Mapping gender and sexual minority representation in cancer research: a scoping review protocol

Abstract

People from gender and sexual minority (GSM) groups are at high risk of experiencing inequities throughout the cancer continuum. [1][2][3] Inequities are defined as unfair, unacceptable and avoidable differences in health resulting from unequal distribution of power, prestige and resources across groups. 4,5 This risk is primarily attributed to the heterocisnormative environment of the health and cancer systems that discriminates against GSM populations and invalidates their experiences. Heterocisnormativity is defined as "the assumption that heterosexuality is the standard for defining normal sexual behavior and that male-female differences and gender roles are the natural and immutable essentials in normal human relations." 6 In the cancer system, this manifests in many ways, including a lack of GSM identifiers in cancer registries, [7][8][9] the exclusion of people from GSM groups from organized cancer screening programs, 10 a lack of culturally appropriate care, 7,11 and individuals from GSM groups with cancer experiencing homophobia and transphobia, and discrimination from cancer care providers. 7,11,12 The implications of heterocisnormativity are profound and observed in the cancer-related inequities GSM populations experience, such as lower screening rates, [13][14][15] higher incidence of viral-related cancers (e.g., HPV), 1,16 and receipt of culturally inappropriate and unsafe care. 12,17,18 Addressing these inequities necessitates a robust synthesis of existing research. Most knowledge syntheses on this topic have been narrative in nature. Few systematic reviews exist, and those that do have focused on specific phases of the cancer continuum (i.e., psychosocial care and survival) 19,20 or only included studies within a limited time frame. 21 Systematic data are lacking on cancer outcomes and experiences of people from GSM groups through all phases of the cancer continuum. In this review, we seek to address this gap through systematically mapping the evidence base describing cancer outcomes for adults from GSM groups and exploring the literature describing cancer care experiences for this population. This scoping review will answer the broad question of