Disparities in cancer care among sexual and gender minority adolescent and young adult patients: A scoping review

Abstract

Background: Adolescent and young adult cancer patients (AYAs) who are sexual and gender minorities (SGM) are a rapidly increasing population that experiences unmet cancer-related needs. Despite emerging awareness, little is known about cancer care and outcomes for this vulnerable population. The purpose of this scoping review was to explore current knowledge and gaps in the literature on cancer care and outcomes for AYAs who identify as SGM. Methods:We reviewed empirical knowledge on SGM AYAs by identifying, describing, and critically appraising the literature to date. We conducted a comprehensive search on OVID MEDLINE, PsycINFO, and CINAHL in February 2022.Additionally, we developed and piloted a conceptual framework for appraising SGM AYA research.Results: A total of 37 articles were included in the final review. Most studies focused exclusively on SGM-related outcomes as the primary aim of the study (81.1%, n = 30), whereas others included some focus on SGM-related outcomes (18.9%, n = 7). The majority of studies included AYAs as part of a broader age range (86.0%, n = 32), and only a few studies examined exclusively AYA samples (14.0%, n = 5). Gaps in scientific evidence on SGM AYAs were seen across the cancer care continuum. Conclusion:Numerous gaps in knowledge of cancer care and outcomes exist for SGM AYAs diagnosed with cancer. Future efforts should fill this void with highquality empirical studies that reveal unknown disparities in care and outcomes and are inclusive of the intersectionality of SGM AYAs with other minoritized experiences, thereby advancing health equity in meaningful ways.

A Needs Assessment Approach for Adolescent and Young Adult Sexual and Gender Diverse Cancer Survivors

“…Our work was guided by the community-based participatory research (CBPR) framework [21], which highlights the interplay among community members and the research process. Together, we engaged in co-learning and bidirectional transferring of expertise and knowledge, recognizing that all members of our team were research partners [22][23][24], and many were embodied researchers as patient scientists and/or SGD individuals [1,25,26]. Institutional Review Board oversight was not required for this study.…”

“…The intersections of cancer survivorship (i.e., from time of diagnosis to end of life) and sexual and gender diverse (SGD) status for adolescents and young adults (AYAs) pose significant challenges that result in cancer-related health and healthcare disparities [1,2]. Sexual and gender diverse (also described as "sexual and gender minority") status is used in this paper as the umbrella term for those who identify as lesbian, gay, bisexual, asexual, transgender, Two-Spirit, queer, and/or intersex (LGBTQI2S+) [3].…”

“…SGD AYAs experience disparities in cancer care delivery that are driven by unmet cancerrelated needs [11,12]. A 2023 scoping review of disparities among SGD AYAs identified numerous gaps in cancer care and outcomes research [1]. Prior studies have identified the multiple healthcare and psychosocial challenges that SGD cancer patients face, compared with their non-SGD counterparts.…”

“…SGD AYAs possess unique intersectional identities of SGD status and cancer as an AYA [1,18,19]. These experiences alone can lead to instances of extreme vulnerability and isolation.…”

Categorization of continuous covariates and complex regression models – friends or foes in intersectionality research

“…Intersectionality provides a framework for an integrated understanding on how characteristics of social privilege and disadvantage are involved in shaping inequalities in health and mortality [2]. Introduced by Kimberle Crenshaw, to express the synergistic experiences of Black women who experience multiple forms of oppression as both being Black and being female [3], the framework of intersectionality is being adopted to a wide range of population based research [4][5][6]. Essentially, intersectionality describes that inequalities between, e.g., women versus men, and immigrants versus non-immigrants, may not simply add for an immigrant woman.…”