How can we meet the support needs of LGBT cancer patients in oncology? A systematic review

Abstract

Objectives: Approximately 3.6 million people in the UK identify as lesbian, gay, bisexual and transgender (LGBT). Fear of discrimination and lack of sexual orientation and gender identity recording suggests LGBT people are invisible to health services. A systematic review was conducted to critically analyse primary research investigating psychosocial support needs for LGBT cancer patients during and after treatment. Key findings: Twenty studies were included in the review; of which ten were qualitative, seven quantitative and three mixed methods. The main themes highlighted include health care professional knowledge and education, negative impact on mental health, lack of inclusive support groups, prevalence of discrimination within healthcare services and the disclosure or non-disclosure of sexual orientation and gender identity. Conclusion:The review highlights how healthcare providers are failing LGBT cancer patients in psychosocial support resulting in unmet needs. Recommendations have been made to ensure an LGBT inclusive environment within cancer services, as well as the need to develop support services for LGBT cancer patients. Implications for practice: Training should be provided for HCP staff in LGBT health and awareness. Sexual orientation and gender identity recording and monitoring is important to ensure LGBT people are not 'invisible' in oncology, radiotherapy and in future research. LGBT cancer support groups and resources should be created, as the review evidence suggests LGBT patients are actively looking for these resources.

Education to Improve Cancer Care for LGBTQ+ Patients in the UK

“…The differential impact of COVID-19 on Black and ethnic minority communities has highlighted this again, but other minority groups experience health inequalities and have unique healthcare needs. Members of the LGBTQþ (lesbian, gay, bisexual, queer or questioning) community are another such group and two recent articles have highlighted the importance of education for UK oncologists and other cancer care professionals in helping to achieve the best possible outcomes for these patients [1,2].…”

“…The unique needs of this population are wide ranging, and include behavioural trends affecting cancer incidence, such as higher rates of smoking and alcohol use, reduced screening uptake and inequalities in provision, and specific concerns around psychosexual function after treatment, fertility and end-of-life care. Highly cis-heteronormative spaces and assumptions by healthcare providers may reduce disclosure, meaning that these healthcare needs are frequently unmet [1]. Trans people may require integration of their gender-affirming care with their anti-cancer treatment or risk-reduction strategy in the case of cancer predisposition syndromes.…”

“…In their systematic review, Webster and Drury-Smith [1] found 'improvement of healthcare professionals' knowledge and education' as one of its five key themes in improving the support of LGBTQþ patients in oncology. A UK-wide study highlighted the need and desire among UK oncologists for further education on this topic [2].…”

“…This is perhaps because patient experience encompasses more than just the clinical interaction. A patient group that continues to face stigma and discrimination needs to encounter a healthcare environment that is inclusive [1]. This means training nonclinical staff in appropriate communication skills and cultural humility, and creating spaces with imagery that reflects a diverse population.…”

“…High-quality education is built on high-quality research, another theme identified by Webster and Drury-Smith [1] in improving LGBTQþ cancer care. This means better inclusion of this population in all research and increasing the number of co-produced studies into the specific healthcare inequalities of LGBTQþ patients as seen by patients themselves, and as identified through publicly available data.…”