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. 2025 Apr;34(4):e70154.
doi: 10.1002/pon.70154.

A Cross-Sectional Analysis of Psychosocial Mediators Between Discrimination and Health-Related Quality of Life Among Sexual and Gender Minority Cancer Survivors

Oscar Y Franco-Rocha  1 , Christopher W Wheldon  2   3 , Carolyn S Phillips  1 , Mansi Patel  4 , Tiffany A Whittaker  5 , Shelli R Kesler  1   6   7 , Ashley M Henneghan  1   7
Affiliations

A Cross-Sectional Analysis of Psychosocial Mediators Between Discrimination and Health-Related Quality of Life Among Sexual and Gender Minority Cancer Survivors

Oscar Y Franco-Rocha et al. Psychooncology. 2025 Apr.

Abstract

Background: Acts of discrimination detrimentally impact the quality of life of sexual and gender minority (SGM) cancer survivors. However, it is unclear how demographic and psychosocial factors shape the impact of discrimination on health.

Aims: To evaluate the intermediating role of everyday discrimination on physical and mental health-related quality of life (HRQOL), and how such relationships vary based on the demographic and psychosocial factors of SGM survivors.

Methods: Secondary analysis with 381 SGM cancer survivors participating in the All of Us (AoU) research program. Valid and reliable measures to assess depression, anxiety, stress, social support, and loneliness were used to test whether these psychosocial variables mediated the relationship between discrimination and HRQOL. The hypothesized model was tested using structural equation modeling in the AoU workbench's RStudio platform.

Results: Discrimination affected physical (β = -0.141, p < 0.001) and mental (β = -0.115, p < 0.001) HRQOL through loneliness and psychological distress. The relationship between racial/ethnic minority status and physical (β = -0.045, p = 0.007) and mental (β = -0.036, p = 0.008) HRQOL was directly mediated by discrimination via psychological distress, and indirectly through loneliness and psychological distress (β physical HRQOL = -0.025, p = 0.010; β mental HRQOL = -0.020, p = 0.010).

Conclusions: Loneliness and psychological distress mediate the relationship between discrimination and HRQOL. The impact of discrimination on HRQOL was particularly higher for SGM survivors that were also part of a racial or ethnic minority group. Addressing psychosocial mediators through tailored support programs could mitigate the harmful effects of discrimination, thereby improving HRQOL for SGM cancer survivors.

Keywords: cancer; minority stress; oncology; psychosocial oncology; quality of life; sexual and gender minorities; social discrimination.

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References

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