Minority Stress Clusters and Health and Cancer Care Outcomes of Sexual and Gender Minority Cancer Survivors

Purpose: Structural factors affect the health of sexual and gender minority (SGM) cancer survivors, yet how people experience minority stress within their social and health care systems remains unclear. We explored experiences of minority stress across health care and sociocultural contexts and their impact on health and cancer outcomes. Methods: We conducted a K-medoid cluster analysis (grouping technique) using data from 2519 participants (training subset = 2015, testing subset = 504) from OUT: The National Cancer Survey (2020-2021). Cluster differences in the testing subset were assessed using chi-square, analysis of variance, and nonparametric tests. Regression models examined associations between cluster membership and health (mentally unhealthy days) and cancer outcomes (perceived welcomeness after identity disclosure and treatment satisfaction), adjusting for demographic and clinical factors. Results: Five clusters emerged, differing in demographics, mental and social health outcomes, SGM identity disclosure, and perceived welcomeness after disclosure (0.017 < p < 0.001). Cluster one experienced poorer mental health than cluster five (odds ratio [OR] = 1.182, 95% confidence interval [CI] = 1.003-1.392), lower cancer care satisfaction than all other clusters (1.177 < OR <1.265; 1.091 < 95% CI <1.389), and perceived less welcoming or unchanged environments after SGM identity disclosure than all other clusters (1.278 < OR <1.314; 1.161 < 95% CI <1.431). Conclusion: The study highlights the impact of minority stress across different contexts. The findings emphasize the need for targeted interventions to address the unique vulnerabilities of SGM individuals, particularly in health care contexts, to improve their overall health and cancer care experiences.