Abstract B066: Rejection of cancer identity among sexual and gender minority patients
Authors: Pearson Amy W. Farnbach , Jaffe Shoshana Adler , Baca Lila A. , Dimauro Nina , Jacobson Kendal A. , Kano Miria 
Published: January 2023

Abstract
For sexual and gender minority (SGM) populations, minority stress exacerbates the physical and emotional challenges of cancer diagnosis, treatment and survivorship; mitigating these effects will require improved understanding of SGM individuals’ cancer experiences both within and beyond the clinic. Among SGM cancer health disparities are increased stress surrounding diagnosis and treatment and poorer post-treatment mental and overall health. Emotional distress accompanying significant or chronic diseases such as cancer results in part from the threat illness poses to personal identity, often leading to disruption and subsequent realignment of one’s self-conception to a “new normal” as a cancer patient or cancer survivor. However, the process of aligning multiple stigmatized identities, as when SGM individuals experience cancer, is relatively unexplored. To this end, transcripts of semi-structured interviews with 11 SGM cancer patients and 8 cisgender, heterosexual (CH) patients matched for sex assigned at birth and cancer type were coded for indicators of health and illness in personal identity. Codes included (1) assertion of prior healthy behavior, (2) rejection of cancer identity, and (3) assertion of cancer identity; these were not mutually exclusive. SGM patients were less likely than CH peers to report engaging in healthy behaviors (exercise, dietary choices): 4 of 11 (36%) SGM patients did so, compared with 7 of 8 CH patients (88%). In contrast, SGM patients were more likely to explicitly reject self-identification as a cancer patient or cancer survivor: this occurred in interviews with 7 of 11 (64%) SGM patients but only 2 of 8 (25%) CH patients. Assertion of cancer identity – either through self-identification with a survivor label or intentional disclosure to reduce cancer stigma or obtain formal health accommodations – did not differ among SGM and CH patients. Five of 11 (46%) SGM patients and 4 of 8 (50%) CH patients identified as a cancer patient or cancer survivor in these ways. Notably for this sample, compared with CH peers SGM cancer patients were both less likely to volunteer a history of engaging in healthy behaviors and more likely to explicitly reject personal identity as a cancer patient or cancer survivor. This may indicate reluctance on the part of already-minoritized individuals to take on additional stigmatized identities, or may represent particular difficulty faced by SGM cancer patients in realigning their personal identities to accommodate their illness experiences. The ways individuals with cancer navigate personal identity following diagnosis and treatment has implications for cancer survivorship care: some aspects of cancer survivor identity are associated with positive outcomes, including improved mental health, more positive engagement with peers, and better quality of life. Understanding the ways cancer shapes personal identity among SGM patients and other minoritized individuals may offer pathways to constructive emotional processing of cancer experiences to reduce post-treatment cancer health disparities.
Citation Format: Amy W. Farnbach Pearson, Shoshana Adler Jaffe, Lila A. Baca, Nina Dimauro, Kendal A. Jacobson, Miria Kano. Rejection of cancer identity among sexual and gender minority patients [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B066.