Sexual orientation and gender identity can have a significant impact on the well-being of those with cancer. Discrimination and systemic barriers to care for Lesbian, Gay, Bisexual, Trans, Queer or Questioning, Intersex or Asexual (LGBTQIA+) individuals can add to the stress of coping with a cancer diagnosis. There are ways to advocate for yourself and find the care you need and deserve.
Health Care Disparities for LGBTQ+ Populations
The care an LGBTQ+ person receives can be impacted by health care disparities. Health care disparities are differences in adequate and appropriate care for marginalized or socially excluded people based on either implicit or explicit biases against them.
When LGBTQ+ people don’t have a medical provider they can trust, they may delay routine check-ups, screenings and other early detection exams. Missing these can lead to cancer being diagnosed at later stages when cancer is harder to treat. Individuals may also not feel safe sharing information that a provider might need for proper, holistic care. Some patients may feel traumatized or be refused treatment completely. Reduced medical options can multiply the stress of their diagnosis.
Some of the reasons LGBTQ+ populations report feeling uncomfortable include:
Fear of discrimination: LGBTQ+ individuals may worry that disclosing their sexual orientation or gender identity will affect the quality of health care they receive.
Negative experiences: Fear of non-affirming interactions with health care providers can limit openness, safety and trust.
Lower rates of health insurance: Health insurance policies sometimes do not recognize unmarried partners. This makes it harder to get the needed health care coverage. Legal protections against discrimination at both the state and federal level are inconsistent.
Outright denial of care: While acceptance of LGBTQ+ identities is rising, homophobia and transphobia remain stark realities. Some may find themselves having to fight for the care they deserve. For example, one in five transgender patients have been turned away by a health care provider.
In addition to the lack of partnership benefits, many have limited or no contact with their biological families. This places a larger burden of support on friends and others in their community.
Doctors may hold implicit biases in care. They may simply not be aware of differences in health care needs and realities. This affects the types of screening that are recommended. Lesbians are often screened at a lower rate for cancers associated with reproduction, such as cervical and ovarian cancer. For gay men and others, doctors may not be aware that the human papilloma virus (HPV) is equally transmitted by anal intercourse as it is vaginal intercourse, and so requires screening for anal cancer.
A transgender person might retain aspects of their biological sex that require certain forms of care. A trans man may need care from a gynecologist or continued breast exams. A trans woman may require care from a proctologist. Many health care systems still rely on male-female binaries, potentially making non-binary or gender nonconforming patients feel invisible.
For more information about these concerns, please read our fact sheet “Cancer and Gender Diversity.”
Coming Out to Your Health Care Provider
Sharing correct pronouns, names or partner status can lead to an increased level of comfort. A patient who feels comfortable with their medical treatment team may experience better health outcomes. However, given threats of prejudice, harassment and sometimes violence, care should be taken. Safety should always come first.
Allied organizations exist to help those who seek LGBTQ+ affirming healthcare services. These include the LGBT Cancer Network or the Human Rights Campaign Foundation. They maintain listings of LGBTQ+ inclusive medical providers across the U.S.
If you face discrimination, do not be afraid to seek a second opinion or a better fit. The Affordable Care Act prevents health care providers who receive federal funding from discriminating on the basis of sexual orientation or gender. This includes Medicare and Medicaid. Organizations such as Transgender Law Center and Lambda Legal are dedicated to assisting the LGBTQ+ community through legal action, including changes to names and gender markers.
Self-Advocacy and Support
One of the benefits of coming out to your provider is that you can be honest about your support network. These individuals can then be included in the overall plan of care. From a coping perspective, a sense of being recognized and accepted can enhance feelings of trust. This is the foundation of successful care.
Being open with your providers also means that you can devote your energy to coping with your diagnosis, treatment and self-care. A sensitive health care team allows you to utilize the full spectrum of support that is available to you.
CancerCare offers supportive services that celebrate LGBTQ+ identities and relationships. These are free of charge for anyone affected by cancer. Case management and support groups are available throughout the country. Counseling is available in New York and New Jersey.
Edited by Rachel Barnhart, LMSW