Data Show Increases in Chronic Health Risk for Gay/Bisexual Cancer Survivors

“Lesbian, gay, and bisexual survivors of [adolescent and young adult] cancer are at very high risk for long-term health issues and we urgently need to address this disparity in long-term health outcomes,” according to Michael E. Roth, MD.

Lesbian, gay, and bisexual (LGB) adolescent and young adult cancer survivors experience an increased risk of chronic health conditions compared with LGB individuals without a history of cancer and heterosexual cancer survivors, according to findings from a study published in Cancer.

Overall, 71% of LGB cancer survivors reported having 1 or more chronic health conditions compared with 51% of LGB individuals without a history of cancer (OR, 2.45; 95% CI, 1.57-3.65); 21.0% and 7.7% of patients in each respective population reported having more than 2 chronic health conditions (P <.001). Compared with LGB individuals who had no history of cancer, LGB cancer survivors experienced a higher risk of cardiovascular disease (OR, 3.67; 95% CI, 1.78-8.07), arthritis (OR, 1.85; 95% CI, 1.17-2.93), pulmonary disease (OR, 2.23; 95% CI, 1.46-3.40), and stroke (OR, 2.88; 95% CI, 1.17-7.10).

Investigators highlighted that LGB adolescent and young adult (AYA) cancer survivors were more likely to experience chronic health conditions compared with heterosexual cancer survivors, 71% vs 59% of whom, respectively, reported having 1 or more chronic health conditions (OR, 2.16; 95% CI, 1.25-2.89) and 21.0% vs 15.1% of whom reported having more than 2 conditions (P = .023). Between these groups, LGB cancer survivors had a higher risk of arthritis (OR, 1.61; 95% CI, 1.12-2.61) and pulmonary disease (OR, 1.90; 95% CI, 1.23-2.81).

When adjusting for sociodemographic variables, investigators reported that LGB AYA cancer survivors were 2.5 times more likely to experience chronic health conditions compared with LGB individuals without cancer and 2.2 times more likely compared with heterosexual AYA cancer survivors.

Additionally, an assessment of bivariate associations between sociodemographic factors and chronic health conditions among LGB AYA cancer survivors revealed significant differences in age at survey, poverty, education, and insurance status between those with and without a history of cancer. Investigators noted no statistical significance when assessing chronic health conditions across sociodemographic variables within the group of LGB AYA cancer survivors.

“Lesbian, gay, and bisexual survivors of [adolescent and young adult] cancer are at very high risk for long-term health issues and we urgently need to address this disparity in long-term health outcomes,” study author Michael E. Roth, MD, stated in a written comment to CancerNetwork^®. “Ensuring equitable access to high quality survivorship care and increasing access to resources promoting positive health behaviors are high priorities to improve care and outcomes for this vulnerable population.”

Roth is an associate professor in the Division of Pediatrics at The University of Texas, MD Anderson Cancer Center in Houston, Texas.

Investigators pooled data from the National Health Interview Survey collected between 2013 and 2020 to assess how socioeconomic status variables affected chronic health conditions among LGB AYA cancer survivors (n = 170) compared with outcomes among LGB individuals without a history of cancer (n = 1700) and heterosexual AYA cancer survivors (n = 1700). Differences in socioeconomic factors and presence of chronic health conditions among these groups were evaluated with a survey-weighted χ² test. Additionally, investigators used logistic regression models to determine chronic health condition probabilities based on socioeconomic factors.

The mean ages of LGB and heterosexual AYA cancer survivors at time of survey completion, respectively, were 41 years and 44 years (P = .009). Additionally, 58% and 65% of each respective group reported being married (P = .001), and 30% and 15% reported that they had never married (P <.001).

Among LGB AYA cancer survivors and LGB individuals without a history of cancer, respectively, 67% and 57% reported that they attained less than a bachelor’s degree (P = .009), and 26% and 18% had incomes ranging from 100% to 200% of the federal poverty level (P = .021).

Roth emphasized the need to understand the underlying factors contributing to the chronic health disparities observed among LGB AYA cancer survivors.

“Is this population receiving the recommended screening for and prevention of late [adverse] effects and subsequent cancers,” he asked. “Are they getting access to high quality health care? Are there other health behaviors that are contributing to the higher risk of developing chronic health conditions? No matter what the cause, we need to intervene, promote increased utilization of health care, and positively change the trajectory of their long-term health.”

Reference

Berkman AM, Choi E, Cheung CK, et al. Risk of chronic health conditions in lesbian, gay, and bisexual survivors of adolescent and young adult cancers. Cancer. 2023;1-10. doi:10.1002/cncr.35015