LGBTQ+ and Black Breast Cancer Survivors

Background

Significant disparity exists in the diagnosis, treatment, and survivorship outcomes among Black breast cancer (BC) survivors

Unmet physical and emotional needs in BC survivors are well documented, but there is mounting evidence that Black BC survivors have more significant survivorship issues and a greater burden of illness than their White counterparts

Barriers to rehabilitation and recovery care exist for all BC survivors but are magnified in Black survivors due to systemic racism, healthcare provider bias and discrimination, lack of culturally relevant care models, and socio-economic barriers

Compared to heterosexual women, sexual minority cisgender women (SMW) experience increased stigma, discrimination and violence; decreased access to healthcare; increased prevalence of health risk behaviors; and increased rates of adverse health outcomes

Compared to white SMW, racial/ethnic minority SMW face increased minority stress and increased health disparities

Despite mounting evidence regarding the benefits of specialized cancer rehabilitation, implementation is often challenged by limited health facilities, inadequate health promotion, and lack of specialized providers

The Atlanta Initiative provides significant insight to the physical therapy community as a model for providing sustainable, equitable and intersectional care to marginalized communities and additional insight in the many remaining opportunities for growth

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Methods

In an effort to create a community-based care model to address known disparities that exist, TurningPoint Breast Cancer Rehabilitation created The Atlanta Initiative (TAI)

TAI is a project of the GAP Initiative with the goal of reducing disparity in breast cancer survivorship among Black and LGBTQIA+ individuals in Atlanta

The initiative incorporates principles of health justice, community engagement, patient empowerment, and culturally concordant care bringing specialized rehabilitation directly into the community it serves

TAI works alongside the community to directly impact Black and LGBTQIA+ breast cancer survivors, reduce survivorship care barriers and facilitate expansion of community resources

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The findings provide compelling documentation of lived personal and professional experiences of racial and gender disparities in BC survivorship. These issues have been described in the literature for nearly two decades. Potential solutions exist and must be enacted immediately to ensure equitable survivorship outcomes for Black and LGBTQIA+ individuals following a BC diagnosis.

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“ The Atlanta Initiative is important for me because it is a safe space for me to be open and honest about my cancer journey. Whether it is addressing the pain my body may be going through, to financial hardships, or just needing a shoulder to cry on, having someone who has walked this walk to comfort me and tell me that its normal makes me feel less crazy”

“It is important to me because bringing therapy to downtown Atlanta helps the patients that don’t have affordable care and transportation be able to receive the proper breast cancer therapy then need”

“The Atlanta initiative’s additional focus on serving LGBTQ+ persons adds another dimension of support- a clear message of acceptance and respect. When I’m already feeling so challenged by the demands of recovery, the last thing I want to be worrying about is discomfort, ignorance, stigma, or discrimination.”

“Many African Americans have limited access to rehabilitation clinics that increase the likelihood of returning back to day-to-day activities. TurningPoint’s clinic in Atlanta is important to African American communities because it provides proper care and great resources, and gives us the confidence we need to fight against cancer”

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Results: Elements of Success

TAI meets the needs of Black and LGBTQIA+ individuals going through breast cancer in metro Atlanta

To date, 68 Black women have been provided with 1,036 individualized physical therapy appointments and 14 LGBTQIA+ patients have been provided with 137 individualized physical therapy appointments

coalition, that represents the Center for Black Women’s Wellness, Grady Hospital Cancer Center and rehabilitation department, community stakeholders and members of the Atlanta faith community

Additional factors include the tireless work of our Community Advocate and marketing efforts of the clinical team

Patients served at TAI also demonstrate statistically significant improvements in overall shoulder ROM, decreased pain levels, and increased subjective report of function

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