LGBTQ+ cancer: priority or lip service? A qualitative content analysis of LGBTQ+ considerations in U.S. state, jurisdiction, and tribal comprehensive cancer control plans

Austin R Waters; Madeline H Bono; Mayuko Ito Fukunaga; Manal Masud; Megan A Mullins; Ryan Suk; Meghan C O'Leary; Swann A Adams; Renée M Ferrari; Mary Wangen; Olufeyisayo O Odebunmi; Sarah H Nash; Lisa P Spees; Stephanie B Wheeler; Prajakta Adsul; Perla Chebli; Rachel Hirschey; Jamie L Studts; Aaron Seaman; Matthew Lee

doi:10.1007/s10552-024-01887-z

LGBTQ+ cancer: priority or lip service? A qualitative content analysis of LGBTQ+ considerations in U.S. state, jurisdiction, and tribal comprehensive cancer control plans

Cancer Causes Control. 2024 Sep;35(9):1297-1309. doi: 10.1007/s10552-024-01887-z. Epub 2024 May 25.

Authors

Austin R Waters^{1

2}, Madeline H Bono³, Mayuko Ito Fukunaga⁴, Manal Masud⁵, Megan A Mullins^{6

7}, Ryan Suk^{8

9

10}, Meghan C O'Leary^{11

12}, Swann A Adams^{13

14}, Renée M Ferrari^{12

15}, Mary Wangen¹⁶, Olufeyisayo O Odebunmi^{11

12}, Sarah H Nash^{17

18}, Lisa P Spees^{12

19}, Stephanie B Wheeler^{11

12

16}, Prajakta Adsul^{20

21}, Perla Chebli²², Rachel Hirschey^{12

23}, Jamie L Studts^{24

25}, Aaron Seaman^{18

26}, Matthew Lee²²

Affiliations

¹ Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA. awaters@unc.edu.
² Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA. awaters@unc.edu.
³ Gender Multispecialty Service, Boston Children's Hospital, Boston, MA, USA.
⁴ Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA.
⁵ Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA.
⁶ O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA.
⁷ Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.
⁸ Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
⁹ Winship Cancer Institute of Emory University, Atlanta, GA, USA.
¹⁰ Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
¹¹ Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
¹² Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
¹³ Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, USA.
¹⁴ Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
¹⁵ Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
¹⁶ Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, USA.
¹⁷ Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA.
¹⁸ Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA.
¹⁹ Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA.
²⁰ Department of Internal Medicine, Division of Epidemiology, Biostatistics, and Preventive Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA.
²¹ Cancer Control and Research Program, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.
²² Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA.
²³ School of Nursing, University of North Carolina, Chapel Hill, NC, USA.
²⁴ Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
²⁵ Cancer Prevention and Control Program, University of Colorado Cancer Center, Aurora, CO, USA.
²⁶ Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.

Abstract

The National Comprehensive Cancer Control Program, a Centers for Disease Control and Prevention funded program, supports cancer coalitions across the United States (US) in efforts to prevent and control cancer including development of comprehensive cancer control (CCC) plans. CCC plans often focus health equity within their priorities, but it is unclear to what extent lesbian, gay, bisexual, transgender, queer/questioning, plus (LGBTQ+) populations are considered in CCC plans. We qualitatively examined to what extent LGBTQ+ populations were referenced in 64 U.S. state, jurisdiction, tribes, and tribal organization CCC plans. A total of 55% of CCC plans mentioned LGBTQ+ populations, however, only one in three CCC plans mentioned any kind of LGBTQ+ inequity or LGBTQ+ specific recommendations. Even fewer plans included mention of LGBTQ+ specific resources, organizations, or citations. At the same time almost three fourths of plans conflated sex and gender throughout their CCC plans. The findings of this study highlight the lack of prioritization of LGBTQ+ populations in CCC plans broadly while highlighting exemplar plans that can serve as a roadmap to more inclusive future CCC plans. Comprehensive cancer control plans can serve as a key policy and advocacy structure to promote a focus on LGBTQ+ cancer prevention and control.

Keywords: Health disparities; Cancer; Comprehensive cancer control; LGBTQ+ equity; SOGI data collection.

MeSH terms

Female
Humans
Male
Neoplasms* / epidemiology
Neoplasms* / prevention & control
Qualitative Research
Sexual and Gender Minorities*
United States / epidemiology

Abstract

MeSH terms

Grants and funding