Discrimination and disparities experienced among LGBTQ+ young adult cancer survivors (22-39) and adult cancer survivors (40+): A mixed-method study.
Authors: Clark Viktor , Brown Richard F. , Janelsins Michelle Christine , Mattick Lindsey Jean , Yilmaz Sule , Rieth Katherine , Kadambi Sindhuja G , Kamen Charles Stewart 
Published: June 2024

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Background: Americans who identify as lesbian, gay, bisexual, transgender, or other sexual and/or gender expansive identities (LGBTQ+) represent approximately 24.2 million (7.2%) people, living in the United States. Those who identify as LGBTQ+ face distinct barriers to preventing and treating cancer. In a recently convened ASCO steering committee meeting, reducing LGBTQ+ discrimination both within and outside the healthcare setting was discussed as a high priority area. Across generations, adults who openly identify as LGBTQ+ has increased, with nearly 20% of younger generations identifying as LGBTQ+. This shift in willingness to openly identify as LGBTQ+ may result from decreased discrimination felt by younger generations. Decreasing discrimination may ultimately help improve cancer-care engagement among people who identify as LGBTQ+. Methods: Utilizing a mixed method sequential approach, we examined a national sample of 60 LGBTQ+ cancer survivors’ online quantitative survey data including experiences of discrimination. We performed a t-test to compare young adults (22-39 years old) to adults (40+ years old). Next, we conducted in-depth interviews with ten individuals from as a subset of the 60 cancer survivors. The transcribed data was analyzed using constant comparative methods and sorted into themes. Results: Among the 60 survey respondents, 31 (51.7%) were 40+ years old. Majority of the survey respondents were White (n = 55, 88.3%), ciswomen (n = 40, 66.7%), and identified as bisexual (n = 20, 33.3%). The subset of in-depth interview participants shared similar demographics. Quantitative: The adult cancer survivors reported experiencing higher levels of discrimination than younger adult cancer survivors (Mean Difference = 5.82, 95% CI [1.11, 10.54]). Qualitative: Among the adult cancer survivors (k = 8), three endorsed the theme of “discrimination”. While one of the young adult cancer survivors (k = 2), endorsed the theme of “identity pride” defined as satisfaction from and immersion within their LGBTQ+ identity. Mixed Methods: Both quantitative and qualitative data confirmed that adult cancer survivors experienced significant differences in discrimination compared to the younger adult cancer survivors. Within the adult cancer survivor interviews, historical experiences such as the AIDS epidemic led to discriminatory experiences and ongoing medical mistrust. Among younger adult cancer survivors, openly embracing their identities and engaging with the healthcare system was described. These disparities may explain the variation in levels of reported discrimination. Conclusions: Research shows discrimination has a profound impact on whether a person identifying as LGBTQ+ will seek out cancer-related care. Therefore, reducing discrimination for people who identify as LGBTQ+ is crucial to reducing cancer disparities.