Skip to main content

Needs of LGBT Cancer Survivors

  • Chapter
  • First Online:
Cancer and the LGBT Community

Abstract

Lesbian, gay, bisexual, and transgender (LGBT) cancer survivors in the United States have unique needs that may go unaddressed in cancer care. Many of these needs center around deciding whether or not to disclose LGBT identity and how to include diverse supportive others in the medical decision making and treatment experience. Others arise from disparities that impact the LGBT community at large and that may be further complicated by a diagnosis of cancer. In this chapter, we outline several specific needs, including: acceptance of identity disclosure, respect for unique social support systems, understanding of LGBT sexuality, and reduction of gender expectations. We underscore these needs by including quotes from LGBT survivors describing their experiences receiving a cancer diagnosis and seeking cancer treatment. We also discuss tailored and LGBT-friendly support services, cultural competence in providing cancer care, and interventions to address specific disparities that impact LGBT survivors. We close with recommendations for future service development and research.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Gates G. How many people are lesbian, gay, bisexual, and transgender? Los Angeles: The Williams Institute, UCLA School of Law; 2011.

    Google Scholar 

  2. LIVESTRONG Foundation. Coming out with cancer. Austin: LIVESTRONG Foundation; 2010.

    Google Scholar 

  3. Mariotto AB, Rowland JH, Yabroff KR, et al. Long-term survivors of childhood cancers in the United States. Cancer Epidemiol Biomarkers Prev. 2009;18(4):1033–40.

    Article  PubMed  Google Scholar 

  4. Howlader N, Ries LA, Mariotto AB, Reichman ME, Ruhl J, Cronin KA. Improved estimates of cancer-specific survival rates from population-based data. J Natl Cancer Inst. 2010;102(20):1584–98.

    Google Scholar 

  5. Boehmer U. Twenty years of public health research: inclusion of lesbian, gay, bisexual, and transgender populations. Am J Public Health. 2002;92(7):1125–30.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Sell RL, Becker JB. Sexual orientation data collection and progress toward healthy people 2010. Am J Public Health. 2001;91(6):876–82.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Margolies L, Scout NFN. LGBT patient-centered outcomes: cancer survivors teach us how to improve care for all: national LGBT cancer network; April 2013.

    Google Scholar 

  8. Kamen C, Margolies L, Smith-Stoner M, et al. Correlates and outcomes of Lesbian, Gay, Bisexual, and Transgender (LGBT) identity disclosure to cancer care providers. Multinational Association of Supportive Care in Cancer. Miami, FL; 2014.

    Google Scholar 

  9. Holland JC, Bultz BD, National comprehensive Cancer N. The NCCN guideline for distress management: a case for making distress the sixth vital sign. J Natl Compr Cancer Netw. 2007;5(1):3–7.

    Google Scholar 

  10. Jepson C, McCorkle R, Adler D, Nuamah I, Lusk E. Effects of home care on caregivers’ psychosocial status. Image J Nurs Sch. 1999;31(2):115–20.

    Article  CAS  PubMed  Google Scholar 

  11. Parle M, Jones B, Maguire P. Maladaptive coping and affective disorders among cancer patients. Psychol Med. 1996;26(4):735–44.

    Article  CAS  PubMed  Google Scholar 

  12. Sheard T, Maguire P. The effect of psychological interventions on anxiety and depression in cancer patients: results of two meta-analyses. Br J Cancer. 1999;80(11):1770–80.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Lerman C, Kash K, Stefanek M. Younger women at increased risk for breast cancer: perceived risk, psychological well-being, and surveillance behavior. J Natl Cancer Inst Monogr. 1994(16):171–6.

    Google Scholar 

  14. Buchmueller T, Carpenter CS. Disparities in health insurance coverage, access, and outcomes for individuals in same-sex versus different-sex relationships, 2000–2007. Am J Public Health. 2010;100(3):489–95.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Herek GM. Hate crimes and stigma-related experiences among sexual minority adults in the United States: prevalence estimates from a national probability sample. J Interpers Violence. 2009;24(1):54–74.

    Article  PubMed  Google Scholar 

  16. Ryan C, Russell ST, Huebner D, Diaz R, Sanchez J. Family acceptance in adolescence and the health of LGBT young adults. J Child Adolesc Psychiatr Nurs. 2010;23(4):205–13.

    Article  PubMed  Google Scholar 

  17. Ganz PA, Desmond KA, Leedham B, Rowland JH, Meyerowitz BE, Belin TR. Quality of life in long-term, disease-free survivors of breast cancer: a follow-up study. J Natl Cancer Inst. 2002;94(1):39–49.

    Article  PubMed  Google Scholar 

  18. Kornblith AB, Herndon JE, 2nd, Zuckerman E, et al. Social support as a buffer to the psychological impact of stressful life events in women with breast cancer. Cancer. 2001;91(2):443–54.

    Google Scholar 

  19. Kornblith AB, Ligibel J. Psychosocial and sexual functioning of survivors of breast cancer. Semin Oncol. 2003;30(6):799–813.

    Article  PubMed  Google Scholar 

  20. Low CA, Stanton AL, Thompson N, Kwan L, Ganz PA. Contextual life stress and coping strategies as predictors of adjustment to breast cancer survivorship. Ann Behav Med. 2006;32(3):235–44.

    Article  PubMed  Google Scholar 

  21. Mehnert A, Koch U. Psychological comorbidity and health-related quality of life and its association with awareness, utilization, and need for psychosocial support in a cancer register-based sample of long-term breast cancer survivors. J Psychosom Res. 2008;64(4):383–91.

    Article  PubMed  Google Scholar 

  22. Baider L, Andritsch E, Uziely B, et al. Effects of age on coping and psychological distress in women diagnosed with breast cancer: review of literature and analysis of two different geographical settings. Crit Rev Oncol Hematol. 2003;46(1):5–16.

    Article  CAS  PubMed  Google Scholar 

  23. Boehmer U, Freund KM, Linde R. Support providers of sexual minority women with breast cancer: who they are and how they impact the breast cancer experience. J Psychosom Res. 2005;59(5):307–14.

    Article  PubMed  Google Scholar 

  24. Boehmer U, Linde R, Freund KM. Sexual minority women’s coping and psychological adjustment after a diagnosis of breast cancer. J Women’s Health. 2005;14(3):214–24.

    Article  Google Scholar 

  25. Durso LE, Meyer IH. Patterns and predictors of disclosure of sexual orientation to healthcare providers among lesbians, gay men, and bisexuals. Sex Res Social Policy. 2013;10(1):35–42.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49(9):796–804.

    CAS  PubMed  Google Scholar 

  27. Savin-Williams RC. Verbal and physical abuse as stressors in the lives of lesbian, gay male, and bisexual youths: associations with school problems, running away, substance abuse, prostitution, and suicide. J Consult Clin Psychol. 1994;62(2):261–9.

    Article  CAS  PubMed  Google Scholar 

  28. Grossman AH, Daugelli AR, Hershberger SL. Social support networks of lesbian, gay, and bisexual adults 60 years of age and older. J Gerontol. 2000;55(3):171–9.

    Article  Google Scholar 

  29. Badger T, Segrin C, Dorros SM, Meek P, Lopez AM. Depression and anxiety in women with breast cancer and their partners. Nurs Res. 2007;56(1):44–53.

    Article  PubMed  Google Scholar 

  30. Northouse L, Williams AL, Given B, McCorkle R Psychosocial care for family caregivers of patients with cancer. J Clin Oncol. 2012;30(11):1227–34.

    Article  PubMed  Google Scholar 

  31. Given BA, Given CW, Sherwood PR. Family and caregiver needs over the course of the cancer trajectory. J Support Oncol. 2012;10(2):57–64.

    Article  PubMed  Google Scholar 

  32. Kamen C, Burns M, Beach SR. Minority stress in same-sex male relationships: when does it impact relationship satisfaction? J Homosex. 2011;58(10):1372–90.

    Article  PubMed  Google Scholar 

  33. Hatzenbuehler ML, Keyes KM, Hasin DS. State-level policies and psychiatric morbidity in lesbian, gay, and bisexual populations. Am J Public Health. 2009;99(12):2275–81.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Ida DJ. Cultural competency and recovery within diverse populations. Psychiatric Rehabilitation J. Summer 2007;31(1):49–53.

    Article  CAS  Google Scholar 

  35. Knight SJ, Latini DM. Sexual side effects and prostate cancer treatment decisions: patient information needs and preferences. Cancer J. 2009;15(1):41–4.

    Article  PubMed  Google Scholar 

  36. Blank TO. Gay men and prostate cancer: invisible diversity. J Clin Oncol. 2005;23(12):2593–96.

    Article  PubMed  Google Scholar 

  37. Al-Ghazal SK, Sully L, Fallowfield L, Blamey RW. The psychological impact of immediate rather than delayed breast reconstruction. Eur J Surg Oncol. 2000;26(1):17–9.

    Article  CAS  PubMed  Google Scholar 

  38. Boehmer U, Linde R, Freund KM. Breast reconstruction following mastectomy for breast cancer: the decisions of sexual minority women. Plast Reconstr Surg. 2007;119(2):464–72.

    Article  CAS  PubMed  Google Scholar 

  39. Hoyt MA, Stanton AL, Irwin MR, Thomas KS. Cancer-related masculine threat, emotional approach coping, and physical functioning following treatment for prostate cancer. Health Psychol. 2013;32(1):66–74.

    Article  PubMed  Google Scholar 

  40. Davies NJ, Kinman G, Thomas RJ, Bailey T. Information satisfaction in breast and prostate cancer patients: implications for quality of life. Psychooncology. 2008;17(10):1048–52.

    Article  PubMed  Google Scholar 

  41. Palacios R, Pascual J, Cabrera E, Lebrón JM, Guerrero-León MA, del Arco A, Santos J. Lung cancer in HIV-infected patients. Int J STD & AIDS. 2013. 0956462413499317.

    Google Scholar 

  42. Hou W, Fu J, Ge Y, Du J, Hua S. Incidence and risk of lung cancer in HIV-infected patients. J Cancer Res Clin Oncol. 2013;139(11):1781–94.

    Article  PubMed  Google Scholar 

  43. Matthews AK, Li CC, Kuhns LM, Tasker TB, Cesario JA. Results from a community-based smoking cessation treatment program for LGBT smokers. J Environ Public Health. 2013;2013:984508.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Kamen C, Palesh O, Gerry A, et al. Disparities in health risk behavior and psychological distress among gay versus heterosexual cancer survivors. (In submission).

    Google Scholar 

  45. Eliason MJ, Dibble SL, Gordon R, Soliz GB. The last drag: an evaluation of an LGBT-specific smoking intervention. J Homosex. 2012;59(6):864–78.

    Article  PubMed  Google Scholar 

  46. Johns MM, Pingel ES, Youatt EJ, Soler JH, McClelland SI, Bauermeister JA. LGBT community, social network characteristics, and smoking behaviors in young sexual minority women. Am J Commun Psychol. 2013;52(1–2):141–54.

    Article  Google Scholar 

  47. Holly EA, Lele C Non-Hodgkin’s lymphoma in HIV-positive and HIV-negative homosexual men in the San Francisco Bay Area: allergies, prior medication use, and sexual practices. J Acquir Immune Defic Syndr Hum Retrovirol. 1997;15(3):211–22.

    Article  CAS  PubMed  Google Scholar 

  48. Gopal S, Patel MR, Yanik EL, et al. Association of early HIV viremia with mortality after HIV-associated lymphoma. AIDS. 2013;27(15):2365–73.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  49. Jabson JM, Blosnich JR. Representation of lesbian, gay, and bisexual people in clinical cancer trials. Ann Epidemiol. 2012;22(11):821–3.

    Article  PubMed Central  PubMed  Google Scholar 

  50. Katz A. Gay and lesbian patients with cancer. Oncol Nurs Forum. 2009;36(2):203–7.

    Article  PubMed  Google Scholar 

  51. Boehmer U, Glickman M, Milton J, Winter M. Health-related quality of life in breast cancer survivors of different sexual orientations. Qual Life Res. 2012;21(2):225–36.

    Article  PubMed  Google Scholar 

  52. Boehmer U, Cooley TP, Clark MA. Cancer and men who have sex with men: a systematic review. Lancet Oncol. 2012;13(12):e545–e53.

    Article  PubMed  Google Scholar 

  53. Boehmer U, Miao X, Ozonoff A Cancer survivorship and sexual orientation. Cancer. 2011;117(16):3796–804.

    Article  PubMed  Google Scholar 

  54. Carmack Taylor CL, Kulik J, Badr H, et al. A social comparison theory analysis of group composition and efficacy of cancer support group programs. Soc Sci Med. 2007;65(2):262–73.

    Article  PubMed  Google Scholar 

  55. Ussher JM, Kirsten L, Butow P, Sandoval M. A qualitative analysis of reasons for leaving, or not attending, a cancer support group. Soc Work Health Care. 2008;47(1):14–29.

    Article  PubMed  Google Scholar 

  56. Boehmer U, Glickman M, Winter M, Clark MA. Lesbian and bisexual women’s adjustment after a breast cancer diagnosis. J Am Psychiatr Nurses Assoc. 2013;19(5):280–92.

    Article  PubMed  Google Scholar 

  57. Garnets L, Hancock KA, Cochran SD, Goodchilds J, Peplau LA. Issues in psychotherapy with lesbians and gay men. A survey of psychologists. Am Psychol. 1991;46(9):964–72.

    Article  CAS  PubMed  Google Scholar 

  58. Cochran SD, Mays VM, Sullivan JG. Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. J Consult Clin Psychol. 2003;71(1):53–61.

    Article  PubMed Central  PubMed  Google Scholar 

  59. Willging CE, Salvador M, Kano M. Brief reports: unequal treatment: mental health care for sexual and gender minority groups in a rural state. Psychiatr Serv. 2006;57(6):867–70.

    Article  PubMed  Google Scholar 

  60. Berg MB, Mimiaga MJ, Safren SA. Mental health concerns of gay and bisexual men seeking mental health services. J Homosex. 2008;54(3):293–306.

    Article  PubMed  Google Scholar 

  61. Price M, Butow P, Kirsten L. Support and training needs of cancer support group leaders: a review. Psychooncology. 2006;15(8):651–63.

    Article  PubMed  Google Scholar 

  62. Margolies L Families of choice; Sources of support for LGBT cancer survivors. LIVESTRONG Foundation Blog: LIVESTRONG Foundation; 2013.

    Google Scholar 

  63. Corliss HL, Belzer M, Forbes C, Wilson EC. An evaluation of service utilization among male to female transgender youth: qualitative study of a clinic-based sample. J LGBT Health Res. 2007;3(2):49–61.

    Article  PubMed  Google Scholar 

  64. Thomas C, Wootten A, Robinson P. The experiences of gay and bisexual men diagnosed with prostate cancer: results from an online focus group. Eur J Cancer Care. 2013;22(4):522–9.

    Article  CAS  Google Scholar 

  65. Winzelberg AJ, Classen C, Alpers GW, et al. Evaluation of an internet support group for women with primary breast cancer. Cancer. 2003;97(5):1164–73.

    Article  PubMed  Google Scholar 

  66. Resnicow K, Baranowski T, Ahluwalia JS, Braithwaite RL. Cultural sensitivity in public health: defined and demystified. Ethn Dis. Winter 1999;9(1):10–21.

    Google Scholar 

  67. Chambers SK, Ferguson M, Gardiner RA, Aitken J, Occhipinti S. Intervening to improve psychological outcomes for men with prostate cancer. Psychooncology. 2013;22(5):1025–34.

    Article  PubMed  Google Scholar 

  68. Palefsky J. Human papillomavirus and anal neoplasia. Curr HIV/AIDS Rep. 2008;5(2):78–85.

    Article  PubMed  Google Scholar 

  69. Brotman S, Ryan B, Cormier R. The health and social service needs of gay and lesbian elders and their families in Canada. Gerontologist. 2003;43(2):192–202.

    Article  PubMed  Google Scholar 

  70. Institute of Medicine. The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding. Washington, DC; 2011.

    Google Scholar 

  71. Rankin KM, David RJ, Collins JW Jr. African American women's exposure to interpersonal racial discrimination in public settings and preterm birth: the effect of coping behaviors. Ethn Dis. Summer 2011;21(3):370–6.

    Google Scholar 

  72. Davies B, Larson J, Contro N, Cabrera AP. Perceptions of discrimination among Mexican American families of seriously ill children. J Palliat Med. 2011;14(1):71–6.

    Article  PubMed Central  PubMed  Google Scholar 

  73. Grant JM, Mottet LA, Tanis J. National transgender discrimination survey: report on health and health care. Washington, DC: National Center for Transgender Equality; October 2010.

    Google Scholar 

  74. McNair R. Outing lesbian health in medical education. Women Health. 2003;37(4):89–103.

    Article  PubMed  Google Scholar 

  75. Gonser PA. Culturally competent care for members of sexual minorities. J Cult Divers. 2000 Fall;7(3):72–5.

    Google Scholar 

  76. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97.

    Article  PubMed Central  PubMed  Google Scholar 

  77. Stanton AL. Psychosocial concerns and interventions for cancer survivors. J Clin Oncol. 2006;24(32):5132–37.

    Article  PubMed  Google Scholar 

  78. Deimling GT, Bowman KF, Sterns S, Wagner LJ, Kahana B. Cancer-related health worries and psychological distress among older adult, long-term cancer survivors. Psychooncology. 2006;15(4):306–20.

    Article  PubMed  Google Scholar 

  79. Hamer M, Chida Y, Molloy GJ. Psychological distress and cancer mortality. J Psychosom Res. 2009;66(3):255–8.

    Article  PubMed  Google Scholar 

  80. Schwartz CL. Long-term survivors of childhood cancer: the late effects of therapy. Oncologist. 1999;4(1):45–54.

    CAS  PubMed  Google Scholar 

  81. Cochran SD, Mays VM. Burden of psychiatric morbidity among lesbian, gay, and bisexual individuals in the California quality of life survey. J Abnorm Psychology. 2009;118(3):647–58.

    Article  Google Scholar 

  82. Hecht SS. Tobacco smoke carcinogens and lung cancer. J Natl Cancer Inst. 1999;91(14):1194–210.

    Article  CAS  PubMed  Google Scholar 

  83. Marron M, Boffetta P, Zhang ZF, et al. Cessation of alcohol drinking, tobacco smoking and the reversal of head and neck cancer risk. Int J Epidemiol. 2010;39(1):182–96.

    Article  PubMed Central  PubMed  Google Scholar 

  84. Ostroff JS, Jacobsen PB, Moadel AB, et al. Prevalence and predictors of continued tobacco use after treatment of patients with head and neck cancer. Cancer. 1995;75(2):569–76.

    Article  CAS  PubMed  Google Scholar 

  85. Talamini R, Bosetti C, La Vecchia C, et al. Combined effect of tobacco and alcohol on laryngeal cancer risk: a case-control study. Cancer Causes Control. 2002;13(10):957–64.

    Article  CAS  PubMed  Google Scholar 

  86. Bagnardi V, Blangiardo M, Vecchia C L, Corrao G. A meta-analysis of alcohol drinking and cancer risk. Br J Cancer. 2001;85(11):1700–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  87. Kwan ML, Kushi LH, Weltzien E, et al. Alcohol consumption and breast cancer recurrence and survival among women with early-stage breast cancer: the life after cancer epidemiology study. J Clin Oncol. 2010;28(29):4410–6.

    Article  PubMed Central  PubMed  Google Scholar 

  88. Wong FL, Rotheram-Borus MJ, Lightfoot M, et al. Effects of behavioral intervention on substance use among people living with HIV: the healthy living project randomized controlled study. Addiction. 2008;103(7):1206–14.

    Article  PubMed Central  PubMed  Google Scholar 

  89. Jones-Webb R, Smolenski D, Brady S, Wilkerson M, Rosser BR. Drinking settings, alcohol consumption, and sexual risk behavior among gay men. Addict Behav. 2013;38(3):1824–30.

    Article  PubMed Central  PubMed  Google Scholar 

  90. Lindley LL, Walsemann KM, Carter JW Jr. The association of sexual orientation measures with young adults’ health-related outcomes. Am J Public Health. 2012;102(6):1177–85.

    Article  PubMed Central  PubMed  Google Scholar 

  91. Mimiaga MJ, Reisner SL, Vanderwarker R, et al. Polysubstance use and HIV/STD risk behavior among Massachusetts men who have sex with men accessing Department of Public Health mobile van services: implications for intervention development. AIDS Patient Care STDS. 2008;22(9):745–51.

    Article  PubMed  Google Scholar 

  92. Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371(9612):569–78.

    Article  PubMed  Google Scholar 

  93. Litton JK, Gonzalez-Angulo AM, Warneke CL, et al. Relationship between obesity and pathologic response to neoadjuvant chemotherapy among women with operable breast cancer. J Clin Oncol. 2008;26(25):4072–77.

    Article  PubMed  Google Scholar 

  94. Calle EE, Thun MJ. Obesity and cancer. Oncogene. 2004;23(38):6365–78.

    Article  CAS  PubMed  Google Scholar 

  95. Fogel S, Young L, Dietrich M, Blakemore D. Weight loss and related behavior changes among lesbians. J Homosex. 2012;59(5):689–702.

    Article  PubMed  Google Scholar 

  96. Conron KJ, Mimiaga MJ, Landers SJ. A population-based study of sexual orientation identity and gender differences in adult health. Am J Public Health. 2010;100(10):1953–60.

    Article  PubMed Central  PubMed  Google Scholar 

  97. Fredriksen-Goldsen KI, Cook-Daniels L, Kim HJ, et al. Physical and mental health of transgender older adults: an at-risk and underserved population. Gerontologist. 2014;54(3):488–500.

    Google Scholar 

  98. Kaminski PL, Chapman BP, Haynes SD, Own L. Body image, eating behaviors, and attitudes toward exercise among gay and straight men. Eat Behav. 2005;6(3):179–87.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Liz Margolies .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Margolies, L., Kamen, C. (2015). Needs of LGBT Cancer Survivors. In: Boehmer, U., Elk, R. (eds) Cancer and the LGBT Community. Springer, Cham. https://doi.org/10.1007/978-3-319-15057-4_13

Download citation

Publish with us

Policies and ethics