Racial/Ethnic Differences in Health-Related Quality of Life Among Gay and Bisexual Prostate Cancer Survivors

Bates, Alex J.; Rosser, B. R. Simon; Polter, Elizabeth J.; Wheldon, Christopher W.; Talley, Kristine Mc; Haggart, Ryan; Wright, Morgan; Mitteldorf, Darryl; West, William; Ross, Michael W.; Konety, Badrinath R.; Kohli, Nidhi

doi:10.3389/fonc.2022.833197

Cited by 7 publications

(5 citation statements)

References 75 publications

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“…There is little research on psycho-social outcomes of TGD people with cancer ( 1 , 3 , 21 ), other than a recent study reporting higher rates of depression in TGD compared to cisgender people ( 22 ), and small scale qualitative research studies of TGD cancer survivorship experiences ( 8 , 23 , 24 ). This is also little research including LGBTQ people of color, migrants, and Aboriginal and Torres Strait Islander people ( 3 , 25 ). There is no research to date on the cancer experiences of people with intersex variations ( 1 ).…”

Section: Introductionmentioning

confidence: 99%

LGBTQI cancer patients’ quality of life and distress: A comparison by gender, sexuality, age, cancer type and geographical remoteness

Ussher

Allison²,

Perz³

et al. 2022

Front. Oncol.

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BackgroundThere is growing acknowledgement of the psycho-social vulnerability of lesbian, gay, bisexual, transgender, queer and/or intersex (LGBTQI) people with cancer. The majority of research to date has focused on cisgender adults with breast or prostate cancer.Study AimThis study examined psycho-social factors associated with distress and quality of life for LGBTQI cancer patients and survivors, across a range of sexualities and gender identities, intersex status, tumor types, ages and urban/rural/remote location using an intersectional theoretical framework.Method430 LGBTQI people with cancer completed an online survey, measuring distress, quality of life (QOL), and a range of psycho-social variables. Participants included 216 (50.2%) cisgender women, 145 (33.7%) cisgender men, and 63 (14.7%) transgender and gender diverse (TGD) people. Thirty-one (7.2%) participants reported intersex variation and 90 (20%) were adolescents or young adults (AYA), aged 15-39. The majority lived in urban areas (54.4%) and identified as lesbian, gay or bisexual (73.7%), with 10.9% identifying as bisexual, and 10.5% as queer, including reproductive (32.4%) and non-reproductive (67.6%) cancers.ResultsForty-one percent of participants reported high or very high distress levels, 3-6 times higher than previous non-LGBTQI cancer studies. Higher rates of distress and lower QOL were identified in TGD compared to cisgender people, AYAs compared to older people, those who identify as bisexual or queer, compared to those who identify as lesbian, gay or homosexual, and those who live in rural or regional areas, compared to urban areas. Elevated distress and lower QOL was associated with greater minority stress (discrimination in life and in cancer care, discomfort being LGBTQI, lower outness) and lower social support, in these subgroups. There were no differences between reproductive and non-reproductive cancers. For the whole sample, distress and poor QOL were associated with physical and sexual concerns, the impact of cancer on gender and LGBTQI identities, minority stress, and lack of social support.ConclusionLGBTQI people with cancer are at high risk of distress and impaired QOL. Research and oncology healthcare practice needs to recognize the diversity of LGBTQI communities, and the ways in which minority stress and lack of social support may affect wellbeing.

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Section: Introductionmentioning

confidence: 99%

LGBTQI cancer patients’ quality of life and distress: A comparison by gender, sexuality, age, cancer type and geographical remoteness

Ussher

Allison²,

Perz³

et al. 2022

Front. Oncol.

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“…Those Black SD women with breast cancer who engaged in cancer treatment often faced Healthcare Provider (HCP) assumptions, mistreatment and felt misunderstood during their care according to a review on the topic [7]. In addition, surveys have revealed that Black SGD prostate cancer survivors are more likely to have a lower health-related quality of life following treatment despite considering covariates [8] and Black and Hispanic SGD cancer survivors were 2 to 3 times more likely to experience depression and poor mental health in comparison with Black and Hispanic heterosexual cancer survivors [9 ▪ ].…”

Section: Resultsmentioning

confidence: 99%

Sexual and gender diversity in cancer care and survivorship

Schulz-Quach

Kennedy

Lyver

2023

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of the review Sexual and gender diverse (SGD) cancer patients possess unique identities and needs that must be considered during their cancer care. This narrative review explores the current literature on sexual and gender diversity in cancer care and survivorship, in addition to providing recommendations encouraged by the current literature. Recent findings We performed a literature search for articles published in English between January 2021 and June 2022 in Medline ALL and Embase. Fifty-two studies were included in this review. The many identities encapsulated in 2SLGBTQIA+ (2 Spirited, Lesbian, Gay, Bisexual, Transgender, Queer, Intersexual, Asexual, Agender, Aromantic and all gender identities and sexual orientations that are not listed) communities each have their own unique backgrounds, needs and disparities in cancer care and survivorship. However, we also identified specific protective factors in the cancer experience of SGD patients such as reports of higher resiliency and stronger support networks. Much of the recent research features recommendations on improving cancer care by creating inclusive patient questionnaires, improving in-person and online resources, and educating healthcare providers and patient-facing staff on inclusive care. Summary SGD patients have their own specific challenges during and following their cancer care. As the research continues to grow, we gain a better understanding of the needs of these patients and future steps to take to improve SGD patients’ cancer experience.

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“…Multivariable linear regression (MLR) was used to assess the unadjusted and adjusted mean differences of each HRQOL measure across discrimination as a binary variable. The following covariates were chosen a priori based on previous research: treatment type, time since treatment, age, HIV status, race/ethnicity (used as a proxy for experiences of racism), and education (Bates et al, 2022; Gong et al, 2017; Herek et al, 2002; Huebner et al, 2004; Kessler et al, 1999; Odeo & Degu, 2020; Polter et al, 2019; Rice et al, 2021; Ross et al, 2023; Rosser et al, 2020; Rosser, Polter, et al, 2022). To determine whether there was a dose–response for discrimination, all adjusted MLR models were run with the three-category EDS variable in place of the dichotomized EDS variable.…”

Section: Methodsmentioning

confidence: 99%

Discrimination against gay and bisexual patients in prostate cancer treatment: Results from the Restore-2 study.

Bates¹,

Ross²,

Rosser³

et al. 2023

Stigma and Health

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The purpose of this study was to examine the experiences of discrimination during prostate cancer treatment and assess the association with health-related quality of life (HRQOL) in a cohort of gay and bisexual men (GBM) prostate cancer survivors. This is a cross-sectional analysis of the 24-month follow-up survey from the Restore-2 clinical trial that tested the effectiveness of an online rehabilitation program tailored for GBM prostate cancer survivors in the United States. This analysis uses data from the 347 participants who completed all items of the Everyday Discrimination Scale (EDS) at the 24-month follow-up. A log-binomial regression model estimated the risk of experiencing discrimination across treatment received and demographic characteristics. Multivariable linear regression models estimated mean differences in HRQOL measures with discrimination as a binary variable after adjustment for relevant covariates. Nearly half (49.3%) of participants endorsed at least one experience of discrimination during prostate cancer treatment. About half (52%) of these rated the discrimination as "rare" (total EDS = 1-3), while 48% reported it as more common (total EDS ≥ 4). Most attributed the discrimination to their sexual orientation (35.5%) or their provider's attributes (29.6%). Those who underwent systemic/combined treatment (vs. either surgery or radiation only) and those with less than a bachelor's or graduate-level degree (vs. bachelor's degree) were more likely to report discrimination. Experiencing any discrimination was associated with significantly worse HRQOL outcomes. Discrimination during prostate cancer treatment appears to be a common experience for GBM patients and may result in poorer treatment outcomes. Clinical Impact StatementThis study found that discrimination is common for gay and bisexual men during their prostate cancer treatment and is also related to worse health-related quality of life outcomes. Experiences of discrimination were commonly attributed to the cancer survivor's sexual orientation or a characteristic of their health care provider. This study highlights the need to adequately train cancer providers in providing culturally responsive care to sexual and gender minority patients.

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Racial/Ethnic Differences in Health-Related Quality of Life Among Gay and Bisexual Prostate Cancer Survivors

Cited by 7 publications

References 75 publications

LGBTQI cancer patients’ quality of life and distress: A comparison by gender, sexuality, age, cancer type and geographical remoteness

LGBTQI cancer patients’ quality of life and distress: A comparison by gender, sexuality, age, cancer type and geographical remoteness

Sexual and gender diversity in cancer care and survivorship

Discrimination against gay and bisexual patients in prostate cancer treatment: Results from the Restore-2 study.

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