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Health outcomes of sexual and gender minorities after cancer: a systematic review



Cancer research on sexual and gender minority (SGM) populations is gaining momentum. The purpose of this systematic review was to examine what is currently known in the research literature regarding patient-reported health outcomes after cancer treatment among SGM populations.


In March 2021, a medical librarian conducted a systematic keyword search on PubMed, Embase, Scopus, Web of Science, PsycINFO,, and the Cochrane Central Register of Controlled Trials. The primary inclusion criterion was assessment of at least one physical, psychosocial, emotional, or functional patient-reported health outcome related to the impacts of cancer diagnosis and/or treatment. Articles that met inclusion criteria were reviewed in their entirety, charted in a Word Table, and assessed for quality. Quality considerations included study design, sampling approach, diversity of sample, measures used, and analytic procedures. Studies were synthesized based on type of cancer study participants experienced.


Sixty-four studies were included in the final analysis: most were quantitative, secondary analyses or cross-sectional studies with convenience samples, and focused on people with a history of breast or prostate cancer. Differences between sexual minority men and women in terms of coping and resilience were noted. Few studies reported on experiences of transgender persons and none reported on experiences of intersex persons.


A growing literature describes the patient-reported health outcomes of SGM people with a history of cancer. This study summarizes important between-group differences among SGM and heterosexual, cisgender counterparts that are critical for clinicians to consider when providing care.

Implications for cancer survivors

Sexual orientation and gender identity are relevant to cancer survivors’ health outcomes. Subgroups of SGM people have differential experiences and outcomes related to cancer and its impacts.

Peer Review reports


Lesbian, gay, bisexual, transgender, queer, and/or intersex (LGBTQI) populations, also known as sexual and gender minorities (SGM), have been largely ignored in research until recently. While it is likely that these populations have been included in previous research, lack of data collection about sexual orientation and gender identity and lack of prioritizing the health of these populations has led to limited knowledge of their specific needs. Before the National Academies of Sciences 2011 report, The Health of Lesbian, Gay, Bisexual, and Transgender (LGBT) People: Building a Foundation for Better Understanding, few studies investigated disparities in cancer-related health outcomes based on sexual orientation and no studies investigated the outcomes of gender minority people [1]. In 2016, the National Institutes of Health (NIH) opened a new office dedicated to SGM health research, designating SGM people a minority population [2]. In 2017, the American Society of Clinical Oncology issued a call to action to reduce cancer health disparities for SGM populations [3].

However, most oncology practitioners have not been trained to address the needs of SGM people, and most cancer centers have yet to institute explicit policies or routine practices to collect sexual orientation and gender-identity data in the electronic medical record, use gender-neutral language on forms, provide SGM-specific support services, and/or require SGM cultural humility training for all staff [4]. Lack of training on the clinical and psychosocial needs of SGM patients perpetuates a system in which patients have to teach their clinicians about how to care for them, resulting in suboptimal care and potentially perpetuating stigmatizing behaviors of clinicians [5, 6]. Fortunately, cancer research on SGM patients has started to gain momentum. This review aimed to synthesize what is currently known about patient-reported health outcomes of SGM people after definitive cancer treatment to inform clinical practice and identify gaps in the literature to guide future research.

Notes on terminology

In this manuscript and in the review conducted, we used “SGM” as a term meant to encompass diverse people whose gender differs from their sex-assigned-at-birth and/or are not heterosexual. While “SGM” is not a term typically used by LGBTQI people to describe themselves, and the authors do not wish to minoritize LGBTQI people, the authors use this acronym, which has been adopted by the NIH, to be inclusive of a wide range of people, including people who do not identify with the words represented in the acronym “LGBTQI.” If a study is focused on a subgroup within the SGM umbrella, the specific subgroup is referred to rather than the broader term “SGM.” Furthermore, the authors acknowledge that the term “survivor” is not universally embraced. Our use of the term, while imperfect, is for the sake of efficiency of wording. We attempt to, whenever is reasonably efficient, refer to people with a history of cancer rather than a cancer “survivor.”



No previous protocol for this study has been published. The search strategy intentionally aimed to cast a wide net before selecting eligible studies for full review. Data were reported following the Preferred Reporting Items for Systematic. Reviews and Meta-Analyses (PRISMA) 2020 guidelines [7, 8].

Data sources and search strategy

A medical librarian constructed a comprehensive database search in March 2021. The search was conducted using a combination of keywords in the title or abstract and index terms on PubMed and Embase and keyword in the title or abstract only for Scopus, Web of Science (all databases), PsycINFO,, and the Cochrane Central Register of Controlled Trials (Cochrane Library). The search strategy included three distinct concepts that were combined using the “AND” Boolean operator: Sexual and Gender Minorities, Cancer, and Survivor. For the complete PubMed strategy, see Appendix 1. Filters were used to exclude conference abstracts, conference papers, and conference reviews from Embase; no other filters were used. EndNote was used to identify duplicates and additional duplicates were manually removed before screening for inclusion began. Reference lists from review articles that were identified through the database search were then hand searched to identify additional articles for possible inclusion.

Eligibility criteria

Studies were limited to articles published in English that included outcomes of SGM people with a history of a cancer diagnosis. To be included in the review, studies had to investigate and report on at least one physical, psychological, or social patient-reported outcome resulting from impact of a cancer diagnosis and/or treatment: studies with patient experience or satisfaction as the sole endpoint were not included. Commentaries, case studies, abstracts, reviews, dissertations, conference posters, provider-focused trainings and interventions, protocol articles without results, and studies conducted prior to the conclusion of cancer therapy were excluded.

Critical appraisal

Quality considerations included study design, sampling approach, diversity of sample, measures used, and analytic procedures. Cross-sectional designs, convenience samples, homogenous samples, and non-validated measures were considered limitations. Randomized controlled trials, rigorous qualitative methods, diverse samples, and validated measures were considered strengths.


All included studies were reported in two word tables. Table 1 includes place where study took place, types of SGM subpopulations included, study design, and type of cancer study participants experienced. Appendix 2 reports studies in alphabetical order clustered by age (e.g., AYA) and type of cancer experienced (e.g., breast, colorectal, prostate, various). Studies were synthesized according to experiences of women who have sex with women (WSW), men who have sex with men (MSM), and transgender persons. Given the small number of studies focused on AYA and colorectal cancer survivors, data for these studies were only reported in Appendix 2. Comparisons of SGM subgroups are included in the “Discussion.”

Table 1 Characteristics of included studies (n = 64)


Study selection

Database searches for peer-reviewed articles focused on health outcomes among SGM persons after definitive treatment for cancer yielded 201 entries in PubMed, 671 in Embase, 344 in Scopus, 279 in Web of Science, 118 in PsycINFO, 12 in, and 7 in Cochrane Library’s Central Register of Controlled Trials for a total of 1632 articles. All included articles were required to have SGM people with a history of cancer as a primary focus of the study. Checking for duplicates on EndNote identified 604 duplicates leaving 1028 articles. There were 930 total articles identified for review after manual duplication screen of the EndNote library identified an additional 98 duplicates.

Authors MPC and AA independently reviewed all titles in Excel for these 930 entries. At the title review stage, 796 articles were eliminated. MPC reviewed all abstracts (n = 134), and AA reviewed 10% of the abstracts based on random selection and agreed with MPC on exclusion and inclusion for full-text review. A manual review of reference lists of review articles was conducted to ensure no studies were missed in systematic searches, adding additional 14 articles for abstract review for a total of n = 148 abstracts [9]. Forty-nine studies were eliminated at the abstract review stage leaving n = 99. MPC and AA each reviewed half of the remaining full texts. Full-text articles were reviewed for compliance with the inclusion criteria; reasons for exclusion of 35 articles after full-text review are provided in Fig. 1. The full-text articles included in the final synthesis were n = 64.

Fig. 1

PRISMA diagram of study selection

Study characteristics

Most studies were of people with a history of breast or prostate cancer and were focused on disparities based on sexual orientation. Two studies focused on people who were diagnosed with cancer during adolescence and young adulthood (AYA) and two studies focused on people with a history of colorectal cancer. Most studies were conducted in the USA, Australia, and Canada. See Table 1 for general characteristics of included studies.

Data charting: summary of studies

Appendix 2 was used as a template for data charting. Studies were sorted by the following demographic groups: adolescent and young adults and studies focused on those diagnosed with breast, prostate, or other cancers, respectively. Lead author and year, location, population of interest including any comparison group(s) when relevant, type of study, design, outcomes, and critical appraisal of each study are reported.

Women who have sex with women

The majority of studies found on SGM people with a history of cancer focused on those who had been diagnosed with breast cancer, mostly comparing lesbians to heterosexual counterparts. Half of the studies on breast cancer were quantitative and analyzed a variety of outcomes from the same two cohorts or subsets of those cohorts [10,11,12,13,14,15,16,17] and [12, 18,19,20]. Given that half of the analyses were conducted in the same two samples of women, extrapolating findings from these studies on SGM with a history of breast cancer should be done with caution. Nevertheless, studies from these two cohorts combined with additional qualitative studies and two mixed methods studies yielded important insights [21,22,23,24].

Participants studied were mostly White, educated, employed, and identified as women. Women who have sex with women (WSW, a term used to be inclusive of lesbian, bisexual, and queer women, and women who do not identify in these ways but partner with women) and heterosexual peers had similar quality of life (QOL) [11, 25] with a few exceptions. WSW with less financial means and those who experienced greater discrimination were more likely to have poorer physical health and increased anxiety and depression [11, 20]. WSW also reported greater stress [26] and less satisfaction with care [24]. In one study, discrimination was associated with anxiety, but resilience and social support buffered this association [26]. Thematic analysis from another study also noted the importance of recognition of partners for psychological wellness, the need for SGM-specific support groups, and the negative impacts of breast cancer treatment on relationships including sexual intimacy [22].

WSW in these studies and their caregivers also showed greater dyadic effects on quality of life compared to heterosexual couples [19]. WSW reported more adaptive coping and improved health behaviors in response to a cancer diagnosis. After cancer diagnoses, WSW with BMI greater than 25 were more likely to lose weight compared with heterosexual counterparts, eliminating a statistically significant pre-diagnosis difference [10]. WSW reported less avoidant coping and anxious preoccupation than heterosexual peers [13, 27] and had similar rates of anxiety and depression [28]. For WSW, having a partner was associated with better sexual function, greater sexual desire, better mental and physical health, and less fear of recurrence compared to heterosexual counterparts [12,13,14]. WSW also reported that female partners were a singular and valuable source of support and were able to perceive partner distress, manage home and caretaking, and share a life beyond cancer [24]. In addition, WSW reported being less focused on body image, suffered fewer identity issues due to breast cancer and chose not to have reconstruction more often than heterosexual peers [22, 29, 30]. However, WSW reported more challenges with access to care [31] and experienced more physical complications related to mastectomy and radiation than heterosexual peers [15]. Overall, WSW displayed more resilient behaviors than heterosexual peers, although one study indicated there were no between-group differences in resilience based on sexual practices (WSW vs. heterosexual women) [32].

Counter to other studies, one study demonstrated an association between degree of “outness” (defined in the study as the number of relationships in which people were open about their identity) and higher distress [26], which may suggest increased experiences of stigmatization when people were open about their identities. While WSW did not perceive they were treated differently based on sexual orientation, 39% of WSW in one study said they were assumed to be heterosexual by their health care team [25, 33]. Whether level of outness is linked to discriminatory experiences has not been explored.

Men who have sex with men

Studies on people with a history of prostate cancer primarily focused on genitourinary and relationship changes for men who have sex with men (MSM). Overall, MSM reported more genitourinary challenges than heterosexual peers, including worse urinary and bowel function, lack of ejaculation, changes to erectile function, climacturia, pain during anal sex, penile shortening, loss of libido, and less frequency of sexual activity, although one study demonstrated better sexual function in MSM diagnosed with prostate cancer than that reported in the literature [34,35,36,37]. MSM with HIV reported more significant detrimental effects of treatment than MSM without HIV [38]. One study showed that MSM had greater sexual dysfunction after bicalutamide monotherapy compared to heterosexual peers [39]. One novel study assessed the discussions between MSM and their clinicians regarding sexual and urinary effects of prostate cancer and the treatments offered and noted that while the most common problems reported were loss of ejaculate (93.8%), erectile difficulties (89.6%), change in sense of orgasm (87.0%), loss of sexual confidence (76.7%), changes to the penis (65.8%), increased pain in receptive anal sex (64.8%), urinary incontinence not related to sex (64.2%), and urinary incontinence during sex (49.2%), only loss of ejaculate, erectile difficulties, and nonsexual urinary problems were commonly discussed by clinicians during prostate cancer treatment. Satisfaction with specific rehabilitation options varied widely [40].

In qualitative studies, people with a history of prostate cancer reported fearing rejection and sexual abstinence after treatment: “Afterward I felt like I would never find another partner again and there was a depression” [41]. Among MSM who were dating or seeking casual sex, disclosure was seen as a challenge: “A lot of people hit on me, but I just dread that part in the conversation where I have to go, ‘Well, just so you know, I’m a survivor of prostate cancer and there’s never going to be any cum” [42]. Erectile dysfunction led to break-ups in some cases: “For a month or so it was going really nicely, but about a month in he stopped in the middle of sex one night and he said, ‘I’m sorry, you’re just not hard enough for me.’ I was really upset because I was developing feelings for him” [42]. Loss of spontaneity was another noted adjustment:

“Everything has to be planned ahead of time. How much are you drinking? How much salt did you take? Did you take Cialis? If you’re on a date, you may want to have 100 milligram Viagra in your pocket. If you have any chance of going home with somebody, if you want to leave and do that, you can’t drink a lot beforehand because you don’t want to pee in the guy’s bed. All the stuff I never used to think of, ever. It was just wham, bam, thank you, man. You were much more free. Now, all the spontaneity is gone, which is a shame” [42].

Several studies reported changes to participants’ sense of identity as gay men, resulting in changes to relationships and worse mental health [36, 42,43,44]. In one qualitative study, MSM participants describe erectile dysfunction as a persistent problem that is paramount to being “sexually inferior” or “leading to a sense of ‘disqualification’ of the sexual experience” [36]. Another study reported MSM participants feeling unattractive or even disabled [34]. Sexual changes were reported to adversely affect the mental health and identities of MSM. In Ussher et al.’s [36] study, a gay interviewee reported that erectile dysfunction was “the most horrific thing that I’ve ever been through psychologically.” Another respondent indicated decisional regret, preferring to “take my risks with the cancer” if he could go back in time. One MSM interviewee explained his loss of libido as “a profound change in identity” and another said he felt “outside the sexual community” after the change in his sexual function [36]. Two qualitative studies found that renegotiation of exclusivity was one strategy that couples used to cope with physical symptoms and reduced sexual interest of the survivor. Specifically, survivors in this study encouraged partners to obtain sexual satisfaction outside of their relationship [42, 45]. In contrast, some MSM reported more profound intimacy with their partner [36, 42] after cancer diagnosis and treatment.

Several studies demonstrated benefits of MSM’s disclosure of sexual identity to their providers. In one study, MSM who were comfortable disclosing their sexual orientation had greater masculine self-esteem scores, which was linked to greater mental health [46]. Another study demonstrated reduced anxiety and less illness intrusiveness for MSM who had shared their sexual orientation with providers [35].

Studies also highlighted lack of resources and support tailored for MSM [44, 47]. In Ussher et al.’s qualitative study [36], one MSM respondent summarized the issue like this: “Most health care professionals and others working in the prostate cancer field have no understanding of the different ways that prostate cancer can affect gay and bisexual men. Not just sexually, but in the nonsexual side of relationships. It’s as though we’re invisible.” Other MSM described discomfort with a support group that was mostly attended by heterosexual people: “It’s horrifying because there’s this old man talking about sex with the wife. They don’t want to hear about my problem. I didn’t want to hear about theirs. It didn’t work for me” [41]. In the same study, single MSM expressed the need to be extremely independent and not seek out support: “I was alone to recover… I didn’t really want a lot of company. I mean, I’m walking around the house with a catheter tube sticking out of me, it wasn’t really the time” [41]. Other participants noted that they did not want to bother their friends or chose to hire staff to help them rather than seek help from their friends [41].

Transgender participants

Only seven studies included transgender and/or genderqueer respondents [21, 22, 31, 48,49,50,51]. Boehmer et al. [31] reported an analysis of BRFSS data from 2014 to 2018 that indicated that transgender men had a higher likelihood of having a cancer diagnosis than cisgender men as well as poorer physical health and more comorbidities compared to cisgender men and cisgender women. Bryson et al. [48] found that intersectional identities impacted the experiences of transgender cancer survivors. Brown and McElroy [21] described health care providers “gender policing” when genderqueer patients made the decision to “go flat” and declined breast reconstruction. These experiences and treatment choices were associated with mixed physical and emotional outcomes. Participants reported being unprepared for early menopause and mental health impacts of hysterectomy. Respondents in another study who identified as “queer,” “questioning,” “genderqueer,” “transgender,” or “other” compared with other SGM people were more likely to report that their current level of support was below average [22]. Kamen et al. [50] and Lisy et al. [51] included transgender respondents in their studies, but the former did not stratify outcomes specific to transgender respondents, and the latter did not decouple gender identity from sexual orientation.

Critical appraisal

Most studies were either (1) secondary analyses of state-level data where data were available on sexual orientation and gender identity in population surveys or (2) cross-sectional surveys of survivors that could be subject to recall, self-selection, and social desirability bias. Only one study assessed the impact of a therapeutic drug on survivor outcomes [39]. The study was based on binary assumptions about sex and sexual orientation. However, it is singular in demonstrating hormone-based differences in response to cancer pharmacotherapies. A strength among many studies was use of validated measures, although sometimes these had to be adapted to be responsive to the experiences of SGM people. Table 2 catalogs measures used in the included studies.

Table 2 Summary of validated scales used in SGM survivorship research


Differences among SGM populations

Most of the studies reviewed were focused on breast cancer for WSW or prostate cancer for MSM. Several studies that synthesized outcomes for people with a history of various cancers indicated worse physical outcomes for SGM compared to heterosexual, cisgender counterparts [91]. However, studies identified no mental health differences between WSW with cancer compared to heterosexual peers. In contrast, a number of studies demonstrated poorer mental health and increased relationship difficulties for MSM with cancer compared to heterosexual peers [92]. In two separate studies, WSW reported lower fear of recurrence while MSM reported greater fear of recurrence compared to heterosexual counterparts [17, 93]. In other studies, MSM were also less likely to be partnered than heterosexual people in contrast to WSW, who were more likely to be partnered [14, 94]. Partner support appeared to buffer negative effects for WSW [13, 17, 29], and partner support was associated with greater reduction in depression [50, 95]. This buffering effect of partnership was not necessarily true for MSM [96]. The heightened dyadic effect of patient-caregiver quality of life shown in Boehmer et al.’s 2020 study [19] highlights the importance of providers including WSW caregivers in cancer treatment discussions.

Additionally, knowledge and competence with SGM health emerged as a critical concern. One study found that SGM who reported their oncologist was not knowledgeable about SGM care reported greater unmet needs and were less likely to disclose their sexual orientation or gender identity to their oncologist [52]. Unmet needs included depression, sadness, cancer-related fears, uncertainty, stress, and sexual dysfunction [52]. Another study found bisexual women who had a history of cancer to be three times more likely to report psychological distress [97]. Bisexual individuals often experience dual discrimination by both mainstream and SGM communities, which may account for this heightened distress. Collectively, these findings support past research that has demonstrated the importance of knowledgeable and unassuming providers in meeting the cancer care needs of SGM persons. For example, a recent study about gender diverse individuals’ satisfaction with care reported discontent with provider assumptions about lesbians wanting breast reconstruction and transgender men wanting hysterectomies; the same study reported that transgender men experienced challenges to male chest reconstruction after breast cancer [98]. Greater clinical and cultural knowledge of SGM concerns and SGM-affirming interventions for concerns are needed.

Gaps in research

Since the National Academies 2011 report on SGM health, more studies have been published which examine patient-reported outcomes of SGM people with a history of breast or prostate cancers. However, studies exploring the needs and outcomes of sexual minorities with other cancers as well as studies documenting and addressing the needs of gender minorities are severely limited. Only two studies focused on people with a history of colorectal cancer. One study reported financial challenges of queer colorectal cancer survivors; however, there was no comparison group and no other studies with which to compare the sample. Boehmer et al.’s registry-based study of colorectal cancer survivors showed no differences in patient-reported experiences regarding physician communication, nursing care, or coordination of care, but sexual minorities were more likely to categorize their care overall as “excellent” compared to heterosexual counterparts. A major implication of this study is the potential role of resilience among sexual minorities when facing multiple traumatic events across the lifespan. A weakness of the study was the inability to examine differences in MSM and WSW outcomes within studies due to the aggregation of male and female sexual minorities in the literature. A few studies examined outcomes of people diagnosed with diverse cancers, but overall, more research on people surviving a variety of types of cancer is needed to understand differences in health-related outcomes for SGM survivors.

A critical gap exists in studies focusing on transgender, genderqueer, gender diverse, and intersex patient-reported outcomes. Only seven studies mentioned transgender patients [21, 22, 31, 48,49,50,51]. Of these, one study mentioned the term “intersex,” yet no intersex people were actually included in the study; in addition, sexual orientation was not reported separately from gender identity, conflating multiple constructs [50]. Of note, intersex people often refer to themselves as female or male rather than intersex. Therefore, intersex individuals may be overlooked within some studies under binary sex categories when intersex status is not assessed.

Another critical gap exists in studies focusing on SGM people of color and SGM people with other intersecting marginalized identities. This work is needed to understand the ways that multiple axes of oppression may affect the outcomes of patients after a cancer diagnosis.

Only two studies focused on AYA people with a history of cancer. Desai et al. [99] found greater likelihood of anxiety among sexual minority AYA survivors compared to heterosexual counterparts. Another qualitative study reported that SGM AYA survivors were less concerned with the possibility of infertility and more open to being non-biological parents than heterosexual peers [100]. More work on AYA cancer survivorship that stratifies experiences and outcomes based on sexual orientation and gender identity is needed.

A strength of many of the studies was the use of validated measures. A list of measures is provided in Table 2 for reference. In some cases, measures used were constructed for heterosexual people and were not relevant to SGM populations. This was particularly true of measures focused on sexual function and outcomes. This limitation of existing measures led researchers to sometimes create or adapt instruments for their studies. Validation of measures focused on SGM sexual outcomes is needed to ensure rigor and reliability of research and to allow for comparisons across studies of SGM survivors.

Finally, only two studies were interventional. Kamen et al. [95] found a dyadic exercise intervention for partners to be more effective in reducing depression than a survivor-only intervention. Anderson et al. [46] found that among elderly gay men who were long-term survivors of AIDS and had another serious medical illness (e.g., cancer), psilocybin-supported group therapy was feasible and appeared to have positive effects. This interventional study was novel as a group-based intervention rather than individual-level intervention coupled with pharmacotherapy for clinically demoralized patients [46]. Interventional research to address poorer physical health among lesbians who have been diagnosed with breast cancer and greater sexual challenges for MSM with prostate cancer are needed. Interventional research that provides early and clear information on fertility preservation is also needed for AYA and other survivors regardless of sexual orientation or gender identity.

Limitations and strengths of the literature reviewed and of this study

Notably, a limitation of the current literature on SGM people with a history of cancer is lack of diversity of samples, reliance on cross-sectional studies, and lack of interventional studies. Lack of studies in people diagnosed with cancers other than breast or prostate are also significantly lacking. Greater attention to intersectionality, distinctions among SGM subgroups and reporting of data for transgender, gender diverse, and intersex persons are warranted.

This study was limited to articles published through March 2021 focused on SGM people with a history of cancer that reported at least one post-treatment physical, psychological, or social outcome. The study did not include studies that focused only on experiences of care (such as patient satisfaction) unless at least one health-related patient-reported outcome was also included as an endpoint. For a recent review that includes studies of patient satisfaction [101], care decision-making [102, 103], provider training for improved SGM care [104], supportive care needs [104, 105], and other disparities affecting SGM persons [106], see Kent et al. [107]. These studies were not included here, because our focus was on patient-reported outcomes as a result of cancer and treatment rather than satisfaction or care experiences in treatment.

A major strength of this review is its comprehensiveness in summarizing SGM survivorship research to date due to the systematic search methods [8]. This review contributes uniquely to the literature by providing an update to existing reviews [107], focusing on health outcomes as the endpoints of interest, providing a critical appraisal of studies, comparing differences among SGM subgroups (e.g., research findings relevant to sexual minority women v. sexual minority men), and identifying additional gaps in the research literature. Secondary analyses of primary data sets are also included, unlike existing reviews [107]. Finally, a table of measures used in research focused on SGM cancer survivors is included in Table 2. This summary can assist with scale selection and adaptation for future research to aid in comparisons across studies over time.


This study summarized important between-group differences among SGM people and heterosexual, cisgender counterparts. This review found clear differences in perspectives and health outcomes between WSW and MSM and a lack of reporting regarding whether participants were cisgender or transgender. Thus, researchers should take care to not conflate WSW and MSM when conducting analyses and should ask participants about transgender and gender expansive identities. Gender minority people have been understudied; expanding research in this area will be important to the creation of interventions to improve post-treatment experiences of gender minority people with a history of cancer. Sexual orientation, gender identity, genomic material, hormone balance, and physical anatomy are separate constructs that should not be conflated. Finally, attention to intersectionality within SGM populations is critical as people with multiple intersecting aspects of their identity may have drastically different needs, experiences, and outcomes than those of SGM people who identify with only one marginalized population. Intersectionality was not well-addressed in the extant literature reviewed.

It is paramount that anatomy (including intersex status), sexual orientation, and gender identity be documented in electronic health records and population-based surveys. Until these important variables are systematically recorded and used by clinicians and researchers, SGM research will continue to be restricted to small sample sizes that are not powered to detect subgroup differences. Studies focused on heterosexual, cisgender populations will need to be replicated in convenience samples of SGM patients, which is poor stewardship of research funding dollars. Adding sexual orientation, gender identity, and intersex questions to all studies would be more efficient and provide more robust data to inform clinical care.

Finally, a shift to healthcare that accounts for social determinants of health and intersectionality is critical to effectively address the needs of SGM people with a cancer diagnosis. Clinicians must be trained on how to tailor medical management based on patient values and priorities of care, including considerations for sexual orientation, gender identity, sexual practices, hormone levels, and physical anatomy rather than by monolithic, binary gender markers. Distinctions between sexual orientation and gender identity in research; structured data collection; and clinician training are critical for evidence-based, quality cancer care to improve health outcomes for SGM people. Furthermore, important cultural distinctions within groups that share sexual orientation, gender identity, and/or intersex categories may yield additional insights regarding within-group differences. Accounting for the diversity of lived experiences of SGM people in research design and analysis will help cancer care better address the needs of diverse populations. In sum, a growing literature describes patient-reported health outcomes of SGM people with a history of cancer, but without systematic registries and/or population-based data collection, data will continue to suffer substantial limitations, thereby reducing utility for clinical practice.

Availability of data and materials

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.



Adolescents and young adults


Body mass index


Human immunodeficiency virus


Lesbian, gay, bisexual, transgender, queer, and/or intersex


Men who have sex with men


National Institutes of Health


Patient/Population/Problem, Intervention, Comparison, Outcome


Sexual and gender minorities


Quality of life


Women who have sex with women


  1. 1.

    Institute of Medicine (U.S.). Committee on Lesbian Gay Bisexual and Transgender Health Issues and Research Gaps and Opportunities. The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding. Washington, DC: National Academies Press; 2011.

    Google Scholar 

  2. 2.

    National Institutes of Health. Sexual and Gender Minority Research Office (SGMRO) website. Accessed 5 Jan 2020

  3. 3.

    Griggs J, Maingi S, Blinder V, Denduluri N, Khorana AA, Norton L, et al. American Society of Clinical Oncology position statement: strategies for reducing cancer health disparities among sexual and gender minority populations. J Clin Oncol. 2017;35(19):2203–8.

    Article  PubMed  Google Scholar 

  4. 4.

    Wheldon CW, Schabath MB, Hudson J, Bowman Curci M, Kanetsky P, Vadaparampil ST, et al. Culturally competent care for sexual and gender minority patients at national cancer institute-designated comprehensive cancer centers. Lgbt Health. 2018;5(3):203–11.

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Poteat T, German D, Kerrigan D. Managing uncertainty: a grounded theory of stigma in transgender health care encounters. Soc Sci Med. 2013;84:22–9.

    Article  PubMed  Google Scholar 

  6. 6.

    James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi M. The Report of the 2015 U.S. Transgender Survey. 2016. Accessed 5 Jan 2020.

    Google Scholar 

  7. 7.

    Page MJ, McKenzie JE, Bossuyt PM, Bouton I, Hoffman TC, Mulrow CD, et al. Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement. J Clin Epidemiol. 2021;134:103–12.

    Article  PubMed  Google Scholar 

  8. 8.

    Page MJ, McKenzie JE, Bossuyt PM, Bouton I, Hoffman TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Boehmer U, Cooley TP, Clark MA. Cancer and men who have sex with men: a systematic review. Lancet Oncol. 2012;13(12):E545–E53.

    Article  PubMed  Google Scholar 

  10. 10.

    Boehmer U, Mertz M, Timm A, Glickman M, Sullivan M, Potter J. Overweight and obesity in long-term breast cancer survivors: how does sexual orientation impact BMI? Cancer Investig. 2011;29(3):220–8.

    Article  Google Scholar 

  11. 11.

    Boehmer U, Glickman M, Milton J, Winter M. Health-related quality of life in breast cancer survivors of different sexual orientations. Qual Life Res. 2012;21(2):225–36.

    Article  PubMed  Google Scholar 

  12. 12.

    Boehmer U, Timm A, Ozonoff A, Potter J. Explanatory factors of sexual function in sexual minority women breast cancer survivors. Ann Oncol. 2012;23(11):2873–8.

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Boehmer U, Glickman M, Winter M, Clark MA. Breast cancer survivors of different sexual orientations: which factors explain survivors’ quality of life and adjustment? Ann Oncol. 2013;24(6):1622–30.

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Boehmer U, Glickman M, Winter M, Clark MA. Lesbian and bisexual women’s adjustment after a breast cancer diagnosis. J Am Psychiat Nurses. 2013;19(5):280–92.

    Article  Google Scholar 

  15. 15.

    Boehmer U, Glickman M, Winter M, Clark MA. Long-term breast cancer survivors’ symptoms and morbidity: differences by sexual orientation? J Cancer Surviv. 2013;7(2):203–10.

    Article  PubMed  Google Scholar 

  16. 16.

    Boehmer U, Ozonoff A, Timm A, Winter M, Potter J. After breast cancer: sexual functioning of sexual minority survivors. J Sex Res. 2014;51(6):681–9.

    Article  PubMed  Google Scholar 

  17. 17.

    Boehmer U, Tripodis Y, Bazzi AR, Winter M, Clark MA. Fear of cancer recurrence in survivor and caregiver dyads: differences by sexual orientation and how dyad members influence each other. J Cancer Surviv. 2016;10(5):802–13.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Boehmer U, Ozonoff A, Potter J. Sexual minority women’s health behaviors and outcomes after breast cancer. Lgbt Health. 2015;2(3):221–7.

    Article  PubMed  Google Scholar 

  19. 19.

    Boehmer U, Stokes JE, Bazzi AR, Clark MA. Dyadic quality of life among heterosexual and sexual minority breast cancer survivors and their caregivers. Support Care Cancer. 2020;28(6):2769–78.

    Article  PubMed  Google Scholar 

  20. 20.

    Jabson JM, Donatelle RJ, Bowen D. Breast cancer survivorship: the role of perceived discrimination and sexual orientation. J Cancer Surviv. 2011;5(1):92–101.

    Article  PubMed  Google Scholar 

  21. 21.

    Brown MT, McElroy JA. Unmet support needs of sexual and gender minority breast cancer survivors. Support Care Cancer. 2018;26(4):1189–96.

    Article  Google Scholar 

  22. 22.

    Brown MT, McElroy JA. Sexual and gender minority breast cancer patients choosing bilateral mastectomy without reconstruction: "I now have a body that fits me". Women Health. 2018;58(4):403–18.

    Article  PubMed  Google Scholar 

  23. 23.

    Matthews AK, Peterman AH, Delaney P, Menard L, Brandenburg D, editors. A qualitative exploration of the experiences of lesbian and heterosexual patients with breast cancer. Oncology Nursing Forum-Oncology Nursing Society. Pittsburgh: Oncology Nursing Society; 2002.

    Google Scholar 

  24. 24.

    White JL, Boehmer U. Long-term breast cancer survivors’ perceptions of support from female partners: an exploratory study. Oncol Nurs Forum. 2012;39(2):210-7.

  25. 25.

    Jabson JM, Bowen DJ. Perceived stress and sexual orientation among breast cancer survivors. J Homosex. 2014;61(6):889–98.

    Article  PubMed  Google Scholar 

  26. 26.

    Kamen C, Jabson JM, Mustian KM, Boehmer U. Minority stress, psychosocial resources, and psychological distress among sexual minority breast cancer survivors. Health Psychol. 2017;36(6):529–37.

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Wheldon CW, Roberts MC, Boehmer U. Differences in coping with breast cancer between lesbian and heterosexual women: a life course perspective. J Women's Health (Larchmt). 2019;28(8):1023–30.

    Article  Google Scholar 

  28. 28.

    Boehmer U, Glickman M, Winter M. Anxiety and depression in breast cancer survivors of different sexual orientations. J Consult Clin Psychol. 2012;80(3):382.

    Article  Google Scholar 

  29. 29.

    Boehmer U, White JL. Sexual minority status and long-term breast cancer survivorship. Women Health. 2012;52(1):71–87.

    Article  PubMed  Google Scholar 

  30. 30.

    Boehmer U, Gereige J, Winter M, Ozonoff A. Cancer survivors’ access to care and quality of life: do sexual minorities fare worse than heterosexuals? Cancer-Am Cancer Soc. 2019;125(17):3079–85.

    Article  Google Scholar 

  31. 31.

    Boehmer U, Miao XP, Ozonoff A. Cancer survivorship and sexual orientation. Cancer-Am Cancer Soc. 2011;117(16):3796–804.

    Article  Google Scholar 

  32. 32.

    Bazzi AR, Clark MA, Winter MR, Ozonoff A, Boehmer U. Resilience among breast cancer survivors of different sexual orientations. Lgbt Health. 2018;5(5):295–302.

    Article  PubMed  PubMed Central  Google Scholar 

  33. 33.

    Jabson JM, Donatelle RJ, Bowen DJ. Relationship between sexual orientation and quality of life in female breast cancer survivors. J Women's Health (Larchmt). 2011;20(12):1819–24.

    Article  Google Scholar 

  34. 34.

    Jagervall CD, Bruggeman J, Johnson E. Gay men's experiences of sexual changes after prostate cancer treatment: A qualitative study in Sweden. Scand J Urol. 2019;53(1):40–4.

    Article  Google Scholar 

  35. 35.

    Crangle CJ, Latini DM, Hart TL. The effects of attachment and outness on illness adjustment among gay men with prostate cancer. Psycho-Oncology. 2017;26(4):500–7.

    Article  PubMed  Google Scholar 

  36. 36.

    Ussher JM, Perz J, Rose D, Dowsett GW, Chambers S, Williams S, et al. Threat of sexual disqualification: the consequences of erectile dysfunction and other sexual changes for gay and bisexual men with prostate cancer. Arch Sex Behav. 2017;46(7):2043–57.

    Article  PubMed  Google Scholar 

  37. 37.

    Wassersug RJ, Lyons A, Duncan D, Dowsett GW, Pitts M. Diagnostic and outcome differences between heterosexual and nonheterosexual men treated for prostate cancer. Urology. 2013;82(3):565–71.

    Article  PubMed  Google Scholar 

  38. 38.

    Polter EJ, Wheldon CW, Rosser BRS, Kohli N, Capistrant BD, Kapoor A, et al. Health-related quality of life by human immunodeficiency virus status in a cross-sectional survey of gay and bisexual prostate cancer survivors. Psychooncology. 2019;28(12):2351–7.

    Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    Motofei IG, Rowland DL, Popa F, Kreienkamp D, Paunica S. Preliminary study with bicalutamide in heterosexual and homosexual patients with prostate cancer: a possible implication of androgens in male homosexual arousal. BJU Int. 2011;108(1):110–5.

    CAS  Article  PubMed  Google Scholar 

  40. 40.

    Rosser BRS, Kohli N, Polter EJ, Lesher L, Capistrant BD, Konety BR, et al. The sexual functioning of gay and bisexual men following prostate cancer treatment: results from the restore study. Arch Sex Behav. 2020;49(5):1589–600.

    Article  Google Scholar 

  41. 41.

    Capistrant BD, Torres B, Merengwa E, West WG, Mitteldorf D, Rosser BR. Caregiving and social support for gay and bisexual men with prostate cancer. Psycho-Oncology. 2016;25(11):1329–36.

    Article  PubMed  PubMed Central  Google Scholar 

  42. 42.

    Rosser BR, Capistrant B, Torres B, Konety B, Merengwa E, Mitteldorf D, et al. The effects of radical prostatectomy on gay and bisexual men’s mental health, sexual identity and relationships: qualitative results from the Restore Study. Sex Relation Ther. 2016;31(4):446–61.

    Article  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Lee TK, Breau RH, Eapen L. Pilot study on quality of life and sexual function in men-who-have-sex-with-men treated for prostate cancer. J Sex Med. 2013;10(8):2094–100.

    Article  PubMed  Google Scholar 

  44. 44.

    McConkey RW, Holborn C. Exploring the lived experience of gay men with prostate cancer: a phenomenological study. Eur J Oncol Nurs. 2018;33:62–9.

    Article  PubMed  Google Scholar 

  45. 45.

    Hartman ME, Irvine J, Currie KL, Ritvo P, Trachtenberg L, Louis A, et al. Exploring gay couples' experience with sexual dysfunction after radical prostatectomy: a qualitative study. J Sex Marital Ther. 2014;40(3):233–53.

    Article  PubMed  Google Scholar 

  46. 46.

    Anderson BT, Danforth A, Daroff R, Stauffer C, Ekman E, Agin-Liebes G, et al. Psilocybin-assisted group therapy for demoralized older long-term AIDS survivor men: an open-label safety and feasibility pilot study. Eclinical Med. 2020;27:100557.

    Article  Google Scholar 

  47. 47.

    Thomas C, Wootten A, Robinson P. The experiences of gay and bisexual men diagnosed with prostate cancer: results from an online focus group. Eur J Cancer Care. 2013;22(4):522–9.

    CAS  Article  Google Scholar 

  48. 48.

    Boehmer U, Gereige J, Winter M, Ozonoff A, Scout N. Transgender individuals’ cancer survivorship: results of a cross-sectional study. Cancer. 2020.

  49. 49.

    Bryson MK, Taylor ET, Boschman L, Hart TL, Gahagan J, Rail G, et al. Awkward choreographies from cancer's margins: incommensurabilities of biographical and biomedical knowledge in sexual and/or gender minority cancer patients' treatment. J Med Humanit. 2018.

  50. 50.

    Kamen CS, Smith-Stoner M, Heckler CE, Flannery M, Margolies L. Social support, self-rated health, and lesbian, gay, bisexual, and transgender identity disclosure to cancer care providers. Oncol Nurs Forum. 2015;42(1):44–51.

    Article  PubMed  PubMed Central  Google Scholar 

  51. 51.

    Lisy K, Ward A, Schofield P, Hulbert-Williams N, Bishop J, Jefford M. Patient-reported outcomes of sexual and gender minority cancer survivors in Australia. Psycho-Oncology. 2019;28(2):442–4.

    Article  PubMed  Google Scholar 

  52. 52.

    Antoni MH, Lehman JM, Kilbourn KM, Boyers AE, Culver JL, Alferi SM, et al. Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer. Health Psychol. 2001;20(1):20–32.

    CAS  Article  PubMed  Google Scholar 

  53. 53.

    Frierson GM, Thiel DL, Andersen BL. Body change stress for women with breast cancer: the Breast-Impact of Treatment Scale. Ann Behav Med. 2006;32(1):77–81.

    Article  PubMed  Google Scholar 

  54. 54.

    Derogatis LR, Melisaratos N. The Brief Symptom Inventory: an introductory report. Psychol Med. 1983;13(3):595–605.

    CAS  Article  Google Scholar 

  55. 55.

    Schulz U, Schwarzer R. Soziale Unterstützung bei der Krankheitsbewältigung: Die Berliner Social Support Skalen (BSSS) [Social support in coping with illness: the Berlin Social Support Scales (BSSS)]. Diagnostica. 2003;49(2):73–82.

    Article  Google Scholar 

  56. 56.

    Lubeck DP, Litwin MS, Henning JM, Stier DM, Mazonson P, Fisk R, et al. The CaPSURE database: a methodology for clinical practice and research in prostate cancer. CaPSURE Research Panel. Cancer of the Prostate Strategic Urologic Research Endeavor. Urology. 1996;48(5):773–7.

    CAS  Article  PubMed  Google Scholar 

  57. 57.

    Radloff LS. The CES-D scale: a self report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.

    Article  Google Scholar 

  58. 58.

    UCLA Center for Health Policy Research. California Health Interview Survey. 2012. Accessed 5 Jan 2020.

    Google Scholar 

  59. 59.

    Keller A, McGarvey EL, Clayton AH. Reliability and construct validity of the Changes in Sexual Functioning Questionnaire short-form (CSFQ-14). J Sex Marital Ther. 2006;32(1):43–52.

    Article  PubMed  Google Scholar 

  60. 60.

    Spanier GB. Measuring dyadic adjustment: new scales for assessing the quality of marriage or similar dyads. J Marriage Fam. 1976;38(1):15–28.

    Article  Google Scholar 

  61. 61.

    Robinson S, Kissane DW, Brooker J, Hempton C, Michael N, Fischer J, et al. Refinement and revalidation of the demoralization scale: the DSII—External validity. Cancer. 2016;122(14):2260–7.

    Article  Google Scholar 

  62. 62.

    Clark JA, Bokhour BG, Inui TS, Silliman RA, Talcott JA. Measuring patients’ perceptions of the outcomes of treatment for early prostate cancer. Med Care. 2003;41(8):923–36.

    Article  PubMed  Google Scholar 

  63. 63.

    Vinokur AD, van Ryn M. Social support and undermining in close relationships: their independent effects on the mental health of unemployed persons. J Pers Soc Psychol. 1993;65(2):350–9.

    CAS  Article  PubMed  Google Scholar 

  64. 64.

    Wei JT, Dunn RL, Litwin MS, Sandler HM, Sanda MG. Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology. 2000;56(6):899–905.

    CAS  Article  PubMed  Google Scholar 

  65. 65.

    Esper P, Mo F, Chodak G, Sinner M, Cella D, Pienta KJ. Measuring quality of life in men with prostate cancer using the functional assessment of cancer therapy-prostate instrument. Urology. 1997;50(6):920–8.

    CAS  Article  PubMed  Google Scholar 

  66. 66.

    Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191–208.

    CAS  Article  PubMed  Google Scholar 

  67. 67.

    Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092–7.

    Article  Google Scholar 

  68. 68.

    Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  69. 69.

    Thoresen S, Tambs K, Hussain A, Heir T, Johansen V, Bisson JI. Brief measure of posttraumatic stress reactions: impact of Event Scale-6. Soc Psychiatry Psychiatr Epidemiol. 2010;45(3):405–12.

    Article  PubMed  Google Scholar 

  70. 70.

    Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49(6):822–30.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  71. 71.

    Devins GM, Dion R, Pelletier LG, et al. Structure of lifestyle disruptions in chronic disease: a confirmatory factor analysis of the Illness Intrusiveness Ratings Scale. Med Care. 2001;39(10):1097–104.

    CAS  Article  PubMed  Google Scholar 

  72. 72.

    Cohen S, Hoberman HM. Positive events and social supports as buffers of life change stress. J Appl Soc Psychol. 1983;13(2):99–125.

    Article  Google Scholar 

  73. 73.

    Watson M, Law M, dos-Santos M, Greer S, Baruch J, Bliss JM. The mini MAC: further development of the mental adjustment to cancer scale. J Psychosoc Oncol. 1994;12(3):33–46.

    Article  Google Scholar 

  74. 74.

    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85(5):365–76.

    CAS  Article  PubMed  Google Scholar 

  75. 75.

    Roth AJ, Rosenfeld B, Kornblith AB, Gibson C, Scher HI, Curley-Smart T, et al. The memorial anxiety scale for prostate cancer: validation of a new scale to measure anxiety in men with prostate cancer. Cancer-Am Cancer Soc. 2003;97(11):2910–8.

    Article  Google Scholar 

  76. 76.

    Cash T. Manual for the Multidimensional Body-Self Relations Questionnaire (MBSRQ) (3rd rev.). 2000. Accessed 5 Jan 2020.

    Google Scholar 

  77. 77.

    Moser A, Stuck AE, Silliman RA, Ganz PA, Clough-Gorr KM. The eight-item modified Medical Outcomes Study Social Support Survey: psychometric evaluation showed excellent performance. J Clin Epidemiol. 2012;65(10):1107–16.

    Article  Google Scholar 

  78. 78.

    Rosen RC, Catania JA, Althof SE, Pollack LM, O'Leary M, Seftel AD, et al. Development and validation of four-item version of Male Sexual Health Questionnaire to assess ejaculatory dysfunction. Urology. 2007;69(5):805–9.

    Article  PubMed  Google Scholar 

  79. 79.

    Zimet GD, Dahlem NW, Zimet SG, Farley GK. Multidimensional scale of perceived social support (MSPSS). J Pers Assess. 1988;52(1):30–41.

    Article  Google Scholar 

  80. 80.

    Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey Data. Atlanta: National Center for Health Statistics; 2008.

  81. 81.

    Kroenke K, Strine TW, Spitzer RL, Williams JB, Berry JT, Mokdad AH. The PHQ-8 as a measure of current depression in the general population. J Affect Disord. 2009;114(1-3):163–73.

    Article  Google Scholar 

  82. 82.

    Cohen S, Wills TA. Stress, social support, and the buffering hypothesis. Psychol Bull. 1985;98(2):310–57.

    CAS  Article  Google Scholar 

  83. 83.

    Ferrell BR, Hassey-Dow K, Grant M. Quality of Life Patient/Cancer Survivor Version (QOL-CSV). 2012. Accessed 5 Jan 2020.

    Google Scholar 

  84. 84.

    Wagnild GM, Young HM. Development and psychometric evaluation of the Resilience Scale. J Nurs Meas. 1993;1(2):165–78.

    CAS  PubMed  Google Scholar 

  85. 85.

    Bartholomew K, Horowitz LM. Attachment styles among young adults: a test of a four-category model. J Pers Soc Psychol. 1991;61(2):226–44.

    CAS  Article  PubMed  Google Scholar 

  86. 86.

    Boyes A, Girgis A, Lecathelinais C. Brief assessment of adult cancer patients’ perceived needs: development and validation of the 34-item Supportive Care Needs Survey (SCNS-SF34). J Eval Clin Pract. 2009;15(4):602–6.

    Article  PubMed  Google Scholar 

  87. 87.

    Ware J, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–33.

    Article  PubMed  Google Scholar 

  88. 88.

    Ware J, Kosinski M, Keller S. SF-36 physical and mental health summary scales: a user’s manual. Boston: The Health Institute, New England Medical Center; 1994.

    Google Scholar 

  89. 89.

    Spielberger C, Gorsuch R, Lushene R. The State-Trait Anxiety Inventory (STAI). Palo Alto: Consulting Psychologists Press; 1968.

    Google Scholar 

  90. 90.

    Anderson LA, Dedrick RF. Trust in Physician Scale (TPS). Measures for clinical practice: Vol. 2. Adults New York: The Free Press; 1990.

    Google Scholar 

  91. 91.

    Jabson JM, Farmer GW, Bowen DJ. Health behaviors and self-reported health among cancer survivors by sexual orientation. Lgbt Health. 2015;2(1):41–7.

    Article  PubMed  PubMed Central  Google Scholar 

  92. 92.

    Kamen C, Mustian KM, Dozier A, Bowen DJ, Li Y. Disparities in psychological distress impacting lesbian, gay, bisexual and transgender cancer survivors. Psycho-Oncology. 2015;24(11):1384–91.

    Article  PubMed  PubMed Central  Google Scholar 

  93. 93.

    Torbit LA, Albiani JJ, Crangle CJ, Latini DM, Hart TL. Fear of recurrence: the importance of self-efficacy and satisfaction with care in gay men with prostate cancer. Psycho-Oncology. 2015;24(6):691–8.

    Article  PubMed  Google Scholar 

  94. 94.

    Ussher JM, Perz J, Kellett A, Chambers S, Latini D, Davis ID, et al. Health-related quality of life, psychological distress, and sexual changes following prostate cancer: a comparison of gay and bisexual men with heterosexual men. J Sex Med. 2016;13(3):425–34.

    Article  PubMed  Google Scholar 

  95. 95.

    Kamen C, Heckler C, Janelsins MC, Peppone LJ, McMahon JM, Morrow GR, et al. A dyadic exercise intervention to reduce psychological distress among lesbian, gay, and heterosexual cancer survivors. LGBT Health. 2016;3(1):57–64.

    Article  PubMed  PubMed Central  Google Scholar 

  96. 96.

    Hart TL, Coon DW, Kowalkowski MA, Zhang K, Hersom JI, Goltz HH, et al. Changes in sexual roles and quality of life for gay men after prostate cancer: challenges for sexual health providers. J Sex Med. 2014;11(9):2308–17.

    Article  PubMed  PubMed Central  Google Scholar 

  97. 97.

    Hutchcraft ML, Teferra AA, Montemorano L, Patterson JG. Differences in health-related quality of life and health behaviors among lesbian, bisexual, and heterosexual women surviving cancer from the 2013 to 2018 National Health Interview Survey. LGBT Health. 2021;8(1):68–78.

    Article  Google Scholar 

  98. 98.

    Sledge P. From decision to incision: Ideologies of gender in surgical cancer care. Soc Sci Med. 2019;239:112550.

    Article  PubMed  Google Scholar 

  99. 99.

    Desai MJ, Gold RS, Jones CK, Din H, Dietz AC, Shliakhtsitsava K, et al. Mental health outcomes in adolescent and young adult female cancer survivors of a sexual minority. JAYAO. 2020;00(00).

  100. 100.

    Russell AM, Galvin KM, Harper MM, Clayman ML. A comparison of heterosexual and LGBTQ cancer survivors’ outlooks on relationships, family building, possible infertility, and patient-doctor fertility risk communication. J Cancer Surviv. 2016;10(5):935–42.

    Article  Google Scholar 

  101. 101.

    Jabson JM, Taylor ET, Bryson MK. Cancer’s margins: trans* and gender nonconforming people’s access to knowledge, experiences of cancer health, and decision-making. LGBT Health. 2016;3:89.

    Google Scholar 

  102. 102.

    Rubin LR, Tanenbaum M. “Does that make me a woman?” Breast cancer, mastectomy, and breast reconstruction decisions among sexual minority women. Pscchol Women Q. 2011;35:401–14.

    Article  Google Scholar 

  103. 103.

    Reygan FC, D’Alton P. A pilot training programme for health and social care professionals providing oncological and palliative care to lesbian, gay and bisexual patients in Ireland. Psychooncology. 2013;22:1050–4.

    Article  Google Scholar 

  104. 104.

    Legere LE, MacDonnell JA. Meaningful support for lesbian and bisexual women navigating reproductive cancer care in Canada: an exploratory study. J Res Nurs. 2016;21:163–74.

    Article  Google Scholar 

  105. 105.

    Paul LB, Pitagora D, Brown B, Tworecke A, Rubin L. Support needs and resources of sexual minority women with breast cancer. Psychoncology. 2014;23:578–84.

    Article  Google Scholar 

  106. 106.

    Kamen CS, Blosnich J, Trevio L, Lytle M, Morrow G. Cigarette smoking disparities among sexual minority cancer survivors. Prev Med Rep. 2013;45:S251.

    Google Scholar 

  107. 107.

    Kent EE, Wheldon CW, Smith AW, Srinivasan S, Geiger AM. Care delivery, patient experiences, and health outcomes among sexual and gender minority patients with cancer and survivors: a scoping review. Cancer-Am Cancer Soc. 2019;125(24):4371–9.

    Article  Google Scholar 

  108. 108.

    Boehmer U, Stokes JE, Bazzi AR, Winter M, Clark MA. Dyadic stress of breast cancer survivors and their caregivers: are there differences by sexual orientation? Psycho-Oncology. 2018;27(10):2389–97.

    Article  PubMed  PubMed Central  Google Scholar 

  109. 109.

    Baughman A, Clark MA, Boehmer U. Experiences and concerns of lesbian, gay, or bisexual survivors of colorectal cancer. Oncol Nurs Forum. 2017;44(3):350–7.

    Article  PubMed  PubMed Central  Google Scholar 

  110. 110.

    Boehmer U, Clark MA, Ozonoff A, Winter M, Potter J. Survivors’ perceptions of quality of colorectal cancer care by sexual orientation. J Clin Oncol. 2020;43(9).

  111. 111.

    Allensworth-Davies D, Talcott JA, Heeren T, de Vries B, Blank TO, Clark JA. The health effects of masculine self-esteem following treatment for localized prostate cancer among gay men. Lgbt Health. 2016;3(1):49–56.

    Article  PubMed  PubMed Central  Google Scholar 

  112. 112.

    Lee TK, Handy AB, Kwan W, Oliffe JL, Brotto LA, Wassersug RJ, et al. Impact of prostate cancer treatment on the sexual quality of life for men-who-have-sex-with-men. J Sex Med. 2015;12(12):2378–86.

    Article  PubMed  Google Scholar 

  113. 113.

    Hoyt MA, Frost DM, Cohn E, Millar BM, Diefenbach MA, Revenson TA. Gay men’s experiences with prostate cancer: implications for future research. J Health Psychol. 2020;25(3):298–310.

    Article  PubMed  Google Scholar 

  114. 114.

    Rosser BS, Konety BR, Mitteldorf D, Kohli N, Lesher L, West W, et al. What gay and bisexual men treated for prostate cancer are offered and attempt as sexual rehabilitation for prostate cancer: results from the Restore study. Urol Pract. 2018;5(3):187–91.

    Article  Google Scholar 

  115. 115.

    Thomas C, Wootten AC, Robinson P, Law PCF, McKenzie DP. The impact of sexual orientation on body image, self-esteem, urinary and sexual functions in the experience of prostate cancer. Eur J Cancer Care. 2018;27(2):ARTN e12827.

    Article  Google Scholar 

  116. 116.

    Wright MM, Schreiner P, Rosser BRS, Polter EJ, Mitteldorf D, West W, et al. The influence of companion animals on quality of life of gay and bisexual men diagnosed with prostate cancer. Int J Environ Res Public Health. 2019;16(22).

  117. 117.

    Kamen C, Palesh O, Gerry AA, Andrykowski MA, Heckler C, Mohile S, et al. Disparities in health risk behavior and psychological distress among gay versus heterosexual male cancer survivors. Lgbt Health. 2014;1(2):86–U103.

    Article  PubMed  Google Scholar 

  118. 118.

    Matthews AK, Hotton A, Li CC, Miller K, Johnson A, Jones KW, et al. An internet-based study examining the factors associated with the physical and mental health quality of life of LGBT cancer survivors. Lgbt Health. 2016;3(1):65–73.

    Article  PubMed  Google Scholar 

  119. 119.

    Seay J, Mitteldorf D, Yankie A, Pirl WF, Kobetz E, Schlumbrecht M. Survivorship care needs among LGBT cancer survivors. J Psychosoc Oncol. 2018;36(4):393–405.

    Article  Google Scholar 

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Thank you to the American Society of Clinical Oncology Sexual and Gender Minority Task Force for initiating the working relationship of Drs. Pratt-Chapman and Alpert, which resulted in co-authorship on this paper.

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Author information




MPC conceptualized and designed the study and wrote the majority of the manuscript. AA reviewed titles, abstracts, performed data abstraction, and added to the narrative. DC conducted the systematic search and wrote up the search methods. The author(s) read and approved the final manuscript.

Authors’ information

Mandi L. Pratt-Chapman, PhD is Associate Center Director, Patient Centered Initiatives and Health Equity for the GW Cancer Center. Ash Alpert, MD is a Hematology-Oncology Fellow at the Wilmot Cancer Institute, University of Rochester. Daniel A. Castillo, MLIS is the Head of Scholarly Communication and Research Inititiatives at the Edward G. Miner Libraries, University of Rochester Medical Center.

Corresponding author

Correspondence to Mandi L. Pratt-Chapman.

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Appendix 1

PubMed search strategy

("Neoplasms"[Mesh] OR "Cancer*"[tiab] OR "Carcin*"[tiab] OR "Oncolog*"[tiab] OR "Malignan*"[tiab] OR "Neoplas*"[tiab]) AND ("Survivors"[Mesh] OR "Cancer Survivors"[Mesh] OR "Survivorship"[Mesh] OR "Surviv*"[tiab] OR "History of Cancer"[tiab] OR "Cancer History"[tiab]) AND ("Sexual and Gender Minorities"[Mesh] OR "SGM"[Mesh] OR "Gender minorit*"[tiab] OR "Sexual minorit* "[tiab] OR "LGBT*"[tiab] OR "GLBT*"[tiab] OR "Bisex*"[tiab] OR "Gay"[tiab] OR "Gays"[tiab] OR "Lesbian*"[tiab] OR "Pansex*"[tiab] OR "Queer*"[tiab] OR "Asex*"[tiab] OR "Transgender*"[tiab] OR "Transsex*"[tiab] OR "Transex*"[tiab] OR "Intersex*"[tiab] OR "Gender-expansiv*"[tiab] OR "2-spirit*"[tiab] OR "Two-spirit*"[tiab] OR "Non-conform*"[tiab] OR "Non-binar*"[tiab] OR "Same Gender Loving"[tiab] OR "SGL"[tiab] OR "Women Who Partner with Women"[tiab] OR "Men Who Partner with Men"[tiab] OR "Women Who Have Sex with Women"[tiab] OR "Men Who Have Sex with Men"[tiab]).

Appendix 2

Summary of studies of patient-reported outcomes from SGM people diagnosed with cancer

Table 3

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Pratt-Chapman, M.L., Alpert, A.B. & Castillo, D.A. Health outcomes of sexual and gender minorities after cancer: a systematic review. Syst Rev 10, 183 (2021).

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  • Sexual and gender minorities
  • Sexual orientation
  • Gender identity
  • Cancer survivorship
  • Patient-reported outcomes
  • QOL