Mapping Multilevel Barriers and Facilitators to Inclusive Cancer Care for Sexual and Gender Minority Populations: A Scoping Review.

BACKGROUND

Cancer remains a leading cause of death worldwide, yet advances in prevention, screening, and treatment are not equitably shared. Lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, and additional sexual and gender minority (LGBTQIA+) individuals face persistent disparities in cancer care across individual, interpersonal, and institutional levels. This scoping review aimed to improve cancer care for adult LGBTQIA+ patients by mapping and synthesizing evidence on multilevel barriers and facilitators to inclusive cancer care.

METHODS

A systematic search across PubMed, Scopus, ScienceDirect, and CINAHL was conducted for peer-reviewed studies published between January 2015 and December 2025. Eligible studies examined cancer care accessibility, delivery, and patient experiences for LGBTQIA+ adults.

RESULTS

Twenty studies met the inclusion criteria. Findings revealed critical gaps in provider knowledge. Only 5% of healthcare professionals answered all LGBTQIA+ health questions correctly, 40% reported difficulty addressing sexual health, and 80% expressed interest in LGBTQIA+ training. Among LGBTQIA+ individuals, 65% were uncertain about cancer screening needs, and 76% had not received at least one human papilloma virus vaccine dose. Interpersonal barriers involved inadequate training, communication challenges, and implicit bias. Structural barriers included limited sexual orientation and gender identity fields in electronic records and registries, noninclusive environments, and weak institutional policies. Inclusive communication, routine sexual orientation and gender identity documentation, and visible signals of safety emerged as key facilitators.

CONCLUSIONS

Inclusive cancer care for LGBTQIA+ adults requires coordinated interventions that address provider education, clinical communication, and system-level structures simultaneously. Embedding mandatory LGBTQIA+ cultural-competence training, integrating routine sexual orientation and gender identity collection into electronic health records, and creating visibly welcoming environments represent high-priority, evidence-informed strategies to reduce these disparities. Notably, expanding research that meaningfully includes the LGBTQIA+ population is critical toward more equitable cancer care.