Discrimination Against Gay and Bisexual Patients in Prostate Cancer Treatment: Results From the Restore-2 Study

The purpose of this study was to examine the experiences of discrimination during prostate cancer treatment and assess the association with health-related quality of life (HRQOL) in a cohort of gay and bisexual men (GBM) prostate cancer survivors. This is a cross-sectional analysis of the 24-month follow-up survey from the Restore-2 clinical trial that tested the effectiveness of an online rehabilitation program tailored for GBM prostate cancer survivors in the United States. This analysis uses data from the 347 participants who completed all items of the Everyday Discrimination Scale (EDS) at the 24-month follow-up. A log-binomial regression model estimated the risk of experiencing discrimination across treatment received and demographic characteristics. Multivariable linear regression models estimated mean differences in HRQOL measures with discrimination as a binary variable after adjustment for relevant covariates. Nearly half (49.3%) of participants endorsed at least one experience of discrimination during prostate cancer treatment. About half (52%) of these rated the discrimination as "rare" (total EDS = 1-3), while 48% reported it as more common (total EDS ≥ 4). Most attributed the discrimination to their sexual orientation (35.5%) or their provider's attributes (29.6%). Those who underwent systemic/combined treatment (vs. either surgery or radiation only) and those with less than a bachelor's or graduate-level degree (vs. bachelor's degree) were more likely to report discrimination. Experiencing any discrimination was associated with significantly worse HRQOL outcomes. Discrimination during prostate cancer treatment appears to be a common experience for GBM patients and may result in poorer treatment outcomes. Clinical Impact Statement This study found that discrimination is common for gay and bisexual men during their prostate cancer treatment and is also related to worse health-related quality of life outcomes. Experiences of discrimination were commonly attributed to the cancer survivor's sexual orientation or a characteristic of their health care provider. This study highlights the need to adequately train cancer providers in providing culturally responsive care to sexual and gender minority patients.