Impact of delayed screening/care and frequent mental distress during COVID-19 among SGM cancer survivors

Purpose: Sexual and gender minority (SGM) survivors have a significantly higher risk of late-stage cancer diagnosis compared with cisgender-heterosexual survivors, possibly due to historical exclusion from screening and higher engagement in risk behaviors like smoking, binge drinking, and risky sexual practices. Discrimination, stigma, and minority stress in healthcare settings limit access to screening, care, and treatment and contribute to increasing mental distress. The link between delays and mental health is unclear. This study examines the association between delayed screening/care and frequent mental distress (FMD) during COVID-19 among SGM survivors. Methods: We utilized secondary data from OUT: The National Cancer Survey, an online questionnaire administered to U.S. adult SGM cancer survivors from September 2020 to March 2021. Participants self-reported delayed screening/care (coded as “Yes,” “No,” or “No, not applicable”) and the number of poor mental health days (free-text response) in the past month. FMD was analyzed as a binary outcome using a Centers for Disease Control and Prevention (CDC)-validated cutoff (i.e., 14 or more PMHD in the last 30 days). Age was included as a covariate, given its established impact on mental health outcomes. Descriptive statistics, bivariate correlations, and logistic regression with sensitivity analyses were performed. Results: On average, participants (N = 2,073) were aged 58.69 years (SD = 11.12). The number of poor mental health days reported ranged from 0 to 30, with an average of 9.88 days (SD = 10.75). Delayed screening/care was significantly associated with FMD. 37.5% of participants reported delayed screening/care experienced FMD, compared to 49.6% of those who did not (p < 0.001). Multivariable regression analysis revealed that delayed screening/care and age were significant predictors of FMD. Participants who reported delayed screening/care were 84% more likely to experience FMD compared to those who did not report delayed screening/care (OR = 1.84, 95% CI: 1.41-2.41, p < 0.001). Age was inversely associated with FMD, with each additional year of age reducing the odds of experiencing FMD by 4% (OR = 0.96, 95% CI: 0.95-0.97, p < 0.001). Conclusion: This study highlights the social determinants of health contributing to delays in cancer screening, care, and treatment among SGM cancer survivors. Future research should focus on guiding oncology providers in developing targeted strategies to improve mental health outcomes among marginalized communities, especially during periods of increased healthcare disruption like the COVID-19 pandemic.