Identifying gaps and challenges faced in lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA+) adolescent and young adults (AYA) cancer care: A scoping review.

100 Background: There is a dearth of evidence related to the needs and challenges faced by LGBTQIA+AYA cancer patients and survivors. This scoping review aims to summarize the existing literature about the challenges faced, the nature and currently available services provided for LGBTQIA+ AYA cancer patients and survivors. Methods: In February 2023, a systematic keyword search was conducted on PubMed and Embase. This included the terms, “AYA”, “Adolescent and Young Adults”, “Cancer”, “LGBTQIA+”, “Sexual and Gender Minorities”, “obstacles”, “biases” and “challenges”. The studies selected were screened for further relevant cited references. Papers exploring LGBTQIA+ AYA (ages 15-49) challenges and available services were selected. Exclusion criteria included studies that lacked AYA-specific results, or did not report on challenges/difficulties faced. Included studies were then thematically analyzed according to challenges, available services and help required. Qualitative analysis was subsequently performed. Results: A total of 202 studies were identified. We excluded 185 studies based on the exclusion criteria. 17 studies were included in this review. 7 challenges, 7 help service gaps and 3 available services were identified in LGBTQIA+ AYA cancer care. Major challenges reported include LGBTQIA+ inclusive understanding of psychosocial needs, depression/anxiety, disclosure of sexual and gender minority status to Healthcare Providers (HCPs) and the recognition of partners by HCPs. Deficient services included LGBTQIA+-specific support groups and cultural competence training amongst HCPs. Frameworks are currently being developed to enhance HCP-patient relationships and improve the inclusivity of marginalized LGBTQIA+ patients in the healthcare system. However, the exact available services were unreported or not specific to this population. Conclusions: This review underlined the lack of LGBTQIA+-AYA-specific evidence regarding challenges faced by patients and survivors. While domains relating to mental health outcomes are increasingly reported in the literature, others including identity formation, financial outcomes and fertility needs continue to be underreported. There is also an absence of research on Asian populations and less developed countries. Further research is required to understand and address these specific gaps and difficulties. This is necessary to provide holistic AYA care to improve compliance, and also ensure better cancer treatment and survivorship experiences.