Supporting LGBTQ+ young people with cancer

Finding your identity

Your teenage and young adult years are naturally a time for exploring identity, including your sexual orientation and gender identity. Facing cancer on top of this is a massive challenge.

Cancer can really make you re-examine your identity. It can feel like it takes away the things that make you, you. And that’s especially tough on your mental and emotional wellbeing if you’re still exploring who you are and what’s important to you.

Feeling isolated

Teenagers and young adults only make up 1% of the cancer population. If you already feel different from your peers because of your sexual orientation or gender identity, cancer can make feelings of isolation more intense.

And while peer support among young people with cancer is really important, the lower likelihood of meeting someone who’s also going through it, and who also identifies the same way as you in terms of sexual orientation or gender identity, could make things tougher still.

Worrying about disclosure

You meet a lot of different health professionals when you go through cancer treatment, and it can be stressful weighing up whether to ‘come out’ and disclose your sexual orientation or gender identity to each of them.

You might wonder if it’s relevant, worry about how they’ll react, whether it’ll impact on your care, or whether it’ll be kept confidential – at a time when you’re already likely to feel more vulnerable.

Other people’s assumptions

You might find that other people incorrectly assume you’re in a heterosexual relationship, or that you’re cisgender (meaning your gender identity matches your sex assigned at birth).

This could mean they use the wrong pronoun(s) (e.g. he/she/they) when referring to you, which can be hurtful and erase your identity. Or they might assume your same-sex partner is your friend or relative.

Prejudice and lack of understanding

Prejudice against the LGBTQ+ community unfortunately exists in society. Young people who are trans, non-binary or questioning their gender identity often face a particular lack of understanding.

If you decide to pursue medical treatment to help you live in the gender identity that feels right for you, the waiting times for referral and treatment can be extremely long, and navigating the health service can be very challenging – especially if you’re going through something like cancer at the same time.

We work hard to make our units and services a safe and inclusive space for LGBTQ+ young people. You can expect your care team to treat you with dignity, empathy and respect, no matter how you identify.

If you’re lesbian, gay or bi:

• Your care team shouldn’t make assumptions about your sexual orientation or your relationship(s).
• They shouldn’t ask if you have a ‘boyfriend or girlfriend’ – they might use the word ‘partner’ if it’s relevant to ask. 
• And they shouldn’t assume your same-sex partner is your friend or relative.

If you’re trans or non-binary:

• Your care team shouldn’t make assumptions about your gender identity. 
• They should ask you before using a particular pronoun(s) (e.g. he/she/they) to refer to you. 
• It’s good for members of your care team to share their own pronouns with you too, to help you feel more comfortable.
• Where it’s relevant to your treatment, you may have to fill in forms which ask for your sex assigned at birth, where ‘male’ and ‘female’ are the only options. Your care team should respect the fact that this may be different from your gender identity.
• If you’re filling in a form which specifically asks for your gender, you shouldn’t find that ‘male’ and ‘female’ are the only options, although we know that currently, this isn’t always consistent across the healthcare system.
• If you have a choice between a male or female ward, that choice should be for you to make based on how you identify and where you’re most comfortable – your care team shouldn’t make the choice for you.
• If you’re already receiving medical care as part of a gender incongruence or gender dysphoria diagnosis (e.g. accessing hormone replacement therapy), you should feel comfortable to ask your care team about exploring how this treatment and your cancer treatment are best approached together.

And things we’re working towards in general:

• Visibility is vital. Teenage Cancer Trust spaces in hospitals should clearly display things like posters, leaflets and rainbow badges that show we’re LGBTQ+ allies, and nothing that promotes prejudice or exclusion.
• Confidentiality: If you disclose your sexual orientation or gender identity to someone in your care team, it’s not for them to ‘out’ you to anyone else. They should only ever share that information with other members of your care team if it’s relevant to your care, and if they’ve discussed it with you first.
• As part of your treatment, you should always get the chance to discuss sex, sexual health and fertility with your care team in a way that’s honest, open and relevant to your sexuality and gender identity. This includes discussing your options for fertility preservation if needed, regardless of your sexual orientation and/or gender identity.
• Your Teenage Cancer Trust nurse or Youth Support Coordinator will always listen and make the time to talk with you about anything that’s on your mind, including your sexual orientation or gender identity.
• Our nurses and Youth Support Coordinators might not always be experts in the issues that affect you as an LGBTQ+ young person – but we’ll always take the time to educate ourselves, signpost you to additional support where it’s available, and advocate in the healthcare system on your behalf.

If your care ever falls short of these standards:

As a service user, you have rights that you’re protected with under the Equality Act 2010.

If you want to give feedback or raise a concern about any aspect of your care, our nurses and Youth Support Coordinators will always listen and support you in doing so, if you want them to.

If you’re comfortable resolving a problem directly with the hospital, you can ask to speak to the ‘Sister in charge’ (if you’re on a ward) or the complaints manager. If you don’t want to speak to the hospital directly, you can also contact your local Clinical Commissioning Group.

• Share stories from young people in the LGBTQ+ community who’ve been through or are going through cancer. Your voice is important and we’d love to hear from you, whether it’s a blog, film or just a quote.
• Make sure we’re aware of the right terminology to use when talking with LGBTQ+ young people.
• Learn about LGBT history and key dates for lesbian, gay, bi and trans equality.
• Educate ourselves on the issues that LGBTQ+ people face, and areas of inequality such as mental health and wellbeing.
• Respect other people’s experiences and be aware of how these might differ from our own.
• Always be mindful of our actions and their impact on others.
• Challenge prejudice when we see or hear it.
• Keep listening and use what we learn to continually improve our services. There’s always more learning for us all to do, and we can always do more to support LGBTQ+ young people.

• Trekstock: Lifting the Lid on Cancer in the LGBTQ+ Community (webinar)
• OUTpatients (a cancer support and advocacy service for the LGBTIQ+ community)
• NHS/Porchlight BeYou project (an excellent list of useful contacts and resources)
• The Proud Trust
• Stonewall
• Stonewall Young Futures (a careers and education hub for all LGBTQ+ young people)
• Macmillan: No one overlooked: Experiences of LGBT people affected by cancer (pdf)
• Teenage Cancer Trust’s Blueprint of care - 2nd edition (pdf) (7.13 MB)