L. Borah1, K.L. Newman1, A. Furgal1, P.A. Suwanabol1 1University Of Michigan, Ann Arbor, MI, USA
Introduction: Lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) individuals face disparities in access to high-quality oncology care, in part due to stigma and negative experiences faced in clinical settings. We examined medical discrimination among LGBTQIA cancer survivors and the association with state-level legislation related to sexual orientation and gender identity.
Methods: We conducted a cross-sectional analysis of the National Institutes of Health’s All of Us Research Program to identify participants from 2017-2022 previously diagnosed with cancer. Prevalence of routine medical discrimination was defined as experiencing one or more forms of discrimination at least sometimes in the last 12 months. LGBTQIA participants were identified through self-described sex assigned at birth, gender, and sexual orientation. Participant state of residence was matched to legislative protections for LGBTQIA people determined by the Movement Advancement Project. We performed log-binomial regression to assess the prevalence of LGBTQIA and non-LGBTQIA cancer survivors who experienced routine medical discrimination, adjusted for age, race and ethnicity, and state-level legislative score. Analysis was completed in R (version 4.2.3) and 2-sided p<.05 determined statistical significance.
Results: Among 49,181 adult cancer survivors, 15,542 completed survey questions related to experiences of discrimination in medical settings, including 923 (5.9%) participants who identified as LGBTQIA. LGBTQIA participants more commonly experienced medical discrimination compared to non-LGBTQIA participants (344 [37.3%] vs 4222 [28.9%], p<.001), including treatment with less respect, treatment with poorer service, treatment as if they were not smart, and treatment as if they were lesser. Living in states without protective legislation for gender and sexual minoritized populations was associated with significantly higher prevalence of medical discrimination (93 [45.4%] vs 251 [35.0%], p<.001).
Conclusion: In this study, LGBTQIA cancer survivors experienced significantly greater discrimination in medical settings, compounded by living in states without legislative protections. Previous negative experiences in medical settings may contribute to delayed prevention and screening, presentation at later stages of disease, and worse outcomes. As such, legal safeguards for gender and sexual minority populations, as well as clinician-level interventions to advance cultural humility, may mitigate disparities in access to high-quality oncology care.