer overall health.
Factors such as distrust in the medical team can have a huge impact on the LGBTQ+ community. Disclosure of gender identity and sexual orientation is important in order to receive appropriate services but disclosure does not always happen. These patients are less likely to share with their doctors because of discomfort or fear of doctors’ biases. Some people may have had previous experiences that were not pleasant, and patients were discriminated against or mistreated which adds an additional layer of fear in seeking care and sharing their concerns.3
Communication is an important part of cancer care. Without good communication we are not able to address the needs of individuals like reducing their fears. According to the National LGBT Cancer Network, “Many LGBT cancer survivors report that their partners were not permitted in the emergency [department] with them, leaving them alone and frightened.”4
In order to provide adequate screenings, appropriate information about treatment options and support resources there has to be a trusting relationship between the patients and everyone on the medical team. Lack of communication and disclosure for LGBTQ+ can limit the inclusion of partners or family in their care, which can lead to an increased risk for depression, isolation and distress.
How to Help
It is important to make all individuals feel welcomed and comfortable. Things such as introducing yourself and your pronouns will help them do the same. Let LGBTQ+ individuals know that they are not alone and that you are there to assist. Ask about their preferences and utilize that information to provide them with appropriate support and resources.5 Share information about LGBTQ+ support in the community or virtually.
The cancer journey is scary and presents itself with a lot of emotional and practical obstacles. Simple things such as providing a listening ear and being empathetic to the challenges faced by the patient is enough. Validation of their feelings and understanding of their challenges and concerns is both helpful to the person and to the health care setting as it provides information about the needs of the LGBTQ+ population.
Promoting inclusion of LGBTQ+ people in the health care setting can be done in many ways including the following:
- Encourage diversity among the staff.
- Request culturally appropriate trainings that provides training for all staff in order to be better informed and educated.
- Advocate wherever appropriate for LGBTQ+ inclusion in documentation and services.
In providing services and support to LGBTQ+ patients we can all work as a team in order to address the cancer health disparities that they face. Much information is missing in regards to the LGBTQ+ cancer journey and experience mostly because they do not feel welcomed and important questions are not asked. More open dialogue is necessary within the health care team and in the patient and doctor consult so that LGBTQ+ patients have access to appropriate treatment options and after care support.
LGBTQ+ individuals are not represented properly in data and studies that are available in regard to cancer patients and they are also underrepresented in clinical trials, which can mark the difference in survivorship outcomes.6 In order to assist in providing support to those in the LGBQ+ population here is a quick short list of resources that can be shared:
- The Gay and Lesbian Medical Association, Cancer in Our Lives
- CancerCare’s LGBT Program
- The National Coalition for LGBT Health
- LGBT Health Link
- Trans Care BC (Supports the delivery of equitable and accessible care, surgical planning, and peer and community support for trans individuals across the province.)
Being willing to make small changes and to learn more about the LGBTQ+ community can mark the difference that will help close the disparities gap for this population. Having engaging conversations through the cancer journey along with adequate support will have an impact on how an individual with cancer copes. Striving to be welcoming, asking questions regarding preferences and social support systems such as partners and chosen family, as well as providing appropriate resources, will go a long way in providing care to an LGBTQ+ individual.
1. Winkfield KMP. Cancer does not affect all people equally: an expert Q&A on cancer disparities and health equity. ASCO. June 30, 2022. Accessed August 3, 2022. https://bit.ly/3QgAxQn
2. Schabath MP. The barriers to care faced by LGBTQ people with cancer: an expert perspective. January 21, 2021. Accessed August 3, 2022. American Society of Clinical Oncology. https://bit.ly/3SoiGsJ
3. Olsen KP. AACR conference examines cancer disparities in the LGBTQ population. American Association for Cancer Research. January 26, 2021. Accessed August 3, 2022. https://bit.ly/3vD0yBL
4. LGBT Cancer Information. National LGBT Cancer Network. Accessed August 3, 2022. https://bit.ly/2zidu5f
5. O’Hara J. Promoting inclusion for LGBTQ+ people with cancer: “your stories” podcast. American Society of Clinical Oncology. September 21, 2021. Accessed August 3, 2022. https://bit.ly/3PZRFdo
6. Loftus EG. Examining cancer health disparities in the LGBTQ community. American Association for Cancer Research. September 22, 2019. Accessed August 3, 2022. https://bit.ly/3oPiJAn