Less than 20% of National Cancer Institute Community Oncology Research Program practices routinely report collecting sexual orientation and gender identity (SOGI) data, limiting the available evidence to support recommendations for oncology nursing care of a vulnerable LGBTQ+ population that faces biases, stigma, cultural insensitivity, inequities, and disparities. In a 2022 Clinical Journal of Oncology Nursing article, ONS member Georgina T. Rodgers, BSN, RN, OCN®, NE-BC, and colleagues evaluated the latest studies to identify best practices and care considerations for LGBTQ+ patients with cancer.
Cancer in Individuals Who Identify as LGBTQ+
Often because of previous negative experiences with health care, LGBTQ+ individuals are less likely to adhere to cancer screening recommendations or seek treatment, leading to late-stage diagnoses, the researchers reported. They identified several factors that increase cancer risk for LGBTQ+ populations:
- Increased likelihood of lifestyle behaviors that raise cancer risk, such as alcohol and tobacco use and obesity
- Lower rates of childbirth in assigned females
- Higher rates of anal human papillomavirus and anal cancers
- Lack of awareness of the need for transgender patients to follow cancer screening recommendations for their body parts (e.g., breast, prostate)
- Social determinants (e.g., homelessness, disability, age, race, English language status) that may also contribute to cancer risk
Nursing Strategies to Change the Cancer Experience for LGBTQ+ Patients
After a comprehensive review of the current evidence for LGBTQ+ patient care, the researchers identified strategies that nurses can use to deliver patient-centered, inclusive care.
Build a welcoming environment: Seeing a space that supports LGBTQ+ individuals can make them comfortable being open with their healthcare providers. The researchers recommended:
- Providing cancer-related educational resources and literature for LGBTQ+ patient concerns
- Creating inclusive intake forms
- Depicting LGBTQ+ individuals among other diversities on unit posters and signs
- Making gender-neutral facilities and programs available
- Sharing LGBTQ+ inclusive support groups
- Prominently displaying nondiscrimination policies and a visitation policy for LGBTQ+ partners or chosen families
Collect SOGI data: As part of their patient assessment, the researchers recommended that nurses ask patients about SOGI factors such as sexual orientation, correct names or pronouns, and health assessment items such as tobacco and alcohol use, immunization status, psychosocial distress, and sexual health history.
Use inclusive language: 70% of LGBTQ+ individuals report having a chosen family (e.g., friends instead of partners or biological family members) as their support systems. Before making assumptions about your patient’s relationship to the caregiver or visitor in the room, the researchers advised healthcare professionals to use phrases such as, “Who is here with you today?”
Tailor your care for LGBTQ+ individuals: Account for factors that differ from those in heterosexual patients, such as:
- Retained reproductive organs after gender-affirming surgery or physical changes from cross-sex hormone therapy
- Treatments that decrease libido or result in erectile dysfunction, which studies show is more distressing LGBTQ+ patients
- Bowel complications that make receptive anal sex uncomfortable or impossible
“Understanding the SOGI of LGBTQ+ patients can facilitate appropriate conversations regarding barriers to seeking cancer screening, sexual health concerns during treatment, and quality of life during surveillance and follow-up,” the researchers concluded. “Although further research is needed, quality of care can be improved for LGBTQ+ patients through the collection of SOGI data, use of inclusive language, providing a welcoming and inclusive environment, and providing education and resources to team members on cancer risks, prevention, screening, and treatment unique to LGBTQ+ patients.”
Learn more about cancer care for LGBTQ+ individuals and find case studies depicting the researchers’ recommendations in the full Clinical Journal of Oncology Nursing article.