Gay Men and Cancer
The gay man with cancer brings a history of gay rights and health care disparity influences with him into the oncology office. This history includes his coming out to himself, his family, and society; his relationship with the gay community; his connection to HIV/AIDS treatment or prevention; discrimination and homophobia as a gay man; as well as a history of negative and positive interactions with medical providers.
Research has shown that gay men, in general, are at higher risks for certain types of cancers, including lung, anal, colon, and esophageal as a result of higher rates of health risk behaviors including smoking, substance and alcohol use, lack of exercise, and psychological distress as well as experience prejudice, discrimination, or stigma in the process of seeking health care services.5 In addition, incidence of anal and oral human papillomavirus (HPV) infections are higher in gay men compared with their heterosexual counterparts.
HIV-positive gay men have fewer HIV-related cancers due to the advent of antiretroviral treatment. However, HIV-positive gay men now have a 30% to 40% chance of developing a non-HIV related cancer in their lifetimes, the cause of which is less understood. Those cancers include: Hodgkin disease (10× higher risk), anal cancer (50× higher risk), lung cancer (7× higher risk), and testicular germ cell cancer (6× higher risk).6
Many older gay men have often seen significant and multiple losses of community due to HIV/AIDS. Many are also less likely to be partnered or married but a percentage are living as long-term, HIV- survivors. HIV/AIDS as a comorbidity to a cancer diagnosis often impacts the patient-provider relationship, leading to additional health care fragmentation; poor communication between the patient with HIV and the oncology care team; and increased frustration, distress, and anxiety. Both HIV-negative and HIV-positive gay men often experience cancer as yet another stigma, resulting in further isolation, even within the gay male community, as well as poor psychological and emotional well-being.
Older gay men often do not disclose their orientation to their oncologists. They tend to believe their sexual orientation was not important to their care team, they were not asked about it, or questions related to sexual orientation were not in the intake material. Nondisclosure results in poorer health care and less attention toward disease prevention, including appropriate tests and scans.
Male-identified cancers — prostate, testicular, and penile — hold particular relevance to gay men in contrast to their heterosexual correlates due to sexual lifestyles impacting health care and treatment discussions. Research focused on the gay male experience with prostate cancer has noted that the essential responsibility falls proportionately on the health care team and the institution to create a safe environment for the gay man to review and discuss the significant impact of prostate cancer treatment on life style, including psychological and sexual well-being.7