Mode of Patient Sexual Orientation and Gender Identity Disclosure and Receipt of Tailored Cancer Resources.

Abstract

For lesbian, gay, bisexual, transgender, queer, questioning, and other (LGBTQ+) individuals with cancer, disclosing sexual orientation and gender identity (SOGI) in a safe clinical environment can improve survivorship outcomes and satisfaction. Although SOGI disclosure can facilitate patient-centered care, little is known about whether SOGI information is being used to improve care or how use may vary by mode of SOGI disclosure. To assess whether the mode of SOGI disclosure (self-disclosed, clinic collected, not disclosed, or other) is associated with receipt of clinical resources tailored to LGBTQ+ individuals among cancer survivors. This cross-sectional study uses data from the OUT National Cancer Survey, a web-based survey of LGBTQ+ adults with a history of cancer in the US, collected from September 2020 through March 2021. The study comprised a convenience sample of 2342 LGBTQ+ cancer survivors. Multivariable logistic regression was used to assess the association between SOGI disclosure mode and receipt of at least 1 clinical resource tailored to LGBTQ+ individuals related to mental health, tobacco use, alcohol use, physical activity, or survivorship care. The primary exposure was mode of SOGI disclosure. Covariates included age, cancer type, current cancer status, and region. This national sample of 2342 LGBTQ+ cancer survivors (mean [SD] age, 58.4 [16.7] years; 1428 assigned male at birth [61%]) included 79 Black participants (3%), 136 Hispanic participants (6%), 2019 White participants (86%), 64 multiracial participants (3%), and 90 participants of other race or ethnicity (4%). A total of 1394 participants (60%) identified as cisgender male, and 775 (33%) as cisgender female, and the most common sexual orientation was gay (1272 [54%]). Participants reported many cancer types, with genitourinary cancers being most common (523 [22%]). Most respondents (1798 [77%]) indicated that their care team knew their LGBTQ+ identity, with disclosure most often via self-disclosure (804 [34%]) or clinic collection (944 [42%]). Only 174 (7%) received an LGBTQ+ survivorship care plan, and 892 (38%) received at least 1 resource tailored to LGBTQ+ individuals. Compared with those with clinic-collected SOGI disclosure, those who did not disclose SOGI information (odds ratio [OR], 0.58 [95% CI, 0.44-0.78]) or who self-disclosed SOGI information (OR, 0.84 [95% CI, 0.69-1.02]) had lower odds of receiving any tailored resources. In this cross-sectional study of SOGI disclosure and use, few LGBTQ+ cancer survivors received tailored clinical resources despite high rates of SOGI disclosure. Clinical use of SOGI information remained limited, especially when it was not collected systematically. Efforts should prioritize both safe SOGI data collection and its integration into patient-centered care.