Policy Issue Brief: Reducing Disparities in Cancer Care for Sexual and Gender Minority Individuals

May 25, 2018

ASCO's Policy Issue Briefs provide succinct overviews and relevant data on major policy issues impacting patients with cancer and the physicians who care for them. These briefs are designed to be especially helpful for journalists, offering background information on key issues across health policy today.  Access ASCO's full collection of Policy Issue Briefs.

Issue Overview

Sexual and gender minority (SGM) populations face unique challenges in accessing health services, including discrimination and greater risk of anxiety and depression, that can result in disparate care. SGM populations have low rates of cancer screening for reasons that include lower rates of insurance coverage, exclusion from traditional cancer screening campaigns, and previous experiences of discrimination when interacting with health care systems and providers.1,2,3 Because early diagnosis and prompt management are paramount in the management of many cancers, SGM patients with cancer may be more likely to seek care when the disease is at a later stage.4

Some examples of the disparities in cancer care that SGM individuals face include the fact that compared to heterosexual women, bisexual women were less likely to have health insurance, more likely to have been uninsured during the previous year, and more likely to have difficulty obtaining needed medical care.5 For gay and bisexual men, their odds of having an up-to-date prostate-specific antigen (or PSA) test—a blood test primarily used to screen for prostate cancer—was approximately 40% lower than heterosexuals’.6 And for transgender patients, one study found that 23% of respondents reported they did not seek needed health care in the year prior to completing the survey due to fear of being mistreated as a transgender person, and 33% did not go to a health care provider when needed because they could not afford it.7

Other Key Data Points

According to the National LGBT Cancer Network:

  • In a large study of women in the U.S. ages 50-79, bisexual women reported higher rates of any type of cancer than their heterosexual or lesbian counterparts. Additionally, breast cancer affects this demographic most, where risk factors such as never having given birth to a child are at their highest.8
  • Lesbian breast cancer survivors experience higher stress and lower satisfaction with their care, as well as more problems with chemotherapy side effects, than their heterosexual counterparts.9
  • Among the lesbian, gay, bisexual, and transgender (LGBT) demographic, bisexual women are the most likely never to have had a mammogram or pap test,10 a finding is supported by the Office of Disease Prevention and Health Promotion, which finds that lesbians are less likely to get preventive services for cancer.11 
  • Cigarette smoking among gay men is nearly double that of the general population.12 This is supported by the Office of Disease Prevention and Health Promotion’s findings that LGBT populations have the highest rates of tobacco, alcohol, and other drug use.13
  • The high-risk strains of HPV (human papillomavirus) that cause most cervical cancers in women also cause anal cancer. HPV is estimated to be present in 65% of gay men without HIV and 95% of those who are HIV positive.14

ASCO Efforts and Recommendation

Nearly 10 years ago, ASCO published its first policy statement about disparities in cancer care as it initiated a campaign to fold this goal into the Society’s overall mission. The statement voiced ASCO’s commitment to enhancing awareness of disparities; improving access to care; and supporting research on health disparities.

In April 2017, published a policy statement in the Journal of Clinical Oncology to address the needs of sexual and gender minority (SGM) populations as they relate to cancer. The recommendations were designed to focus attention on the challenges facing the SGM community—including discrimination and greater risk of anxiety and depression, resulting in disparate care—and provide concrete steps that can help minimize health disparities among SGM individuals. This attention to the care needs of the SGM population is part of ASCO’s larger and ongoing mission to reduce disparities in cancer care so that all patients have access to and receive high-quality care.

In the statement, which was reviewed by the Gay and Lesbian Medical Association (GLMA), ASCO calls for a coordinated effort to address health disparities among SGM populations, in the areas of:

  • Patient education and support 
  • Enhance patient navigation and care coordination
  • Expand education for SGM patients with cancer and survivors
  • Increase patient access to culturally competent support services
  • Create safe spaces for SGM patients
  • Increase cancer prevention education for SGM individuals 
  • Workforce development and diversity
  • Expand and promote cultural competency training
  • Incorporate SGM training into training curricula, training requirements, and certification exam content
  • Foster safe environments for SGM staff and providers
  • Integrate a Focus on SGM Physicians in Oncology Workforce Diversity Efforts: Quality improvement strategies
  • Collect and use SGM-relevant data for quality improvement
  • Ensure prompt follow-up and continuity of care
  • Policy solutions 
  • Create and enforce policies ensuring access to culturally competent, equitable cancer care
  • Ensure adequate insurance coverage to meet the needs of SGM individuals affected by cancer
  • Ensure policies prohibiting discrimination
  • Research strategies: 
  • Promote the inclusion of SGM status as a required data element in cancer registries and clinical trials
  • Promote research among SGM populations
  • Train the next generation of researchers.

For More Information

  • Read ASCO’s policy statement on recommendations for treating SGM patients with cancer.
  • Watch a video that gives an overview of this policy statement from Dr. Karen Winkfield.
  • Find additional resources related to this statement on ASCO’s patient information website, Cancer.Net, on the “Health Disparities Resources” page.
  • Read a Cancer.Net “Expert Q&A: Cancer-Related Health Disparities” interview with Dr. Winkfield
  • Read a Cancer.Net blog post about this statement by Jennifer J. Griggs, MD, MPH, lead author of the statement and Professor in the Department of Internal Medicine, Hematology & Oncology Division, and Department of Health Management & Policy at the University of Michigan.
  • Read ASCO’s policy statement on disparities in cancer care.
  • For the latest news and information on this and other cancer policy topics please visit http://ascoaction.asco.org.
  • To schedule a media interview with an ASCO spokesperson or oncology expert, please contact mediateam@asco.org.

 

 

References

1. Austin SB, Pazaris MJ, Nichols LP, et al: An examination of sexual orientation group patterns in mammographic and colorectal screening in a cohort of U.S. women. Cancer Causes Control 24:539-547, 2013.

2. Diamant AL, Wold C, Spritzer K, et al: Health behaviors, health status, and access to and use of health care: A population-based study of lesbian, bisexual, and heterosexual women. Arch FamMed 9:1043-1051, 2000.

3.Blosnich JR, Farmer GW, Lee JG, et al: Health inequalities among sexual minority adults: Evidence from tenU.S. states, 2010. AmJ PrevMed 46:337-349, 2014.

4. Quinn GP, Sanchez JA, Sutton SK, et al: Cancer and lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. CA Cancer J Clin 65:384-400, 2015

5.Diamant A.L., Wold, C., Spritzer, K., Gelberg, L. Health behaviors, health status, and access to and use of health care: a population-based study of lesbian, bisexual and heterosexual women. Archives Family Medicine, 9,10, 2000. p. 1043-1051.

6.Heslin, K, Gore,J., King, W., and Fox, S. (2009) Sexual Orientation and Testing for Prostate and Colorectal Cancers among Men in California. Medical Care. Dec. 2008; 46(12): 1240–1248.

7.“The Report of the 2015 U.S. Transgender Survey.” National Center for Transgender Equality. 2016. https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf. Accessed May 2, 2018.

8.Miller, M., André, A., Ebin, J., and Bessonova, L. (2007). Bisexual health: An introduction and model practices for HIV/STI prevention programming. New York: National Gay and Lesbian Task Force Policy Institute, the Fenway Institute at Fenway Community Health, and BiNet USA.

9.Matthews AK, Peterman AH, Delaney P, Menard L, Brandenburg D. A qualitative exploration of the experiences of lesbian and heterosexual patients with breast cancer. Oncology Nursing Forum. Nov-Dec;29(10), 2002. p. 1455-62.

10.Miller, M., André, A., Ebin, J., and Bessonova, L. (2007). Bisexual health: An introduction and model practices for HIV/STI prevention programming. New York: National Gay and Lesbian Task Force Policy Institute, the Fenway Institute at Fenway Community Health, and BiNet USA.

11.“Lesbian, Gay, Bisexual and Transgender Health.” Office of Disease Prevention and Health Promotion. https://cancer-network.org/wp-content/uploads/2017/02/HP_2020_LGBT_factSheet.pdf. Accessed May 2, 2018.

12.“LGBT Cancer Information.” National LGBT Cancer Network. https://cancer-network.org/cancer-information/. Accessed May 2, 2018.

13.“Lesbian, Gay, Bisexual and Transgender Health.” Office of Disease Prevention and Health Promotion. https://cancer-network.org/wp-content/uploads/2017/02/HP_2020_LGBT_factSheet.pdf. Accessed May 2, 2018. 

14.“LGBT Cancer Information.” National LGBT Cancer Network. https://cancer-network.org/cancer-information/. Accessed May 2, 2018.