Sexual minority cancer survivors face disparities in access to care and quality of life

Results from a study published early online in Cancer, a peer-reviewed journal of the American Cancer Society, point to the need for improved access to medical care for sexual minority cancer survivors, in particular female survivors. In female cancer survivors, poor access to care is more strongly related to poor quality of life among sexual minorities compared with heterosexuals.

Access to quality medical care is critical to the long-term health and well-being of cancer survivors. Evidence from non-cancer-related studies indicates that sexual minorities—including lesbian, gay, bisexual, or other non-heterosexual identified individuals—have worse access to care, but previous studies have not examined the issue among cancer survivors.

To assess sexual minority cancer survivors' access to care and their quality of life, Boston University School of Public Health's Ulrike Boehmer, Ph.D., and Jessica Gereige, MD, along with their colleagues, examined four years of Behavioral Risk Factor Surveillance Survey data on U.S. men and women who reported a history of cancer. Among the 70,524 cancer survivors, 1,931 identified themselves as sexual minorities.

"While we have extensive cancer surveillance in the U.S., sexual minority cancer survivors are excluded from surveillance, which means we have very limited information about this group. This study therefore provides much needed information about sexual minority cancer survivors," said Dr. Gereige.

Compared with heterosexual women, sexual minority women were more likely to report having no health insurance, being without a personal physician, avoiding medical care due to costs, and being without an annual medical visit. Among men, sexual minority men were more likely to avoid medical care due to costs, but men of all sexual orientations had similar access to care with respect to insurance status, having a personal physician, and annual visits.

Sexual minority women's access to care had a stronger association with three quality of life measures compared with heterosexual women. Specifically, deficits in access to care were linked with a greater likelihood of poor physical quality of life, poor mental quality of life, and difficulty concentrating among sexual minority women compared with heterosexual women. In men, deficits in access to care were linked with a higher likelihood of difficulty concentrating among sexual minorities than heterosexuals. Also, sexual minority status increased the likelihood of poor mental quality of life in men.

"Our study shows that sexual minority women suffer from poor access to care and that this is linked to worse quality of life. Since poor quality of life is linked to worse cancer survival rates, this calls for policy changes to improve access to care for sexual minority cancer survivors," said Dr. Boehmer. "The study's findings also point to an opportunity for clinicians to address difficulties in access to care with patients during treatment discussions, or at the completion of cancer therapy and during follow up visits. Clinicians who are aware of these disparities and address them during clinic visits may have an impact on sexual minority women's survival rates, which are lower than their heterosexual counterparts' rates."