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 more than 18 million,1 not all patients with the disease are benefiting from these advances. Austin R. Waters, MSPH, a doctoral candidate in health policy and management at UNC Gillings School of Global Public Health in Chapel Hill, North Carolina, and colleagues conducted a recent study to investigate the prevalence of chronic health conditions, disabilities, and physical and cognitive limitations reported by LGBTQ+ cancer survivors and non-LGBTQ+ cancer survivors. They found that LGBTQ+ cancer survivors experience more myriad chronic health conditions (including asthma, depressive disorder, kidney disease, stroke, and diabetes); vision disabilities; cognitive limitations; and difficulty walking, dressing, and running errands compared with non-LGBTQ+ cancer survivors.2
In addition, transgender or gender-nonconforming individuals experience even higher odds of most conditions compared with cisgender cancer survivors. The findings highlight substantial disparities regarding the health of LGBTQ+ cancer survivors, according to the study authors.
Study Methodology
The researchers used pooled, weighted data from 40,990 cancer survivors in the Behavioral Risk Factor Surveillance System, a phone survey system managed by the Centers for Disease Control and Prevention. These data were collected from 2020 to 2022 from 23 states that 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 in daily activities (eg, walking, dressing, and running errands) in cancer survivors who identify as LGBTQ+, LGB, transgender or gender-nonconforming, and non-LGBTQ+ cancer survivors. Four multivariable logistic regression models controlling for different factors were run for each outcome.
Key Results
Of the 40,990 cancer survivors, 1,715 identified as LGBTQ+. These survivors had significantly higher age-adjusted prevalence of all adverse outcomes. The prevalence of all outcomes was highest among transgender or gender-nonconforming survivors except for depressive disorders and cognitive limitations. LGBTQ+ survivors had higher odds of reporting asthma (adjusted odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.2–1.9); depressive disorders (adjusted OR = 1.9, 95% CI = 1.6–2.4); kidney disease (adjusted OR = 1.5, 95% CI = 1.1–2.1); stroke (adjusted OR = 1.7, 95% CI = 1.3–2.3); diabetes (adjusted OR = 1.3, 95% CI = 1.0–1.6); vision disability (adjusted OR = 1.6, 95% CI = 1.2–2.2); cognitive limitations (adjusted OR = 2.3, 95% CI = 1.8–2.9); difficulty walking (adjusted OR = 1.7, 95% CI = 1.3–2.0); difficulty dressing (adjusted OR = 2.0, 95% CI = 1.5–2.7); and difficulty running errands (adjusted OR = 1.6, 95% CI = 1.3–2.1).
In the transgender or gender-nonconforming models, cancer survivors in this group had increased odds of most outcomes compared with survivors in other groups, 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 survivors also had a higher prevalence of most health conditions compared with lesbian, gay, and bisexual 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 and gender-nonconforming] cancer survivors experience even a 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 LGB [lesbian, gay, or bisexual] individuals,” said Dr. Waters in a statement. “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 Lineberger Comprehensive Cancer Center and the National Cancer Institute. The study authors reported no conflicts of interest.
REFERENCES
1. National Cancer Institute: Cancer Statistics. Available at www.cancer.gov/about-cancer/understanding/statistics. Accessed October 21, 2024.
2. Waters AR, Jin M, Jones SR, et al: Chronic health conditions, disability, and physical and cognitive limitations among LGBTQ+ cancer survivors. Cancer Epidemiol Biomarkers Prev 33:1405-1413, 2024.
