Studies from many countries show that oncologists, nurses, and other cancer professionals often lack solid knowledge about LGBTQ health and do not feel ready to give affirming care. 13(PubMed)
Researchers call this problem limited clinician knowledge and limited cultural competence. Cultural competence means your care team understands how identity, family, community, history, and bias shape your health, and then uses that knowledge to guide respectful care. Many experts also stress cultural humility, which means providers know they do not know everything, stay open, and keep learning from patients. (PMC)
When clinicians lack this knowledge, LGBTQ cancer patients feel confused, unsafe, and alone. Key needs go unmet. Trust drops. Treatment decisions feel harder. Reviews of LGBTQ cancer care and large surveys describe these patterns over and over. (PubMed)
What cultural competence should look like for you
Good cultural competence includes some basic skills.
Your provider uses your correct name and pronouns every time, in speech and in the record.
Your provider understands the difference between sexual orientation, gender identity, and sex assigned at birth.
Your team knows which body parts you have, which hormones you use or have used, and what that means for screening and treatment.
Your relationships and family are respected. Partners are not called “friends” unless you choose that word.
Your provider understands common LGBTQ stressors like discrimination, hiding, or family rejection, and knows these experiences affect mental health, smoking, alcohol use, sex, and treatment decisions. (PubMed)
Large reviews of LGBTQ cancer care show that most systems fall short on these basic points. 13(PubMed)
What studies say about clinician knowledge
A major scoping review on cancer care for sexual and gender minority patients looked at dozens of studies worldwide. The authors found repeated reports of providers who lacked training on LGBTQ health, avoided sexual health discussions, and relied on heterosexual and cisgender assumptions. 1(PubMed)
Another review that focused on lesbian, gay, and bisexual people with cancer found strong themes of feeling ignored, having to educate providers, and meeting staff who did not know how to talk about same sex partners or queer families. 2(PubMed)
Several newer studies look directly at oncology providers. One mixed methods study in Australia and other countries surveyed and interviewed oncology professionals about LGBTQI cancer care. Many said they had positive attitudes, yet large numbers reported low knowledge and did not ask routine questions about sexual orientation or gender identity. Some believed LGBTQ patients should raise these topics on their own. 4(ScienceDirect)
A survey of oncology advanced practice providers in the United States found similar patterns. Many providers lacked training in LGBTQ health, felt unsure about best practices, and did not feel confident when caring for trans and nonbinary patients. Their knowledge scores about sexual and gender minority health were modest, and many reported no formal teaching during their education. 5(BioMed Central)
A study of National Cancer Institute designated centers in the United States reviewed policies, clinic environments, and training. Only a minority had written policies on sexual and gender minority care, clear staff training, and visible signals of LGBTQ inclusion. Many centers had little structure in place to support affirming care. 3(PMC)
Medical trainees are not well prepared either. A project on medical student awareness in cancer care for sexual and gender minorities found low comfort and low knowledge levels, though students wanted more teaching. 17(ASCO Publications)
What LGBTQ patients report
Patient voices make this problem real. A systematic review of lesbian, gay, and bisexual people with cancer found reports of three main issues. Many described providers who assumed everyone was heterosexual. Many felt worried about sharing sexual orientation or partners due to fear of bias. Many saw a lack of discussion about sexual function, fertility, and body image in ways that matched their real lives. 2(PubMed)
More recent reviews of LGBTQ cancer patient experiences show that trans and nonbinary people face even more barriers. Studies describe misgendering, refusal to use correct names, lack of knowledge about hormone therapy and surgeries, and fear of violence or ridicule in health settings. 111[19][20](PubMed)
A recent review that focused on discrimination against LGBTQ cancer patients concluded that stigma, lack of provider knowledge, and weak communication still form major barriers across the cancer journey. 10(PubMed)
How limited knowledge affects your care
These gaps affect more than feelings. They influence real health outcomes across the cancer timeline.
Screening and early detection
When providers do not understand LGBTQ health, they often give poor guidance about screening. Studies show lower screening rates in some sexual minority groups, linked to mistrust and to providers who do not recommend needed tests. 1[36](Europe PMC)
Examples include:
A cisgender man who has sex with men and receives no information about anal cancer risk or HPV vaccination.
A trans man who still has a cervix yet receives no reminder for Pap testing.
A lesbian woman who avoids gynecologic care because prior providers dismissed her identity or assumed no risk.
Diagnosis and treatment planning
Once cancer is found, lack of knowledge shapes treatment talks. Reviews describe oncologists who do not know how surgeries or radiation will affect sex between women, between men, or within trans bodies. Many patients report that providers gave little space to discuss pleasure, touch, or change in sexual roles. (PubMed)
Prostate cancer care offers a clear example. Gay and bisexual men often describe different patterns of sex, different worries about erections and anal sex, and different meanings of orgasm after treatment. Many report that providers did not understand these differences and gave advice that did not fit their lives. 2(PubMed)
Trans and nonbinary patients face even stronger gaps. Oncologists may have limited training on how to manage cancer in someone who uses gender affirming hormones or who has had surgeries. Some providers ask invasive questions that focus more on curiosity than on care. Others avoid all discussion of gender affirming treatment, even when this has strong links to mental health. 1[20](PubMed)
Support, survivorship, and mental health
After treatment, many LGBTQ survivors still meet providers who do not know how minority stress, family rejection, or anti LGBTQ laws affect recovery. Reviews show higher levels of distress in sexual and gender minority survivors, linked in part to these social pressures. 18[32][38](DNB Portal)
People describe hiding partners during clinic visits, skipping follow up appointments, or avoiding support groups that feel hostile or erasing. Some never hear about LGBTQ specific resources such as queer friendly support groups or online communities. (PubMed)
History of silence and stigma
LGBTQ identities were pathologized and criminalized for much of modern medical history. That history shaped medical education. Many older providers studied during years when LGBTQ health received little respectful attention, or no attention at all. One landmark paper on sexual and gender minority patients notes that oncology training once focused almost only on HIV and missed broader LGBTQ health needs. 14(Europe PMC)
Weak training in schools and residency
Reviews of LGBTQ cultural competency training show that health professional schools often add only short, optional sessions on LGBTQ topics. Content may focus on vocabulary rather than real skills for communication and shared decision making. 12(BioMed Central)
A global review of LGBTQ cultural competency training for health workers found wide variation in length, quality, and follow up. Many programs lacked clear goals or ways to check whether training improved actual care. 12(BioMed Central)
Lack of policies and leadership
The study of NCI designated centers showed that many institutions have no written policies on sexual and gender minority inclusion, no visible signs such as inclusive posters, and no required staff training. 3(PMC)
Without strong leadership, LGBTQ education stays optional. Providers who want to learn more often do so on their own time. Those who hold bias or discomfort face little pressure to change.
Limited and flawed data
Weak data about LGBTQ cancer outcomes has its own role. When cancer registries and trials fail to collect sexual orientation and gender identity, leaders see fewer statistics about gaps in care. 1[20](PubMed)
Some providers then assume “we have no LGBTQ patients” or “we treat everyone the same so there is no problem.” These beliefs ignore the experiences that patients report.
What training efforts show so far
Even with these barriers, research on new training models gives some hope.
Cultural humility training in oncology
A related study looked at how to measure change after this type of training. The authors warned that tests of “competence” risk giving a false sense of mastery. They argued for measures that focus on openness, reflection, and real behavior change over time. 8(PubMed)
Oncology nursing and team training
An oncology nursing program tailored LGBTQ cultural competency training to whole cancer care teams. After training, staff reported better knowledge and greater confidence in caring for LGBTQ patients. They also described more comfort speaking up for inclusive practices in their clinics. 15(Oncology Nursing Society)
Implementation at larger centers
A recent report from an NCI designated cancer center described a multi year effort to implement sexual and gender minority training and better sexual orientation and gender identity data collection. The team used stepwise planning, leadership support, and feedback from staff and patients. They still faced challenges such as time pressure and resistance, yet they showed that large centers are able to make real changes. 16(OUP Academic)
These studies suggest that training helps, but also show limits. Training sessions by themselves do not erase structural stigma, weak policies, or missing data. Lasting change needs strong leadership, accountability, and partnership with LGBTQ communities. 12[20](BioMed Central)
How this knowledge helps you
You deserve to know these research findings, because they explain why your care sometimes feels unsafe or incomplete. They also give you tools.
You are able to use this knowledge to prepare for visits. For example, you might write down questions such as:
How many LGBTQ patients do you care for in this clinic
How do you record sexual orientation, gender identity, and pronouns in the chart
How will this treatment affect my sex life, my relationships, and my gender expression
Do you know any support groups or therapists who have experience with LGBTQ cancer survivors
If a provider responds with respect, curiosity, and clear answers, that is a good sign. If a provider reacts with discomfort, dismisses your questions, or refuses to use your correct name and pronouns, that signals a problem.
You are able to bring a partner, friend, or family member for support, especially someone who feels ready to speak up if staff ignore your identity. You have the right to ask for another provider when possible if disrespect continues.
You are also able to seek clinics that show visible signs of inclusion, such as rainbow symbols, trans flags, gender neutral restrooms, and forms with options for sexual orientation and gender identity. Studies of cancer centers suggest that sites with these features are more likely to have training and policies in place. 3[22](PMC)
Why this matters for social justice
Limited clinician knowledge does more than harm individual visits. It widens health gaps.
When LGBTQ people delay screening or treatment due to mistrust, cancers are found at later stages. When providers ignore minority stress, mental health needs go untreated. When data systems hide LGBTQ status, leaders lack the information needed to push change. Reviews of sexual and gender minority health outcomes after cancer show higher levels of distress, pain, and ongoing health problems, linked in part to these social forces. 18[32][38](DNB Portal)
Global work on sexual and gender minority cancer care argues that health systems must treat LGBTQ knowledge and cultural competence as core duties, not optional extras. [20][33][35](The Lancet)
You deserve providers who understand LGBTQ lives and who work with you as a partner in care. The science now makes clear that this level of care remains uneven. The same science shows that education, strong policies, and community leadership are able to move oncology in a better direction.
References
1 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. 2019,125(24),4371-4379. (PubMed)
2 Lisy K, Peters MD, Schofield P, Jefford M. Experiences and unmet needs of lesbian, gay, and bisexual people with cancer care, A systematic review and meta synthesis. Psycho Oncology. 2018,27(6),1480-1489. (PubMed)
3 Wheldon CW, Wiseman KP, Fielding SL. Culturally competent care for sexual and gender minority patients at National Cancer Institute designated comprehensive cancer centers. LGBT Health. 2018,5(3),203-211. (PMC)
4 Ussher JM, Perz J, Kellett A, et al. Attitudes, knowledge and practice behaviours of oncology health care providers regarding LGBTQI cancer care. Patient Education and Counseling. 2022,105(7),2073-2081. (ScienceDirect)
5 Sutter ME, Bowman Curci ML, Duarte Arevalo LF, Sutton SK, Quinn GP, Schabath MB. A survey of oncology advanced practice providers’ knowledge and attitudes towards sexual and gender minorities with cancer. Journal of Clinical Nursing. 2020. (BioMed Central)
6 Seay J, Hicks A, Markham MJ, et al. Web based LGBT cultural competency training intervention for oncologists, The COLORS training. Cancer. 2020,126(5),1123-1130. (ACS Journals)
8 Alpert A, Coston M, Margolies L, Kamen C. What exactly are we measuring, Evaluating sexual and gender minority cultural humility training for oncology care clinicians. Journal of Clinical Oncology. 2020,38(23),2605-2609. (PubMed)
10 Chan ASW, Yuen SK, Lee J, et al. Needs and experiences of cancer care in patients’ sexual and gender minority status, A systematic review. 2023. (PubMed)
11 Zazzera SK, Jackson VA, Katz IT, et al. Investigating the needs and concerns of lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority cancer patients, A scoping review. Journal of Homosexuality. 2025. (Taylor & Francis Online)
12 Yu H, Li X, Zhang H, et al. LGBTQ plus cultural competency training for health professionals, A systematic review. BMC Medical Education. 2023,23,92. (BioMed Central)
13 Wheldon CW, et al. Policies and guidelines regarding culturally competent care of sexual and gender minority cancer patients and survivors. LGBT Health. 2018. (PMC)
14 Cathcart Rake EJ, DeYoreo M, Sandhu NP, et al. Cancer in sexual and gender minority patients, What oncologists need to know. Journal of Oncology Practice. 2018,14(3),129-139. (Europe PMC)
15 Russell S, et al. Addressing cultural competency, Lesbian, gay, bisexual, transgender, and queer oncology training for health care providers. Clinical Journal of Oncology Nursing. 2022,26(2),197-203. (Oncology Nursing Society)
16 Domogauer JD, et al. Implementation of culturally relevant sexual and gender minority and sexual orientation and gender identity training at an NCI designated cancer center. JNCI Monographs. 2025,69,126-146. (OUP Academic)
17 Au C, Samuelson A, Schabath MB, et al. Medical student clinical cultural awareness in cancer care of sexual and gender minorities. Journal of Clinical Oncology. 2022,40(16 suppl),11003. (ASCO Publications)
18 Pratt Chapman ML, Rodriguez Diaz CE, LaFond AF, et al. Health outcomes of sexual and gender minorities after cancer, A scoping review. Systematic Reviews. 2021,10,317. (DNB Portal)
[19] Wang YC, Chen CW, Yang HL, et al. Care needs, challenges, and experiences of sexual and gender minority cancer survivors in Taiwan. Journal of Pediatric and Adolescent Gynecology. 2024. (ScienceDirect)
[20] Patel, et al. Enhancing global cancer care for sexual and gender minority populations. The Lancet Global Health. 2025. (The Lancet)