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Design and Participants: This study used self-reported data from the National Health Interview Survey (2013-2018) to evaluate levels of psychological distress, use of prescription antidepressant and anti-anxiety medications, use of mental health care, and inability to afford mental health care in LGB survivors of AYA cancer vs both LGB individuals with no cancer history and heterosexual survivors of AYA cancer. Chi-square assessed sociodemographics, chronic health conditions, modifiable factors (eg, smoking, alcohol), and psychological outcomes. Logistic regression models (adjusted for survey weights) evaluated the odds of psychological distress by cancer status after accounting for covariates. Interactions between variables and cancer status were explored.
Results: LGB survivors (n=145) were aged mean 27 years (SD=6.7) at diagnosis; 76% female; and 84% White, 7.3% Black, 3.5% Asian, and 11% Hispanic/Latino. LBG individuals with no cancer history (n=1,450) and heterosexual survivors (n=1,450; aged mean 29 years [SD=6.4] at diagnosis) were 72% and 73% female, and 79% and 84% White, 13% and 8.2% Black, 2.2% and 2.6% Asian, and 14% and 13% Hispanic/Latino, respectively. Compared to heterosexuals, LGB survivors were more likely to report severe distress (aOR=2.3, 95% CI=1.1-4.5) and had higher odds of reporting a mental healthcare visit (aOR=2.0, 1.3-3.1). Odds of severe distress (aOR=1.4, 0.71-2.6) and reporting a mental healthcare visit (aOR=1.3, 0.81-2.0) were similar between LGB survivors and LGB individuals with no cancer history. While 48% of LGB survivors reported moderate/severe distress, only 30% reported a mental healthcare visit.
Commentary: This cross-sectional study reinforces important aspects of our existing knowledge on the health disparities experienced by sexual minorities (SM). When the LGB community is further elucidated, those with cancer have increased psychological distress, although not moderate/severe. This study also highlights challenges in capturing the full breadth of disparities experienced by sexual and gender minorities (SGM). For example, only 3% of respondents identified as SM, which is significantly lower than the general population. This may be due to mistrust of the healthcare system. Additionally, the survey did not evaluate gender identity. Future studies should aim to collect this data in an effort to better elucidate health trends among the entire spectrum of SGM.
Bottom Line: Patients with cancer who identify as LGB experience greater psychological distress than both LGB individuals without cancer and heterosexual people with cancer.
Reviewer: Corey X. Tapper, MD MS, Johns Hopkins University School of Medicine, Baltimore, MD
References:
1. Miller KD, Fidler-Benaoudia M, Keegan TH, Hipp HS, Jemal A, Siegel RL. Cancer statistics for adolescents and young adults, 2020. CA Cancer J Clin. 2020;70(6):443-459. doi:10.3322/caac.21637.
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Source: Choi E, Berkman AM, Andersen CR, et al. Psychological distress and mental health care utilization among lesbian, gay, and bisexual survivors of adolescent and young adult cancer. Support Care Cancer. 2024;32(9):585. doi:10.1007/s00520-024-08778-8.
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