Improving Sexual and Gender Minority Cancer Care: Patient and Caregiver Perspectives From a Multi-Methods Pilot Study

Area of Science:

• Oncology
• Health Disparities
• Minority Health

Background:

• Sexual and gender minority (SGM) individuals represent a significant population with cancer histories, facing unique health concerns and disparities.
• SGM individuals experience disproportionately higher risks for certain cancers and report challenges in seeking healthcare, adjusting to illness, and receiving patient-centered care.
• Minority stress, stemming from discrimination and stigma, negatively impacts SGM cancer patients and their caregivers, highlighting a critical gap in research and care.

Purpose of the Study:

• To identify gaps and opportunities for improving cancer care for sexual and gender minority (SGM) patients and their caregivers.
• To explore the quality of life and experiences of SGM cancer patients and their heterosexual, cisgender (H/C) counterparts.
• To understand the role of minority stress and discrimination in the cancer care journey of SGM individuals.

Main Methods:

• A multi-methods study employing PROMIS measures for quality of life and in-depth semi-structured interviews.
• Recruitment of 10 SGM cancer patients, 8 heterosexual, cisgender (H/C) patient matches, and 36 of their informal caregivers.
• Data collection occurred between June 2020 and July 2021, with study approval from the University of New Mexico Human Research Protections Office Institutional Review Board.

Main Results:

• SGM patients reported higher anxiety and depression, while H/C patients reported higher fatigue and pain intensity.
• SGM patients experienced greater social isolation, whereas H/C patients reported more emotional support and companionship.
• Qualitative data revealed that stigma and discrimination contribute to minority stress and medical mistrust in SGM patients and caregivers, impacting initial care encounters.

Conclusions:

• Prior stigmatizing experiences exacerbate minority stress and medical mistrust for SGM cancer patients and caregivers.
• Gaps in SGM cancer care include lack of SOGI conversations, insufficient provider training in cultural competence, and inadequate support for patients lacking social networks.
• There is a critical need for targeted interventions to address minority stress and improve clinic environments, alongside enhanced support services for all informal cancer caregivers.