LGB Cancer Survivors Have Less Access to Health Care.

LGBTQ people are at particular risk for cancer because of a range of disparities, including lifestyle factors like smoking, lower mammography screening adherence among bisexual women and transgender people, difficulty accessing care, and other issues stemming from minority status and discrimination.

Sexual minorities are also less likely to be able to access care after surviving cancer—a time when patients are particularly vulnerable to lower quality of life, disease, and death—according to a new study led by School of Public Health researchers. Published in the journal CANCER, the study also finds that access to care affects quality of life for LGB cancer survivors more than for their heterosexual counterparts.

The study’s findings speak to the importance of expanding data collection on sexual orientation and gender identity, “and against the Trump Administration’s attempts to roll back data collection,”says study lead author Ulrike Boehmer, associate professor of community health sciences. “We need to be able to document sexual and gender minorities’ health-related disparities to then work towards improvement and measure any progress we are making.”

Boehmer and her colleagues used Behavior Risk Factor Surveillance Survey data from 2014 through 2017 on 70,797 cisgender US adults who reported their sexual orientation and that they had ever been diagnosed with cancer. (Transgender cancer survivors were not included in the analysis because of their small sample size.) Of these, 1,931 respondents self-identified as lesbian, gay, bisexual, or “other non-heterosexual.”

The survey included four data points on access to health care: not having health insurance, delaying care, avoiding care because of costs, and lacking a trusted physician. The researchers measured quality of life based on self-reported physical and mental health and difficulty concentrating.

Nearly twice as many sexual minority women than heterosexual women reported healthcare access issues, including reporting over twice the rates of not being insured, not having a personal doctor, and not being able to afford to see a doctor. Healthcare access among men did not vary significantly by orientation, except for avoiding care because of costs, which was almost twice as common for sexual minority men.

To confirm that these healthcare disparities were not simply the result of being uninsured, the researchers also compared heterosexual and sexual minority respondents who had insurance. Among these respondents, women’s yearly checkup rates did not vary by orientation, but the other disparities remained.

Sexual minority respondents reported worse quality of life overall. For heterosexual women, access barriers increased their odds of poor physical health by 30 percent, while it increased the odds for sexual minority women by 200 percent. Access barriers also increased the odds of poor mental health by 50 percent among heterosexual women and 80 percent among sexual minority women.

Among men, the most significant difference was in difficulty concentrating: access barriers increased the odds by 50 percent for heterosexuals and 430 percent for sexual minorities. Barriers increased the odds of poor mental health by 11 percent for heterosexual men and 49 percent for sexual minority men.

The researchers noted that the data are mostly from after the implementation of the Affordable Care Act and the nationwide legalization of same-sex marriage, “which implies that sexual minority cancer survivors in this sample may have already benefitted from greater health care access that resulted from both of these legal changes,” they wrote.

“Since these data were collected, the situation has worsened for LGBT individuals,” Boehmer says. “We now have the ‘religious freedom’ rule that gives healthcare workers a license to discriminate against LGBT individuals, and have seen an increase in hate crimes against LGBT people. One can infer from this a negative impact on sexual minorities’ cancer survivorship, and that the health disparities we have shown will further increase.”

The study was co-authored by Michael Winter, associate director of statistical programming at the Biostatistics & Epidemiology Data Analytics Center, and by Jessica Gereige of Boston Medical Center and Al Ozonoff of Boston Children’s Hospital and Harvard Medical School.

—Michelle Samuels