Advocacy in LGBTQ+ Cancer Care: Historical Resilience as a Model for Further Efforts in Psycho-Oncology

In the United States, an estimated 135,000 lesbian, gay, bisexual, transgender, queer (LGBTQ+) people will be affected by a cancer diagnosis in 2020, a significantly higher statistic than equivalent measures in non-LGBTQ+ populations (American Cancer Society, 2020). As the number of sexual and gender minority (SGM) individuals affected by this disease continues to increase and intergroup disparities in care become more empirically documented, the need for multi-level advocacy in the field of LGBTQ+ psychosocial cancer care becomes apparent. The current body of literature addressing culturally-informed practices, needs, and barriers to care for SGM people is sparse in psycho-oncology and has grossly limited the extent to which advocacy efforts are implemented. This paper seeks to supplement, contextualize, and inform the existing research by examining healthcare experiences and advocacy efforts of LGBTQ+ people through history. The American Psychiatric Association (1952) systemically pathologized SGM groups in 1952, and the disparities in care during and after the AIDS epidemic are explored in detail. This analysis reveals parallels in reported experiences of heterosexism, homophobia, transphobia, discrimination, and institutional stigma in healthcare that persist and have been related to increased feelings of distress and diminished satisfaction with care (Institute of Medicine, 2011; King, 2019). The review and synthesis of the data are operationalized into a tri-level LGBTQ+ advocacy approach for psycho-oncology. Institutional, team-based, and self-advocacy practices are proposed, centering education, creating a safe space for disclosure, and the notable presence of resilience within the LGBTQ+ community (Kamen et al., 2019; Melton, 2018, Meyer, 2015)