Having 'Dignity and Respect' During Cancer

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LGBTQI+ patients with cancer are encouraged to seek positive relationships with care teams despite possible histories of minority stress.

Image of a patient connecting with her doctor.

For patients with cancer in the LGBTQI+ community a strategy to combat discrimination is to seek positive relationships with care teams.

Discrimination, research has shown, can have a direct impact on an individual's physical health.

In its 2024 Cancer Facts & Figures report’s special section dedicated to cancer in lesbian, gay, bisexual, transgender, queer and gender-nonconforming people, the American Cancer Society raised the issue of minority stressors — described by Scout, who goes by one name and is executive director of the National LGBTQI+ Cancer Network, as “how discrimination enacts itself in our everyday life.”

“At the cellular level, psychological stress influences biochemical changes such as increased cortisol levels, which can lead to chronic inflammation that increases the risk of cancer and other diseases,” the American Cancer Society stated in its report. “Research has also found that individuals who experience greater minority stress are more likely to express gene mutations that are functionally related to cancer and to have chronic side effects of cancer treatment.”

The report cited the National LGBTQI+ Cancer Network’s statistic that there are more than 1 million LGBTQ+ cancer survivors in the United States.

“Compared to the general public, LGBTQ+ cancer survivors are more likely to have poor physical and mental health, have higher prevalence of cigarette smoking and heavy alcohol use, and frequently experience homophobia and discomfort expressed by health care providers,” the American Cancer Society reported.

As part of the “Speaking Out” video series, Scout discussed minority stressors’ impact on patients and resources that are available.

Q: How can minority stressors impact patients?

A: It means that we have been unfortunately conditioned by the world and all these discriminatory events [so] that we come with some open wounds, we come with some sensitive spots, and we come very much concerned. We don’t know, is that the reason why [someone is] behaving this way?

When I went to a dermatologist I’d never been to before to get something checked out that did end up being cancerous, I was concerned and nervous about going in.

I called them in advance to see if they were welcoming. They were like, “Oh, it’s not an issue.” But when I saw the dermatologist, she was chilly. She was abrupt. And I don’t know whether that’s because she skipped her coffee that morning, but what I’m positioned to think because of the history of minority stressors and differential treatment is that it’s probably because I’m trans[gender], right?

We have a conditioning, and we walk into these interactions with a different set of lived experiences … that we’re worried may happen again. If we don’t have information otherwise, we’re going to presume that’s probably what is occurring yet again.

Q: What resources are out there for patients to make sure that they receive adequate, fair, equitable care?

A: One of the things that we really encourage everybody to do is if you don’t feel that the relationship between you and your provider is a positive one — and I know it’s hard in cancer … [but] if you have the wherewithal to change your provider, you should be in a relationship where you like your provider.

We know from patient-centered outcome research that if two people are treated with the exact same pills, but one of them has a more positive experience with their provider, their health outcomes are going to be [better]. ... That relationship and that respect are very related to your ongoing health.

We really encourage you to find another provider [if necessary]. There are some lists of welcoming providers. [For example,] we have a list of welcoming care providers. Gay and Lesbian Medical Association has just redone their list. So, they have a whole bunch of lists of welcoming providers.

Use those resources to … make sure that you have a positive relationship to start. But sometimes we understand you can’t. … In situations like that, if you may not have another hospital close by that you can go to, then what we really encourage people to do is name that [issue], be aware of it and do whatever else you can to counterbalance it in your life.

For example, are you going to ask your friends for even more reach outs? Are you going to ask more people to go with you to appointments so if you get that kind of [reception], you don’t have to be the one to tell them, “Hey, maybe you need to check what’s going on here.” See what you can do within your resources to counterbalance [those problems] because you may be working through more barriers than you should need to work through. We don’t have a beautiful fix for it. I wish I could say, “OK, here’s the magic wand, sign up for this app, and we will get rid of that discrimination.”

It’s a really hard thing to get rid of. But being aware of it and realizing that you deserve dignity and respect is absolutely one of the key steps in changing your course.

Transcription was edited for clarity and conciseness.

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