Chronic health conditions ‘very worrisome’ among lesbian, gay, bisexual cancer survivors
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Key takeaways:
- Lesbian, gay and bisexual AYA cancer survivors reported more frequent chronic diseases.
- Younger SGM survivors are more likely to have incomes between 100% and 200% of the federal poverty level.
Lesbian, gay and bisexual survivors of adolescent and young cancer are twice as likely to develop chronic health conditions than their heterosexual counterparts, according to a study published in Cancer.
Results from the analysis show that sexual gender minority (SGM) cancer survivors are less likely to be married and more likely to be impoverished than heterosexual survivors, as well as lesbian, gay and bisexual adolescents and young adults (AYAs) who have not been diagnosed with cancer.
“Unfortunately, when people face disparities in their lives, including limited access to and utilization of health care, they often have other poor health and social outcomes. Adding a cancer diagnosis and treatment during the AYA years to an already vulnerable population likely exacerbates underlying disparities,” Michael E. Roth, MD, professor of pediatrics and medical director of cancer survivorship at The University of Texas MD Anderson Cancer Center, told Healio. “The fact that survivors of [adolescent and young adult] cancer overall have many health challenges, we were worried that the higher rates of chronic health conditions that we’ve seen in racial and ethnic minority survivors would also translate into the sexual gender minority populations, and that is what we found.
Background and methodology
There are roughly 90,000 new cancer diagnoses for AYAs between the ages of 15 and 39 years every year. The average 5-year survival rate for this group has risen to more than 85% due to early detection and treatment, according to background data provided by the study’s investigators.
Nevertheless, AYA cancer survivors have about a significantly increased risk for developing a chronic condition, the researchers noted. Different races are more vulnerable to additional health issues, they added, but few studies have examined whether the same is true for AYAs of non-heterosexual orientation.
Roth and colleagues conducted a cross-sectional study to explore the impact of socioeconomic factors on chronic health conditions among lesbian, gay and bisexual AYA cancer survivors compared with heterosexual AYA cancer survivors and gay, lesbian and bisexual AYAs who have not received a cancer diagnosis.
The analysis used data collected between 2013 and 2020 from 646,879 respondents to the National Health Interview Survey, a self-reported household interview that includes a sexual orientation question.
The study group included 3,570 individuals comprising 170 lesbian, gay and bisexual survivors, 1,700 lesbian, gay and bisexuals without a cancer history, and 1,700 heterosexual survivors.
The survey asked respondents whether they had been previously diagnosed by a health care professional with any chronic conditions, including cardiovascular disease, hypertension, arthritis, pulmonary disease, stroke and type 2 diabetes.
Results
Lesbian, gay and bisexual survivors of AYA cancer reported having at least one chronic condition at significantly higher rates than those without a cancer history (71% vs. 51%; OR = 2.45; 95% CI, 1.57-3.65), as well as two or more conditions (21% vs. 7.7%; P < .001). Likewise, lesbian, gay and bisexual survivors reported significantly higher rates of a least one (71% vs. 59%; OR = 2.16; 95% CI, 1.25-2.89) or two or more (21% vs. 15.1%; P = .023) chronic health conditions compared with heterosexual AYA survivors.
Cardiovascular disease, arthritis and pulmonary disease occurred more frequently among lesbian, gay and bisexual AYA survivors compared with the two other study groups. Meanwhile, stroke occurred more frequently among lesbian, gay and bisexual AYA survivors compared with SGMs who had not been diagnosed with cancer.
Researchers also found lesbian, gay and bisexual AYA survivors less likely to be married than heterosexual survivors (P = .001) and more likely to never have been married (P < .001).
Lesbian, gay and bisexual AYA survivors had incomes between 100% and 200% of the federal poverty level more often than heterosexual survivors (P = .021) and SGMs without a cancer diagnosis (P = .012).
The study’s main limitation included use of self-reported data from the National Health Interview Survey, which researchers cautioned could result in undiagnosed or misreported chronic conditions.
Next steps
“Concerned and worried and driven to really understand why this difference is there,” Roth said in reaction to the results.
“We need to think about the impact of a cancer diagnosis not just on physical health, but on all areas of an individual’s life and health,” Roth said. “I would argue that we need to think holistically, including where patients are in their life stage. What are the factors that could put them at higher risk for having poorer health and psychosocial outcomes? And how can we provide more services for those patients? The poor socioeconomic outcomes identified are very worrisome.”
Fixing the problem starts with asking difficult questions, he added.
“Many of our providers don’t ask questions about patients’ sexual orientation or gender identity, often because they don’t know what to do with that information or they may feel uncomfortable with that information, but we’re showing here it’s important to understand key components of patients’ lives that could impact their long-term health,” Roth told Healio. “We must understand that patients who are from the sexual and gender minorities have higher risks for impaired long-term health and increase support, resources, and access to high-quality health care to improve their trajectory.”
For more information:
Michael E. Roth, MD, can be reached at mroth1@mdanderson.org.
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