Retrospective Findings Show Younger Age of LGBTQI+ Patients at Time of Diagnosis

Shahrzad A. Zamani

Patients with cancer who identified as lesbian, gay, bisexual, transgender, queer, intersex, or other sexual orientation or gender minority (LGBTQI+) were found to be younger at the time of their diagnosis, and there was a higher proportion of ethnic minorities in this population compared with non-LGBTQI+ patients, according to findings from a retrospective study.

Data presented at the 2023 AACR Annual Meeting showed that LGBTQI+ patients were 6.3 years younger at the time of their cancer diagnosis (56.0 years vs 62.3 years). LGBTQI+ patients were also more likely to be everyday smokers (18.8% vs 12.2%) and consume more than 5 alcoholic drinks per day (8.1% vs 6.2%). Regarding colorectal cancer screening, a lower proportion of the LGBTQI+ population received a fecal occult blood test (26.6% vs 32.3%) or colonoscopy (75.1% vs 89.8%).

Among the LGBTQI+ population, 11.5% were Hispanic/Latino vs 8.8% for the non-LGBTQI+ population.

The analysis included 70,182 patients treated at the Moffitt Cancer Center who had previously completed an Electronic Patient Questionnaire prior to or during their first appointment. The questionnaire collected data on self-reported demographics, prior medical history, history of cancer, utilization of cancer screening services, and risk factors.

“We are observing the emerging trends and needs of the LGBTQI+ population. [By] recognizing the needs and the health disparities, then we [could] address them and translate them into clinical interventions,” lead study author Shahrzad A. Zamani said.

In an interview with OncLive®, Zamani, a third-year medical student and a graduate student researcher at Moffitt Cancer Center, in Tampa, Florida, expanded on the research on cancer disparities in patients within the sexual and gender minority population and how these findings could inform further research and decisions in clinical practice.

OncLive: What was the rationale of investigating cancer disparities among sexual and gender minority patients?

Zamani: [Over] the past several decades, there has been a lot of work done to address health disparities among the underserved populations. However, there hasn't been work dedicated to the LGBTQI+ community.

How did you investigate disparities among LGBTQI+ patients?

The aim of our research was to identify the health disparities among sexual and gender minority patients [with cancer]. Using a large dataset, we looked at age, gender, race, and ethnicity to [examine] health disparities among sexual and gender minority populations. Our research goal was to identify the health disparities that are specific to the LGBTQI+ community.

With my background in public health, I have been acutely aware of how health disparities affect the population’s health. I noticed trends [in the] lack of literature and work that has been done [to address disparities] in the LGBTQI+ population. We wanted to focus our research questions toward addressing those disparities.

The first step was to identify those disparities and figure out the points that we were missing in addressing the health needs of this particular population.

The large dataset was provided by Moffitt Cancer Center and the [Florida] cancer registry. We used those data points to create a factor called sexual orientation and gender identity [SOGI]. From that, we were able to categorize the LGBTQI+ population vs the non-LGBTQI+ population.

What cancer types were included in this research?

Due to the younger age of LGBTQI+ patients being diagnosed with cancer, we were not able to see all types of cancer in this population. The average age was 56.0 years for the LGBTQI+ population. A lot of the cancers that happen in older age were not visible in our data. However, we saw that there were much higher rates of gastrointestinal cancer, gynecologic cancer, and sarcoma in this population.

What were the key findings presented at the 2023 AACR Annual Meeting?

One of the most significant findings of our research was the age factor. The LGBTQI+ population was much more likely to be diagnosed with cancer at an earlier age at 56.0 years vs the non-LGBTQI+ population that was 62.3 years of age.

We also found that there was an intersection with race and ethnicity [for disparities] in the LGBTQI+ population.

Other notable findings that we highlighted were the lifestyle modifications that the LGBTQI+ patients could make. We found that the LGBTQI+ population was more likely to smoke cigarettes, more likely to drink alcohol, and have episodes of binge drinking. They were less likely to engage in all forms of physical activity, from walking to moderate or vigorous exercise.

How did these findings align with what was hypothesized prior to conducting the research?

Our findings fell in line with our hypothesis and what we had been expecting. However, our expectations [did not account] for such a drastic difference between the 2 populations.

How could these findings help inform additional research or actions within clinical practice?

We have already continued to collect data on this work, and we hope that our findings will help clinicians better tailor their approach in prevention and early detection of cancer specifically for the LGBTQI+ population.

Talking to patients, regardless of their sexual and gender minority status, and addressing them as individuals, [is the best] choice. Understanding that there are different needs within each population and patient will go a long way inside the clinic to help us reduce cancer disparities and increase prevention.

Reference

Zamani SA, Perez-Morales J, Miller JD et al. Cancer disparities among sexual and gender minority patients at a National Cancer Institute-Designated Comprehensive Cancer Center. Cancer Res. 2023;83(suppl 7):1916. doi.org/10.1158/1538-7445.AM2023-1916