An intersectional analysis of physical and mental health-related quality of life among LGBTQ+ patients with cancer

Background: Prior studies report that LGBTQ+ patients with cancer report poorer health-related quality of life (HRQOL), but very little is known about how their LGBTQ+ identity intersects with their race and ethnicity. Guided by Intersectionality and Minorities' Diminished Returns theories, this study sought to explore the impact of the intersection of these identities on cancer patients' HRQOL. We hypothesize that ethnoracially diverse LGBTQ+ cancer patients will have poorer HRQOL. Methods : Self-reported data were obtained from 97,346 patients, of whom 3,353 self-identified as LGBTQ+, who completed a standard-of-care electronic questionnaire including demographics, psychosocial measures, and the validated Short Form Health Survey-12. Sexual orientation (SO) and gender identity (GI) were used to identify sexual minorities, gender minorities, and cisgender heterosexual persons. SF-12 scores were used to calculate the Physical Component Summary (PCS) and Mental Component Summary (MCS). Age-adjusted generalized linear models estimate mean MCS and PCS for intersectional identities using SAS (version 9.4). For the SO analyses, the reference group was non-Hispanic White heterosexual patients; while for GI analyses, it was non-Hispanic White cisgender male patients. Results: For the intersectional analyses by SO, 39 identities were analyzed. Twenty identities were associated with lower MCS, of which White Heterosexual and Hispanic multiracial lesbian/gay patients had statistically significantly lower scores. For PCS, 23 identities were associated with lower scores, but only while multiracial non-Hispanics with unspecified SO had significantly lower PCS. PCS was significantly higher among Black Hispanic patients who did not disclose their sexual orientation. For the intersectional analyses by GI, 26 of 43 identities were associated with lower MCS, of which White Hispanic transgender, White cisgender females, and Non-Hispanic Asian patients had significantly lower scores. For PCS, 26 identities were associated with lower scores, but only Hispanic Native Hawaiian or other PI Cisgender males had significantly lower PCS. When SO+GI were combined with non-Hispanic White straight cisgender males as the reference, 20 identities had significantly lower MCS, including non-Hispanic Asian straight transgender males and non-Hispanic multiracial genderqueer patients. For PCS, 24 groups had significantly lower scores, including Hispanic American Indian/AN cisgender males and non-Hispanic multiracial bisexuals with other GI. Conclusions : This analysis of intersectional identities by LGBTQ+ status, race, and ethnicity highlights the importance of collecting detailed demographics to reveal cancer-related disparities and underscores the need for personalized care and the delivery of supportive services to populations disproportionately experiencing worse HRQOL.