Introduction
Lesbian, gay, bisexual, and transgender (LGBT) individuals make up one of the most underserved groups when it comes to health care issues. Moreover, one of the diseases that are the burden of American society as a whole and the LGBT population, in particular, is cancer. Wender, Sharpe, Westmaas, and Patel (2016) claim that LGBT communities are influenced by significant disparities that increase the risk of cancer such as smoking and alcohol consumption. Also, there are disparities in early cancer detection (screening) and provider discrimination that result in a decrease in treatment effectiveness and, consequently, worse physical and mental health outcomes. Therefore, there is a need for effective interventions that address these problems and the issue of careening in particular because early detection contributes to better cancer patient outcomes. The purpose of this research is to define healthcare outcomes for LGBT individuals with cancer, analyze interventions developed to focus on cancer screening problems among LGBT individuals, and provide recommendations for nursing practice related to care for LGBT cancer patients.
Cancer Healthcare Outcomes for LGBT Population
According to Hafeez, Zeshan, Tahir, Jahan, and Naveed (2017), 3.5% of American people identify themselves as gay, lesbian, or bisexual while only 0.3% of people claim to be transgender. They all make the LGBT community that comprises people of all ages, races, and genders. Still, due to many health disparities and some other factor’s, LGBT individuals are at higher risk of “sexually transmitted diseases (STDs), cancers, cardiovascular diseases, obesity, bullying, isolation, rejection, anxiety, depression, and suicide as compared to the general population” (Hafeez et al., 2017, p. 1). Consequently, LGBT patients are expected to demonstrate worse patient outcomes than other population groups.
One of the major cancer-related problems of the LGBT population is tobacco smoking, which is among the risk factors for 12 types of cancer. Thus, the rates of smokers among LGBT individuals are from 1.5 to 2 times higher than among the general population (Wender et al., 2016, p. 16). Also, the LGBT community is characterized by higher rates of alcohol consumption, which increases the risk of breast, liver, colon, and rectum cancers. Besides, overweight and obesity are more frequent among lesbian and bisexual women compared to heterosexual ones. These factors increase the risk of esophageal, colorectal, kidney, liver, post-menopausal breast and pancreatic cancers, and gynecologic cancers (Wender et al., 2016). One more problem of the LGBT community related to healthcare is the lack of health insurance, which decreases the probability of early screening and diagnosing.
Another problem that can lead to negative patient outcomes is the attitude of healthcare professionals to LGBT patients on the whole and those involved in the pelvic examination and cervical cancer screening in particular. The major challenge for providers and physical is the “lack of knowledge of the psychosocial, physiological, and clinical concerns” unique to patients on the female-to-male spectrum (Potter et al., 2015). For example, the risk for human papillomavirus can be assessed in the wrong way or not assessed timely, which can contribute to the development of cervical cancer. Consequently, there is a need to reduce the risk of misunderstanding when dealing with female-to-male spectrum patients.
One more concern that can prevent LGBT individuals from timely examinations and screenings is the inability to disclose their identity to cancer care providers (Kamen, Smith-Stoner, Heckler, Flannery, & Margolies, 2016). Thus, same-sex couples are frequently anxious about their disclosure. Nevertheless, they prefer including their partners to cancer care teams. Therefore, it is the task of a provider to involve same-sex partners and use them as a primary source of support for LGBT patients. The presence of partners is expected to increase treatment compliance and, as a result, improve patient outcomes.
Outcomes for LGBT patients can be complicated due to other diseases and comorbid conditions typical of this population group. For example, gay men are more likely to develop prostate, testicular, anal, and colon cancers (Hafeez et al., 2017). In most of the cases, they are the result of poor use of screening services. Since cancer is not diagnosed at early stages in the LGBT community when treatment can be more efficient and take less time for recovery, healthcare outcomes are generally worse than those of the rest of the population. Moreover, LGBT individuals are likely to commit suicide and a cancer diagnosis can trigger this decision. Consequently, there is a need for interventions able to address the cancer screening problem among the LGBT population and thus positively influence their healthcare outcomes.
Interventions to Address the Cancer Screening Problem among LGBT Individuals
One of the agencies involved in the reduction of healthcare disparities on the whole and those of the LGBT population, in particular, is The American Cancer Society (ACS). Its mission is to “substantially eliminate cancer as a major public health care problem in the United States” (Wender et al., 2016, p. 15). Thus, ACS is committed to improving LGBT health by applying its major strategies such as building healthier communities, focus on cancer control efforts, and providing adequate social support and assisting to navigate the health care system (Wender et al., 2016). One of the interventions implemented by ACS is the development of community awareness of the resources provided by the Society for cancer-related needs.
It is also aimed at bridging the gaps in research about cancer risks and outcomes of the LGBT community (Wender et al., 2016). To address the increased risk of cancer-related to smoking, ACS implements a project in cooperation with the New York City Department of Health and Mental Hygiene and the NYC Coalition for a Smoke-Free City. The project is aimed to decrease the intensity of tobacco consumption among LGBT individuals using such methods as education, advocacy, and social change. Their goal is “to save lives and reduce suffering from tobacco-related chronic illnesses such as cancer and heart disease” (Wender et al., 2016, p. 16). To achieve this goal, the Society develops a research program to reveal the health care needs of the LDBT population. Nevertheless, there is no relevant data or statistical information that reveal the effectiveness of the lack of effectiveness of these interventions.
One more way to address the problem of cancer screening for LGBT patients is organization or research to reveal the needs of this population group. The majority of the contemporary studies do not consider sexual orientation and thus do not provide any information about the needs and preferences of LGBT individuals (Fisher & Mustanski, 2015). Therefore, the individual needs of these people are not included in the research findings. The problem can be resolved through the implementation of ethically responsible practices that teach patients to manage their condition disregarding their biological gender and disclose to healthcare providers to receive high-quality help that considers the peculiarities of the LGBT population. The researchers expect that enhancing the responsible behavior of LGBT youth has the potential to reduce health disparities, but there still is no research investigating the effectiveness of this intervention and its influence on the LFBT community.
Research conducted by Ceres, Quinn, Loscalzo, and Rice (2017) analyzes cancer screening considerations and cancer screening uptake for LGBT individuals. Such research is a significant contribution to LGBT health issues and can be considered one of the interventions to address the cancer screening problem. Due to the lack of research discovering the needs and preferences of the LGBT population, diagnosing diseases became a challenge for healthcare providers. This research focuses on high cancer risks and the problem of low cancer screening rates among the LGBT population (Ceres et al., 2017).
The researchers develop evidence-based cancer-screening considerations specific for every group such as lesbian, bisexual, gay, and transgender. For example, they support recommendations of the ACS, the United States Preventive Screening Task Force (USPSTF), and the Office of Disease Prevention and Health Promotion that advise mammography screening once in a year or two for women aged 40 years and older (Ceres et al., 2017). As for cervical cancer, females between the ages of 21 to 65 should pass Pap smear every 3 years or every 5 years. Moreover, HPV testing is advised for women between the ages of 30 to 65. However, studies prove that these interventions are not always effective. Thus, about one-third (30%) of young bisexual women and lesbians did not have any of the recommended screenings in the past three years (Ceres et al., 2017). Transgender men are also not active in following the mentioned recommendation. Thus, only 49.5% of transgender men had passed Pap smear screening during the recent 3 years while more than 30% of transgender men had never had this screening (Ceres et al., 2017). Therefore, it can be concluded that the recommender interventions are not followed. Probably, this situation can be explained by poor access of LGBT patients to health care facilities or inefficient informing about screening opportunities.
Recommendations for Practice
To improve cancer screening rates among GBT patients, the following recommendations can be followed. For example, to reduce patient stress during examination and screening, it is important to prepare the patient. Thus, it is necessary to form a trusting relationship between the female-to-male spectrum patient and provider. Even the way a provider addresses a patient can matter because frequently patients feel uncomfortable with the use of gendered terminology (Potter et al., 2015). Therefore, it is advisable to apply the least gendered terminology during pelvic examinations. Moreover, some individuals can feel more comfortable during examination in case a friend is present.
The role of a nurse is important not only in the technical organization of screening for LGBT patients. For example, Ceres et al. (2017) focus on the significance of nurses who are “frontline, patient-facing professionals who can impact screening uptake and care follow-through” (p. 13). Oncology nurses are particularly important because they work with patients at all stages of cancer diagnosing and treatment. Nurses can give recommendations about the necessity of screening basing on nationally published guidelines thus increasing screening adherence. Regular screening, in turn, can improve the quality and quantity of life for the cancer LGBT Nurses can perform diverse roles including those of a counselor for patients and support.
On the whole, it is important to remember that LGBT individuals can be more sensitive to health information, and thus it is important to deliver information carefully. The whole practice should be directed at eliminating LGBT health disparities at different levels from the hospital administration to the department of healthcare. Also, in addition to managing cancer, it is crucial to pay attention to such patient conditions or demonstrations as depression that frequently develops after a cancer diagnosis.
Conclusion
Summarizing, it should be mentioned that lesbian, gay, bisexual, and transgender individuals have certain health peculiarities. First of all, these are socially and economically determined disparities that include poor access to healthcare services and discrimination that lead to worse patient outcomes. Cancer is among the diseases that frequently affect the LGBT population. The type of cancer depends on the group where an individual belongs. Thus, lesbian patients are likely to develop cervical or breast cancer while gay or transgene individuals will have prostate cancer. Despite opportunities for prevention and timely screening, few LGBT patients use the achievements of contemporary science. Therefore, it can be concluded that there is a gap in delivering knowledge and research-based evidence that needs to be bridged. It is a primary task of health care professionals to reduce the existing disparities in healthcare provision for LGBT individuals thus providing them with equal access to healthcare services. Still, the common effort is needed and cooperation should be organized among patients, healthcare providers, healthcare administrations, and agencies to assure that actions are taken to enhance healthcare availability for the representatives of the LGBT community. Finally, research is necessary to study the primary needs of LGBT individuals and alter health services accordingly.
References
Ceres, M., Quinn, G. P., Loscalzo, M., & Rice, D. (2018). Cancer screening considerations and cancer screening uptake for lesbian, gay, bisexual, and transgender persons. Seminars In Oncology Nursing, 34(1), 37-51. Web.
Fisher, C. B., & Mustanski, B. (2014). Reducing health disparities and enhancing the responsible conduct of research involving LGBT youth. Hastings Center Report, 44(s4), S28-S31. Web.
Hafeez, H., Zeshan, M., Tahir, M. A., Jahan, N., & Naveed, S. (2017). Health care disparities among lesbian, gay, bisexual, and transgender youth: A literature review. Cureus, 9(4), 1-7. Web.
Kamen, C. S., Smith-Stoner, M., Heckler, C. E., Flannery, M., & Margolies, L. (2014). Social support, self-rated health, and lesbian, gay, bisexual, and transgender identity disclosure to cancer care providers. Oncology Nursing Forum, 42(1), 44-51. Web.
Potter, J., Peitzmeier, S., Bernstein, I., Reisner, S., Alizaga, N., Agénor, M., & Pardee, D. (2015). Cervical cancer screening for patients on the female-to-male spectrum: A narrative review and guide for clinicians. Journal of General Internal Medicine, 30(12), 1857-1864. Web.
Wender, R., Sharpe, K., Westmaas, J., & Patel, A. (2015). The American Cancer Society’s approach to addressing the cancer burden in the LGBT community. LGBT Health, 3(1), 15-18. Web.