Adolescents and young adults (AYAs) with cancer who are sexual or gender minorities face unique challenges in the health care setting, according to research presented in a poster at ASCO Breakthrough 2023.
Specialized care is needed for AYAs who are lesbian, gay, bisexual, transgender, queer, or other sexual/gender minorities (LGBTQ+), according to researchers.
The researchers reviewed 17 studies that explored challenges and available services for LGBTQ+ AYAs with cancer. The review revealed 16 unique challenges these patients face.
One of the most common challenges, identified in 9 of the studies, is health care providers’ lack of understanding about psychosocial needs specific to LGBTQ+ patients. This includes providers not using LGBTQ+-specific language and making heteronormative assumptions during discussions with patients. Providers may also be unaware that having to repeatedly disclose their sexual/gender identity can take a psychological toll on patients.
Another of the most common challenges patients face is the stress surrounding the disclosure of LGBTQ+ identity to providers. This was identified in 9 studies. The studies showed associations between stress and having to repeatedly disclose an LGBTQ+ identity, uncertainty about the importance or impact of disclosing said identity, and providers not actively asking about a patient’s identity.
The third most common challenge, identified in 7 studies, is anxiety/depression. LGBTQ+ AYAs reported higher levels of distress and anxiety, as well as stress and depression related to their families’ rejection of their identity.
In addition to identifying challenges, the researchers identified 7 services required to help LGBTQ+ AYAs with cancer.
The most commonly required service, identified in 7 studies, is LGBTQ+-specific support groups. Social support for AYAs was associated with a lower likelihood of depression, but regular support groups did not cater to LGBTQ+ AYA’s needs.
The second most commonly required service, identified in 6 studies, is cultural competence training for health care providers. This includes education on the use of inclusive and gender-neutral language, LGBTQ+-specific needs, and expectations around fertility and reproduction.
The third most commonly required service is inclusive screening and assessment. This was identified in 5 studies. The studies suggested that hospitals should provide visual signifiers of inclusivity, ensure that forms allow for disclosure of LGBTQ+ identity, and provide anxiety screening for LGBTQ+ AYA patients.
The researchers noted that future directions for research include performing meta-analyses of studies with quantifiable mental health outcome measures, as well as focusing research on AYA populations in regions where there is less acceptance around LGBTQ+ identities.
“Greater engagement is required to tailor existing services to improve outcomes,” the researchers wrote in their poster.
Reference
Thaarun T, Heng EH, Poon EYL. Identifying gaps and challenges faced in lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA+) adolescent and young adults (AYA) cancer care: A scoping review. ASCO Breakthrough 2023. August 3-5, 2023. Abstract 100.
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