Although improvements in the early detection and treatment of cancer have reduced cancer-related mortality rates and increased the number of cancer survivors in the United States to over 18 million, not all patients with the disease are benefiting from these advances.
A recent study investigated the prevalence of chronic health conditions, disabilities, and physical and cognitive limitations reported by lesbian, gay, bisexual, transgender, queer, or anything other than straight and cisgender (LGBTQ+) cancer survivors and non-LGBTQ+ cancer survivors. Researchers found that LGBTQ+ cancer survivors experience more myriad chronic health conditions—including asthma; depressive disorder; kidney disease; stroke; diabetes; vision disabilities; cognitive limitations; and difficulty walking, dressing, and running errands—compared with non-LGBTQ+ cancer survivors. In addition, transgender or gender-nonconforming individuals experience even higher odds of most conditions compared with cisgender cancer survivors. These findings were published by Waters et al in Cancer Epidemiology, Biomarkers & Prevention.
Study Methodology
The researchers used pooled, weighted data collected from 2020 to 2022 from 23 states including 40,990 cancer survivors in the Behavioral Risk Factor Surveillance System, a phone survey system managed by the Centers for Disease Control and Prevention. The survey system administered questionnaires about sexual orientation and gender identity, as well as cancer survivorship.
The researchers then calculated age-adjusted prevalence for heart disease, asthma, chronic obstructive pulmonary disease, depressive disorders, myocardial infarction, kidney disease, stroke, diabetes, hearing disability, vision disability, cognitive limitations, and difficulty walking, dressing, and running errands in cancer survivors who identify as LGBTQ+; lesbian, gay, or bisexual; transgender or gender-nonconforming, and non-LGBTQ+ cancer survivors. Four multivariable logistic regression models controlling for different factors were run for each outcome.
Results
Of the 40,990 cancer survivors, 1,715 identified as LGBTQ+. These survivors had significantly higher age-adjusted prevalence of all outcomes. The prevalence of all outcomes was highest among transgender or gender non-conforming survivors, except for depressive disorders and cognitive limitations. LGBTQ+ cancer survivors were more likely to report having asthma (adjusted odds ratio [aOR] = 1.5, 95% confidence interval [CI] = 1.2–1.9); depressive disorders (aOR = 1.9, 95% CI = 1.6–2.4); kidney disease (aOR = 1.5, 95% CI = 1.1–2.1); stroke (aOR = 1.7, 95% CI = 1.3–2.3); diabetes (aOR = 1.3, 95% CI = 1.0–1.6); vision disability (aOR = 1.6, 95% CI = 1.2–2.2); cognitive limitations (aOR = 2.3, 95% CI = 1.8–2.9); and difficulty walking (aOR = 1.7, 95% CI = 1.3–2.0), dressing (aOR = 2.0, 95% CI = 1.5–2.7), and running errands (aOR = 1.6, 95% CI = 1.3–2.1).
In the transgender or gender-nonconforming models, these survivors had increased odds of most outcomes compared with cancer survivors who did not identify as transgender or gender-nonconforming, with increased odds ranging from 2.34 to 6.03—the lone exception was depressive disorder. When adjustments were made for age, transgender or gender-nonconforming cancer survivors also had a higher prevalence of most health conditions compared with lesbian, gay, and bisexual cancer survivors, except for depressive disorder and cognitive limitations.
“LGBTQ+ cancer survivors have an elevated burden of all chronic health conditions, disabilities, and limitations assessed. Transgender or gender-nonconforming cancer survivors experience [an] even higher burden of the same outcomes,” concluded the study authors.
Clinical Significance
“Transgender and gender-nonconforming individuals are some of the most marginalized people in the LGBTQ+ community and are known to experience barriers to health-care discrimination, more exclusion, more violence, and other factors than lesbian, gay, or bisexual individuals,” said first study author Austin R. Waters, MSPH, a doctoral candidate in health policy and management at the UNC Gillings School of Global Public Health in Chapel Hill, North Carolina. “Our study highlights the challenges transgender or gender-nonconforming cancer survivors face and the need for transgender or gender-nonconforming individuals, as well as all other LGBTQ+ cancer survivors, to be prioritized in care across the continuum.”
Disclosure: Funding for this study was provided by the Cancer Care Quality Training Program at the UNC Lineberger Comprehensive Cancer Center and the National Cancer Institute. For full disclosures of the study authors, visit aacrjournals.org/cebp.