‘Distressing’ data show LGBTQ+ cancer survivors at higher risk for chronic health issues
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Key takeaways:
- LGBTQ+ cancer survivors had increased odds of several health conditions and limitations.
- Transgender and gender non-conforming survivors had the highest odds for developing chronic health conditions.
Cancer survivors who identify as LGBTQ+ had increased risk for numerous chronic health issues compared with non-LGBTQ+ survivors, results from a survey study showed.
A deeper breakdown found survivors who identified as transgender and gender non-conforming had the highest odds for developing most of the investigated conditions, disabilities and limitations, according to findings published in Cancer Epidemiology, Biomarkers & Prevention.
“LGBTQ+ cancer survivors — and particularly transgender and gender non-conforming survivors — are sicker than non-LGBTQ+ cancer survivors and are in need of access to high-quality LGBTQ+-inclusive care,” Austin R. Waters, MSPH, predoctoral fellow at the Lineberger Comprehensive Cancer Center and doctoral candidate at University of North Carolina at Chapel Hill, told Healio.
Background and methodology
More than 18 million cancer survivors lived in the U.S. in 2022, and although expanded screening and improved treatments have helped individuals live longer, their extended life has also opened survivors up to other medical issues, according to background information researchers provided.
Previous studies have found survivors have a higher likelihood of developing chronic health conditions such as heart, kidney and liver disease and diabetes compared with individuals who have not had cancer.
The LGBTQ+ community makes up more than 7% of the U.S. population, and prior research suggests they have health inequities compared with non-LGBTQ+ individuals.
Waters and colleagues noted studies that found gay and bisexual men had a higher likelihood of asthma and chronic kidney disease than heterosexual men, and lesbian and bisexual women survivors had increased odds of heart conditions, chronic obstructive pulmonary disease (COPD) and psychological distress compared with non-lesbian and bisexual survivors.
“We know that anti-LGBTQ+ stigma and discrimination drive poor health outcomes among LGBTQ+ populations in general,” Waters said. “Thinking about how LGBTQ+ cancer survivors’ health compares with non-LGBTQ+ cancer survivors’ is an important question because it begins to disentangle what the driving forces of such inequities are.”
Researchers wanted to “assess differences in the age-adjusted prevalence of chronic health conditions, disabilities, as well as physical and cognitive limitations reported by LGBTQ+ and non-LGBTQ+ cancer survivors,” they wrote.
They used the Behavioral Risk Factor Surveillance System, which has collected health-related data via telephone surveys since 1984, to build their study cohort.
The analysis included participants from 23 states who completed both cancer survivorship and sexual orientation and gender identity questionnaires from 2020 to 2022.
The study cohort consisted of 40,990 survivors (4.2% LGBTQ+ — 1.5% lesbian or gay; 1.6% bisexual; 1.2% non-heterosexual orientation; 0.3% transgender or non-conforming).
Researchers evaluated rates of angina, asthma, COPD, depressive disorder, heart disease, kidney disease, stroke, diabetes, hearing disability, vision disability, cognitive limitation, difficulty walking, difficulty dressing and difficulty running errands.
Results and next steps
Survivors who identified as LGBTQ+ had higher age-adjusted rates of all conditions, disabilities and limitations evaluated compared with non-LGBTQ+ individuals.
When researchers adjusted for age, survey year, state, race and ethnicity, smoking status, education, and household income, LGBTQ+ survivors had increased likelihood of asthma (adjusted OR = 1.54; 95% CI, 1.24-1.91), depressive disorders (adjusted OR = 1.94; 95% CI, 1.6-2.36), kidney disease (adjusted OR = 1.54; 95% CI, 1.12-2.11), stroke (adjusted OR = 1.71; 95% CI, 1.27-2.31), diabetes (adjusted OR = 1.3; 95% CI, 1.02-1.64), vision disability (adjusted OR = 1.61; 95% CI, 1.2-2.18), cognition limitation (adjusted OR = 2.3; 95% CI, 1.81-2.91), difficulty walking (adjusted OR = 1.65; 95% CI, 1.33-2.04), difficulty dressing (adjusted OR = 2.02; 95% CI, 1.48-2.74) and difficulty running errands (adjusted OR = 1.63; 95% CI, 1.25-2.13).
Further analysis showed transgender and gender non-conforming individuals, after adjustments, had significantly higher likelihood of heart disease (adjusted OR = 3.67; 95% CI, 1.27-10.63), asthma (adjusted OR = 2.34; 95% CI, 1.21-4.55), COPD (adjusted OR = 3.07; 95% CI, 1.53-6.17), myocardial infarction (adjusted OR = 5.7; 95% CI, 2.53-12.86), kidney disease (adjusted OR = 6.03; 95% CI, 2.73-13.34), stroke (adjusted OR = 4.39; 95% CI, 1.63-11.83), diabetes (adjusted OR = 3.85; 95% CI, 1.69-8.75), hearing disabilities (adjusted OR = 3.05; 95% CI, 1.11-8.37), vision disabilities (adjusted OR = 3.68; 95% CI, 1.8-7.52), cognitive limitations (adjusted OR = 4.37; 95% CI, 2.33-8.2), difficulty walking (adjusted OR = 2.66; 95% CI, 1.49-4.72), difficulty dressing (adjusted OR = 4.37, 95% CI, 2.08-9.21) and difficulty running errands (adjusted OR = 3.08, 95% CI, 1.43-6.65).
“Transgender and gender non-conforming individuals are some of the most marginalized people in the LGBTQ+ community,” Waters said. “They experience more barriers to health care, more discrimination, more exclusion, more violence and other factors than LGB individuals. While distressing, these findings were not necessarily surprising.”
Researchers noted limitations of the study included self-reported data, lack of cancer treatment data, and participants potentially being healthier than other survivors.
“There are a variety of directions that future research could go from this study,” Waters said. “Our next steps include further investigation of how some of the outcomes analyzed in this study such as depression, cognitive limitations, and difficulty walking and running errands are intertwined with financial and employment issues among LGBTQ+ cancer survivors after treatment.”
Researchers also stressed the need for societal and policy changes to deal with these disparities, but clinicians can begin addressing these issues as well.
“This starts with ensuring that clinical spaces are welcoming to LGBTQ+ populations and that informational material, programming, and more do not include unnecessarily gendered or heteronormative language,” Waters said. “Intake forms should ask about sexual orientation and gender identity in inclusive ways to the LGBTQ+ population. Imagery in clinic spaces should reflect the LGBTQ+ population. Clinicians should engage in education and training to be prepared to talk about LGBTQ+-specific topics with their patients.”
References:
- Among cancer survivors, LGBTQ+ individuals report higher prevalence of chronic health conditions, disabilities, other limitations (press release). Available at: https://www.aacr.org/about-the-aacr/newsroom/news-releases/among-cancer-survivors-lgbtq-individuals-report-higher-prevalence-of-chronic-health-conditions-disabilities-other-limitations/. Posted June 20, 2024; Accessed June 20, 2024.
- Waters AR, et al. Cancer Epidemiol, Biomarkers Prev. 2024;doi:10.1158/1055-9965.EPI-24-0166.
For more information:
Austin R. Waters, MSPH, can be reached at awaters@unc.edu.
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Waters AR, et al. Cancer Epidemiol, Biomarkers Prev. 2024;doi:10.1158/1055-9965.EPI-24-0166.
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