Sexual and Gender Minority People Affected by Cancer

Sexual and gender minority (SGM) populations include individuals whose sexual orientation, gender identity, gender expression, or sex characteristics differ from the majority population. This includes people who identify as lesbian, gay, bisexual, transgender, queer, intersex, non-binary, and other diverse sexual and gender identities.

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People from SGM communities experience significant health disparities and may encounter discrimination, stigma, and barriers when accessing healthcare. These experiences can contribute to delays in cancer screening, reduced engagement with healthcare services, poorer psychosocial outcomes, and inequities across the cancer care continuum. Delivering respectful, inclusive, and person-centred care is essential to improving both patient experience and clinical outcomes.

 

Key Definitions

Sex refers to biological characteristics such as chromosomes, reproductive organs, hormones, and anatomy. Sex assigned at birth may influence cancer risk, treatment decisions, medication dosing, interpretation of laboratory values, and eligibility for certain cancer screening programs.

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Gender identity refers to a person's internal sense of their gender, which may or may not align with the sex assigned at birth. Gender identity may include identities such as woman, man, transgender, non-binary, gender diverse, or another gender identity.

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Sexual orientation describes a person's emotional, romantic, or sexual attraction to others and is independent of both sex and gender identity. Examples include heterosexual, lesbian, gay, bisexual, pansexual, queer, and asexual identities.

 

LGBTQI+ is an umbrella term that refers to people who identify as lesbian, gay, bisexual, transgender, queer or questioning, intersex, and other diverse sexual orientations, gender identities, and sex characteristics (represented by the "+" symbol). Although these communities are often grouped together, each population has unique health needs, lived experiences, and cancer care considerations. Healthcare professionals should avoid assuming that all LGBTQI+ individuals have similar experiences or require the same care.

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These concepts are distinct and should not be used interchangeably. For example, sex is a biological characteristic, gender identity reflects a person's internal sense of self, and sexual orientation describes whom a person is attracted to. Understanding these differences enables healthcare professionals to provide respectful, person-centred care, deliver appropriate cancer screening based on anatomy and risk factors, and communicate effectively with patients throughout the cancer care continuum.

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Challenges SGM people might experience during cancer care

Sexual and gender minority (SGM) individuals often experience unique barriers throughout the cancer care continuum. These challenges may occur at the individual, healthcare provider, organisational, and health system levels, contributing to inequities in cancer prevention, diagnosis, treatment, survivorship, and end-of-life care.

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Research has shown that LGBTQI+ individuals are more likely to report negative healthcare experiences than heterosexual and cisgender populations. Approximately one in six LGBTQI+ adults report experiencing discrimination in healthcare, while transgender and gender-diverse people report even higher rates of discrimination, delayed care, and unmet healthcare needs. Previous negative experiences may lead some individuals to delay seeking medical attention, avoid cancer screening, or withhold information about their sexual orientation or gender identity from healthcare providers.

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Administrative and System Barriers

Many healthcare systems continue to rely on binary sex classifications, creating challenges for transgender and gender-diverse patients.

Examples include:

• Electronic medical records that cannot accurately record both sex assigned at birth and current gender identity.

• Cancer screening reminders based solely on legal sex rather than the organs a patient has.

• Health insurance claims being rejected because procedures do not align with a patient's recorded sex.

For example, a transgender man who has retained a uterus may require cervical screening or a hysterectomy. If his legal sex is recorded as male, these investigations or procedures may be incorrectly flagged or denied by insurance systems unless additional documentation is provided.

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Similarly, transgender women may encounter difficulties with laboratory testing. Reference ranges for blood tests are often based on binary sex categories, and laboratory systems may generate alerts if chromosomal, hormonal, or physiological findings do not correspond with the patient's recorded gender. This can result in unnecessary delays, repeated testing, or confusion if clinicians are unfamiliar with interpreting results in transgender patients.

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Communication Challenges

Many SGM patients report concerns about being misgendered, having incorrect names or pronouns used, or needing to repeatedly explain their identity to different members of the healthcare team.

These experiences may:

• Reduce trust in healthcare providers.

• Increase anxiety during treatment.

• Discourage future engagement with healthcare services.

• Negatively affect patient satisfaction and quality of care.

Consistent use of affirmed names and pronouns by all members of the multidisciplinary team is an important aspect of respectful, person-centred care.

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Clinical Challenges

Healthcare professionals should avoid assumptions regarding anatomy, reproductive organs, hormone use, or cancer risk based solely on gender identity.

Clinical challenges may include:

• Determining appropriate organ-specific cancer screening.

• Managing the effects of gender-affirming hormone therapy during cancer treatment.

• Discussing fertility preservation and reproductive health.

• Addressing sexual function and intimacy concerns.

• Supporting body image following surgery or treatment.

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Individualised assessment based on anatomy, medical history, and treatment goals is essential.

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Psychosocial Challenges

Cancer treatment may exacerbate existing psychosocial stressors experienced by SGM individuals.

Patients may experience:

• Fear of discrimination or prejudice within healthcare settings.

• Limited family acceptance or support.

• Reliance on chosen family members who may not be recognised in healthcare systems.

• Greater psychological distress related to body image, identity, and treatment side effects.

• Social isolation and reduced access to culturally appropriate support services.

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Best Practices for Healthcare Professionals

Create a welcoming and inclusive environment

A patient's first interaction with a healthcare service can influence whether they feel comfortable accessing ongoing care.

Healthcare organisations should aim to:

• Display inclusive patient information and health resources.

• Ensure registration and intake forms allow patients to self-identify their gender and sexual orientation.

• Provide private environments for discussing personal information.

• Develop policies that promote equity, inclusion, and non-discrimination.

• Recognise partners, caregivers, and chosen family members in care planning where appropriate.

 

Creating an inclusive clinical environment helps build trust and encourages patients to disclose information that may be relevant to their care.

Use respectful and inclusive communication

Healthcare professionals should avoid making assumptions about a patient's identity, anatomy, relationships, or support network.

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Good communication practices include:

• Asking patients what name they would like to be called.

• Asking what pronouns they use and documenting these in the medical record.

• Using gender-neutral language such as "partner" instead of assuming "husband" or "wife."

• Respecting patients' identities consistently across all members of the multidisciplinary team.

• Correcting mistakes promptly and respectfully if incorrect names or pronouns are used.

 

Simple communication practices can significantly improve patient confidence and satisfaction with care.

Collect demographic information appropriately

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Routine collection of sexual orientation and gender identity (SOGI) information helps healthcare providers deliver personalised care while improving understanding of cancer disparities.

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Healthcare professionals should routinely and respectfully ask about:

• Sex assigned at birth

• Current gender identity

• Sexual orientation

• Preferred name

• Pronouns

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Patients should always have the option to decline answering these questions.

Information should be collected separately rather than combining sex and gender into a single question, as each provides different clinical information.

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Deliver individualized cancer care

Cancer care should be based on each patient's individual anatomy, medical history, treatment history, and personal preferences rather than assumptions based on gender identity.

Healthcare professionals should consider:

• Organ-specific cancer screening based on anatomy present.

• Previous gender-affirming surgery where clinically relevant.

• Current or previous hormone therapy.

• Fertility preservation discussions before treatment.

• Sexual health concerns throughout treatment and survivorship.

• Body image concerns associated with cancer treatment.

• Psychosocial wellbeing and access to supportive care.

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Patients should be involved in shared decision-making throughout their care.

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Recognize the psychosocial impact of cancer

SGM patients may experience unique psychosocial challenges related to cancer diagnosis and treatment.

These may include:

• Fear of discrimination within healthcare settings.

• Limited family support or reliance on chosen family.

• Concerns about disclosure of identity.

• Anxiety surrounding body image or treatment-related physical changes.

• Increased rates of depression, anxiety, and psychological distress.

Healthcare professionals should routinely assess emotional wellbeing and refer patients to appropriate psychosocial services when needed.

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Support partners and chosen family

Not all patients rely on biological relatives for support.

Healthcare professionals should:

• Ask patients who they would like involved in their care.

• Recognise chosen family members and significant support persons.

• Include partners in discussions when appropriate and with patient consent.

• Avoid assumptions regarding family structure or relationships.

Supporting a patient's preferred support network contributes to more person-centred care.

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Provide ongoing education and training

All members of the oncology workforce should receive education on providing inclusive care for SGM populations.

Training should include:

• Understanding health disparities experienced by SGM communities.

• Inclusive communication techniques.

• Appropriate collection of sexual orientation and gender identity information.

• Recognising unconscious bias.

• Cultural safety and cultural humility.

• Trauma-informed care principles.

• Creating welcoming clinical environments.

• Inclusive documentation practices.

Education should extend beyond clinicians to include reception staff, administrative teams, allied health professionals, volunteers, and support services to ensure consistent, respectful care throughout the patient journey.

 

Documentation and Reporting

Healthcare organisations should implement standardised approaches to documenting sexual orientation and gender identity within electronic health records.

Best practice includes:

• Recording sex assigned at birth separately from gender identity.

• Recording preferred name and pronouns.

• Updating demographic information when appropriate.

• Maintaining confidentiality and privacy.

• Using standardised terminology across clinical systems.

Routine collection of these data supports more equitable care and enables healthcare services to identify disparities in access, treatment, and outcomes.

 

Future Research Priorities

Although awareness of cancer disparities affecting SGM populations has increased, significant evidence gaps remain due to inconsistent collection of sexual orientation and gender identity data.

Future research should focus on:

• Standardising the collection of sexual orientation and gender identity data across cancer registries, clinical trials, and electronic medical records.

• Understanding disparities in cancer screening, diagnosis, treatment, survivorship, and end-of-life care among SGM populations.

• Evaluating interventions that improve access to culturally safe and inclusive cancer care.

• Developing and assessing educational programs that improve healthcare professionals' knowledge, confidence, and cultural competence when caring for SGM patients.

• Examining patient-reported experiences and outcomes to inform improvements in cancer services.

• Increasing representation of SGM populations in cancer research to strengthen the evidence base and guide future policy and practice.

Improving data quality and expanding research will support the development of evidence-based strategies that reduce inequities and improve cancer outcomes for sexual and gender minority populations.

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