title: Long-term breast cancer survivors' symptoms and morbidity: differences by sexual orientation?
abstract: OBJECTIVE
  Because little is known about morbidity and symptoms among sexual minority women with breast cancer, that is, lesbian or bisexual-identified women, and women with a preference for a woman partner, we examined differences by sexual orientation in long-term survivors' symptoms and morbidity, considering arm morbidity, systemic therapy side effects, hypertension, and number of comorbidities.
  
  
  METHODS
  From a state cancer registry, we recruited 257 heterosexual and 69 sexual minority women (SMW) with a diagnosis of primary, nonmetastatic breast cancer. To increase the number of SMW, we used convenience recruitment methods and obtained an additional 112 SMW who fit the same eligibility criteria as the registry-derived sample. Using a telephone survey, we collected demographic and self-reported data on arm morbidity and systematic therapy side effects, using the European Organization for Research and Treatment of Cancer Quality of Life scale, QLQ-BR23 and a comorbidity measure developed for breast cancer survivors.
  
  
  RESULTS
  Sexual orientation was more strongly associated with arm morbidity and systemic side effects than with high blood pressure and comorbidities. Sexual orientation related indirectly to systemic side effects and arm morbidity through cancer treatments and some demographic factors.
  
  
  CONCLUSIONS
  Our finding that SMW respond more negatively to certain cancer treatments compared to heterosexual women suggests an opportunity to intervene with education and support for SMW breast cancer survivors for whom these life-saving treatments are necessary.
  
  
  CONCLUSIONS
  Because breast cancer survivors are at risk for multiple severe and persistent symptoms, assessing such symptoms is an important aspect of survivorship care. Cultural differences in perception of symptoms, communication issues, cultural barriers to reporting of symptoms, and different cultural norms about expressing pain or impairments have been established by studies. Knowledge about differences in impairment and symptoms by sexual orientation will help providers' efforts to provide high quality care to breast cancer survivors and may enhance cancer survivorship.
authors: Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, Boston, MA 02118, USA. boehmer@bu.edu
authors: Ulrike
authors: U
authors: Boehmer
authors: Mark
authors: M
authors: Glickman
authors: Michael
authors: M
authors: Winter
authors: Melissa A
authors: MA
authors: Clark
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects; D001134:Arm Injuries / Q000209:etiology / Q000523:psychology; D001294:Attitude to Health; D001727:Bisexuality / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000523:psychology / Q000628:therapy; D015897:Comorbidity; D005260:Female; D020010:Heterosexuality / Q000706:statistics & numerical data; D018452:Homosexuality, Female / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000523:psychology; D007182:Income; D008408:Mastectomy / Q000009:adverse effects; D009765:Obesity / Q000453:epidemiology / Q000523:psychology; D011183:Postoperative Complications / Q000209:etiology / Q000523:psychology; D011287:Prejudice; D044469:Racial Groups / Q000706:statistics & numerical data; D011832:Radiation Injuries / Q000209:etiology / Q000523:psychology; D011878:Radiotherapy / Q000009:adverse effects; D019529:Sexuality / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data*; D063189:Symptom Assessment
chemical_list: D000970:Antineoplastic Agents