Heterosexual Survivors Research Articles

Differential impact of financial hardship on food security between lesbian, gay, and bisexual and heterosexual cancer survivors in the United States.

137 Background: Lesbian, gay, and bisexual (LGB) cancer survivors experience more food insecurity as well as financial hardship than heterosexual cancer survivors. However, how financial hardship impacts food security differently between LGB and heterosexual survivors has not been explored. Methods: National Health Interview Survey data from 2019-2022 were pooled and weighted. Outcomes included a food insecurity measure (food secure, low food security, very low food security) and the manifestations of food insecurity (e.g., cutting size of meals, losing weight due to lack of food). Financial hardship was captured as a binary measure, dichotomized from an 11-item scale which included ability to pay medical bills, worry about paying bills, and delayed or foregone care due to costs. Bivariate analyses were conducted using Chi-Squared tests. Multinomial logistic regression models with an interaction between LGB status and financial hardship status were used to generate relative risk ratios controlling for age, time since last cancer diagnosis, sex, race, region, and year. Results: Of N=13,131 cancer survivors, 2.8% (n=374) identified as LGB. Low/very low food security was reported by 15.6% of LGB survivors in comparison to 6.1% of heterosexual survivors (p<0.001). When stratified by financial hardship, LGB survivors were more likely to report food insecurity in the presence of (22.3% vs. 11.2%, p<0.001) and absence of (6.8% vs. 2.2%, P<0.001) financial hardship. LGB survivors with very low food security often reported cutting the size/cutting meals (93.4%), eating less than they should (94.7%), and being hungry because they could not afford food (80.7%). In the multinomial model, LGB survivors with financial hardship had 5.6 (95%CI:2.9-10.7) times the relative risk of low food security, while heterosexual survivors with financial hardship had 3.9 the relative risk of low food security (95%CI: 2.9-5.2) in comparison to heterosexual survivors with no financial hardship. Furthermore, LGB survivors with financial hardship had 11.8 (95%CI:6.2-22.5) the relative risk of very low food security, LGB survivors with no financial hardship had 6.4 (95%CI: 2.0-20.2) the relative risk of very low food security, and heterosexual survivors with financial hardship had 5.3 the relative risk of low food security (95%CI: 3.6-7.7) in comparison to heterosexual survivors with no financial hardship. Conclusions: Experiencing financial hardship was associated with an increased risk of food insecurity among LGB and heterosexual cancer survivors. However, LGB survivors were more likely to experience food insecurity than heterosexual survivors even when controlling for financial hardship.

Psychological distress and mental health care utilization among lesbian, gay, and bisexual survivors of adolescent and young adult cancer.

Survivors of adolescent and young adult (AYA) cancer face significant psychological distress and encounter barriers accessing mental health care. However, limited research exists on psychological health among lesbian, gay, and bisexual (LGB) survivors of AYA cancer, particularly in comparison with heterosexual survivors and LGB individuals without a history of cancer. Using the National Health Interview Survey (2013-2018), we identified LGB survivors of AYA cancer, LGB individuals without a history of cancer, and heterosexual survivors of AYA cancer. Sociodemographic, chronic health conditions, modifiable factors (such as smoking and alcohol use), and psychological outcomes were assessed using chi-square tests. Logistic regression models, adjusted for survey weights, evaluated the odds of psychological distress by cancer status after accounting for covariates. Interactions between variables and cancer status were explored. The study comprised 145 LGB survivors, 1450 LGB individuals without a history of cancer, and 1450 heterosexual survivors. Compared to heterosexual survivors, LGB survivors were more likely to report severe distress (aOR = 2.26, p = 0.021) and had higher odds of reporting a mental health care visit (aOR = 1.98, p = 0.003). Odds of severe distress (aOR = 1.36, p = 0.36) and reporting a mental health care visit (aOR = 1.27, p = 0.29) were similar between LGB survivors and LGB individuals without a history of cancer. While 47.8% of LGB survivors reported moderate/severe distress, only 29.7% reported a mental health care visit. A history of cancer during the AYA years is associated higher odds of severe psychological distress among LGB survivors compared to heterosexual survivors. However, many LGB survivors with psychological distress have not accessed mental health care.

Material, Psychological, and Behavioral Financial Hardship Among Lesbian, Gay, and Bisexual Cancer Survivors in the United States.

Driven by anti-LGBTQ+ stigma, emerging literature suggests that lesbian, gay, and bisexual (LGB) cancer survivors experience financial hardship (FH) more frequently than heterosexual survivors. However, few studies have used nationally representative samples to estimate this inequity. National Health Interview Survey data from 2019 to 2022 were pooled and weighted. Outcomes included material, psychological, and behavioral FH. The behavioral domain was further broken down into subdomains including medical care, prescription medications, and mental health care. Multivariable logit models controlling for a variety of factors were used to generate LGB and heterosexual predicted probabilities and differential effects for each FH outcome. Stratified estimates were generated by sex and age groups. A total of N = 374 LGB and N = 12,757 heterosexual cancer survivors were included in this analysis. In adjusted analyses, LGB cancer survivors had significantly higher material (19%, 95% CI, 15 to 24 v 12%, 95% CI, 11 to 13; P = .004), psychological (44%, 95% CI, 38 to 51 v 37%, 95% CI, 36 to 38; P = .035), and behavioral (23%, 95% CI, 18 to 28 v 13%, 95% CI, 13 to 14; P < .0001) FH than heterosexual survivors. LGB cancer survivors also had higher medical behavioral (11%, 95% CI, 7 to 15 v 7%, 95% CI, 6 to 7; P = .030), prescription medication behavioral (14%, 95% CI, 10 to 19 v 10%, 95% CI, 9 to 10; P = .032), and mental health behavioral (9%, 95% CI, 6 to 13 v 3%, 95% CI, 3 to 4; P < .0001) FH than heterosexual survivors. Stratified estimates revealed young LGB cancer survivors had the highest probability of each outcome (material: 31%, 95% CI, 23 to 40; psychological: 58%, 95% CI, 50 to 66; behavioral: 45%, 95% CI, 36 to 53). In this nationally representative analysis, LGB cancer survivors experience substantial inequities in all FH outcomes. It is crucial that future FH interventional work should prioritize populations at the highest risk of FH, such as LGB cancer survivors.

Disclosing Sexual Victimization Online and In-Person: An Examination of Bisexual+ and Heterosexual Survivors.

Bisexual+ (bisexual, pansexual, queer, attraction to more than one gender) people are at elevated risk for sexual victimization relative to their heterosexual counterparts. Disclosure of sexual victimization and social reactions received upon disclosure can play a major role in recovery following an assault. Using an online survey, the current study examined whether bisexual+ and heterosexual survivors of sexual victimization (N = 657) varied in disclosure of victimization, the type of disclosure (in-person vs. online via #MeToo), and receipt of various social reactions to disclosure in person and online. A chi-square test examined differences in disclosure and differences in types of disclosure (in-person only vs. MeToo across sexual identity). MANOVAS were used to examine whether in-person and online reactions varied across sexual identity. Bisexual+ survivors were more likely to disclose sexual victimization relative to heterosexual survivors. Among those who disclosed, bisexual+ survivors were more likely to disclose in person only whereas heterosexual survivors were more likely to disclose online via #MeToo. Whereas we did not find any significant differences for in-person reactions, we did find significant differences for online social reactions using #MeToo. Heterosexual survivors received higher turning against reactions (e.g., avoided talking to you or spending time with you) and more unsupportive acknowledgment relative to bisexual+ participants. Whereas bisexual+ participants received less turning against reactions and unsupportive acknowledgment during #MeToo/online disclosure, they were also less likely to disclose using #MeToo. Findings suggest that bisexual+ and heterosexual people vary in the way they disclose sexual victimization, and in how they are responded to when disclosing in person and online.

Risk of chronic health conditions in lesbian, gay, and bisexual survivors of adolescent and young adult cancers.

In the general population, individuals with minoritized sexual orientation and gender identity have a higher burden of chronic health conditions than heterosexual individuals. However, the extent to which sexual orientation is associated with excess burden of chronic conditions in adolescent and young adult cancer survivors (AYACS) is unknown. Lesbian, gay, and bisexual (LGB) AYACSs, LGB individuals without a history of cancer, and heterosexual AYACSs were identified by self-reported data from the cross-sectional National Health Interview Survey (2013-2020). Socioeconomic factors and the prevalence of chronic health conditions were compared between groups using χ2 tests. Logistic regression methods were used to determine the odds of chronic conditions by socioeconomic factors within and between survivor and comparison groups. One hundred seventy LGB cancer survivors, 1700 LGB individuals without a history of cancer, and 1700 heterosexual cancer survivors were included. Compared with heterosexual survivors, LGB survivors were less likely to be married (p=.001) and more likely to have never been married (p<.001). LGB survivors were more likely to have incomes between 100% and 200% of the federal poverty level than LGB individuals without a history of cancer (p=.012) and heterosexual survivors (p=.021) and were less likely to report incomes >200% the federal poverty level. LGB survivors had higher odds of chronic health conditions than LGB individuals without a history of cancer (odds ratio, 2.45; p<.001) and heterosexual survivors (odds ratio, 2.16; p=.003). LGB AYACSs are at increased risk of having chronic health conditions compared with both LGB individuals without a history of cancer and heterosexual AYACSs.

Disparities in health-related quality of life among lesbian, gay, and bisexual cancer survivors

Objective This study compared health-related quality of life (HRQOL) among lesbian, gay, and bisexual (LGB) cancer survivors and their heterosexual counterparts in a US population-based sample of cancer survivors. Methods The study utilized data from the All of Us research program. LGB survivors (n = 885) were matched for age, gender identity, marital status, income, education, and cancer site with heterosexual survivors (n = 885) using 1:1 propensity matching. Physical, mental, and social HRQOL were assessed with items from the Patient-Reported Outcomes Measurement Information System (PROMIS). Results Relative to heterosexuals, LGB cancer survivors reported lower HRQOL in mental and social domains, but not in physical HRQOL. Older age was associated with higher HRQOL across domains. LGB survivors identifying as Black/African American were more likely to experience lower social HRQOL than White survivors. Conclusions This study highlights several disparities in HRQOL that exist between LGB and heterosexual cancer survivors.

Recruitment of sexual minority and heterosexual colorectal cancer survivors through US cancer registries.

Describe the process, outcomes, and costs of cancer registry recruitment and enrollment of sexual minority and heterosexual non-metastatic colorectal cancer survivors into an observational survivorship study. We recruited stage I-III colorectal cancer survivors from four US cancer registries. Potential participants were screened for eligibility, and all eligible sexual minority and every 10th heterosexual survivor was invited to participate in a 45-min telephone interview. We mailed study packets to 17,855 individuals and obtained 6370 screening surveys of presumed eligible individuals. After screening, there were 182 eligible sexual minority and 5568 eligible heterosexual survivors. Of the 719 invited survivors, 127 sexual minority and 353 heterosexual individuals participated in the interview. There were some small differences in personal and neighborhood sociodemographic characteristics for the survivors who screened eligible and completed the interview relative to the registry sample. The per-participant direct costs were about $40, $120, and $1425 in the registry, screened eligible, and interviewed samples, respectively. Although we did not observe substantial selection biases, the costs of enrolling a representative sample were high. Inclusion of sexual orientation and gender identity as standard demographic questions in cancer registries is needed for reliable and cost-efficient monitoring of population health.

"I Could Never Tell My Parents": Barriers to Queer Women's College Sexual Assault Disclosure to Family Members.

Queer women are at high risk of college sexual victimization, but they face barriers to formal support services. As a result, informal support is critical. This study uses data from 40 open-ended interviews to explore family members' reactions to queer women's disclosures and examine whether their family is a reliable source of informal support. Findings indicate that family reactions are often more harmful than helpful. In comparison to research focused on heterosexual survivors, we find family reactions to be more extreme and disparaging of queer survivors' sexual identities. In fact, family members' negative reactions may pose barriers to accessing formal services.

Anxiety and depression in colorectal cancer survivors: Are there differences by sexual orientation?

To examine sexual minority compared to heterosexual survivors' health-related anxiety, anxiety, and depression. Four hundred and eighty eligible survivors participated in a telephone survey, which measured their anxiety and depression. These survivors were diagnosed with stage I, II, or III colorectal cancer an average of three years prior to the survey and were recruited from four cancer registries. As explanatory factors, we considered individual, social and contextual characteristics, prior psychological factors, psychological responses to cancer, and characteristics of cancer and its treatments. Using forward selection with generalized linear models or logistic regression models, we identified significant correlates for each outcome. Prior to adjusting for covariates, depression was similar for all survivors, while sexual minority survivors had worse health-related anxiety and anxiety compared to heterosexual survivors. After adjustment, these differences were no longer statistically significant. Individual, social and contextual characteristics, characteristics of cancer, and psychological responses to cancer explained 44% of the variance in anxiety and 60% of the variance in depression. There are modifiable factors associated with health-related and generalized anxiety as well as depression that can be changed to improve cancer survivorship among diverse survivors.

Health-related quality of life among colorectal cancer survivors of diverse sexual orientations.

The purpose of this study was to examine the health-related quality of life of sexual minority survivors in comparison with heterosexual survivors. Four hundred eighty eligible survivors participated in a telephone survey that measured survivors' outcomes, which consisted of physical and mental quality of life and self-rated fair or poor health. These survivors were diagnosed with stage I, II, or III colorectal cancer an average of 3 years before the survey and were recruited from 4 cancer registries. Using forward selection with generalized linear models or logistic regression models, the authors considered 4 domains-personal factors, environmental factors, health condition characteristics, and body function and structure-as correlates for each survivorship outcome. The authors found that unadjusted physical quality of life and self-rated fair/poor health were similar for all survivors. Sexual minority survivors had poorer unadjusted mental quality of life in comparison with heterosexual survivors. After adjustments for covariates, this difference was no longer statistically significant. Three domains (personal factors, health condition characteristics, and body function and structure) explained colorectal cancer survivors' fair/poor health and 46% of the variance in physical quality of life, whereas 56% of the variance in mental quality of life was explained by personal factors, body function and structure, and environmental factors. This study has identified modifiable factors that can be used to improve cancer survivors' quality of life and are, therefore, relevant to ongoing efforts to improve the survivorship experience.

Follow-up surveillance among colorectal cancer survivors of different sexual orientations.

The purpose of this study was to examine receipt of follow-up surveillance among sexual minority and heterosexual survivors and identify survivor-, physician-, and practice-level characteristics associated with follow-up surveillance. An average of 3 years after their stage I-III colorectal cancer diagnosis, we recruited survivors from four cancer registries. A questionnaire, which queried about sexual orientation and other eligibility criteria, was mailed to all cancer survivors. Subsequently, 418 eligible survivors without recurrent disease participated in a telephone survey. Colorectal cancer-specific follow-up surveillance was defined as colonoscopy, carcinoembryonic antigen (CEA) test, or imaging test. We used logistic regression with forward selection to obtain models that best explained each follow-up test. About 10% of survivors received no follow-up surveillance, while 70% had colonoscopies. While survivors irrespective of sexual orientation received follow-up surveillance, sexual minority survivors had 3 times the odds of receiving imaging tests compared to heterosexual survivors. Having a designated provider of any specialty was most salient for the receipt of surveillance. Sexual minority survivors' greater receipt of imaging tests may indicate providers perceive them at greater risk for recurrence than heterosexual survivors. Future studies need to examine provider behaviors towards monitoring colorectal cancer survivors of diverse sexual orientations. Guidelines recommend surveillance of colorectal cancer survivors to improve survival. This study showed that having a designated provider for follow-up is most salient for the receipt of surveillance, most survivors receive surveillance, and sexual minority survivors had more imaging tests compared to heterosexual survivors.

Assessing the relationship between symptoms and health care utilization in colorectal cancer survivors of different sexual orientations.

The purpose of this study was to determine the association of physical and psychological symptoms with health care utilization in sexual minority and heterosexual colorectal cancer survivors. Four hundred eighteen colorectal cancer survivors who were in remission an average of 3 years after their diagnosis were surveyed about their non-emergency health care visits during the preceding 3 months. Survivors reported whether they had experienced any of 21 symptoms common among colorectal cancer survivors in the past week. The relation between having had two or more health care visits in the preceding 3 months and symptoms experienced was assessed using logistic regression, controlling for cancer registry, sexual orientation, sex, age, race/ethnicity, income, and comorbidities. Of the survivors, 12% reported no symptoms, while 12% reported six or more symptoms. Sexual minority survivors reported significantly more weight concerns and more health-related and general anxiety as well as worse body image than heterosexual survivors. Frequent worrying about weight and experiencing sore skin around the anal area or stoma were the two symptoms that significantly contributed towards explaining survivors' increased health care utilization. Weight concerns, which are more common among the heaviest survivors, may prompt survivors to seek help from health care providers, which may lead to more frequent visits. On the other hand, some symptoms, despite their prevalence, had no relationship with the frequency of health care visits, raising questions about whether survivors share these concerns with providers.

Survivors' Perceptions of Quality of Colorectal Cancer Care by Sexual Orientation.

The objective of this study was to assess sexual minority and heterosexual survivors' perceived quality of cancer care and identify demographic, clinical, and psychosocial characteristics associated with patient-centered quality of care. Four cancer registries provided data on 17,849 individuals who were diagnosed with stage I, II, or III colorectal cancer an average of 3 years prior and resided in predetermined diverse geographic areas. A questionnaire, which queried about sexual orientation and other eligibility criteria was mailed to all cancer survivors. Of these, 480 eligible survivors participated in a telephone survey. Quality of cancer care was defined by 3 measures of interpersonal care (physician communication, nursing care, and coordination of care) and by rating cancer care as excellent. We used generalized linear models and logistic regression with forward selection to obtain models that best explained each quality of care measure. Sexual minority survivors rated physician communication, nursing care, and coordination of care similarly to heterosexual survivors, yet a significantly higher percentage of sexual minority survivors rated the overall quality of their cancer care as excellent (59% vs. 49%). Sexual minority survivors' greater likelihood of reporting excellent care remained unchanged after adjusting for demographic, clinical, and psychosocial characteristics. Sexual minority survivors' ratings of quality of colorectal cancer care were comparable or even higher than heterosexual survivors. Sexual minority survivors' reports of excellent care were not explained by their interpersonal care experiences.

Disclosure of Sexual Violence Victimization and Anticipated Social Reactions among Lesbian, Gay, and Bisexual Community College Students

Lesbian, gay, and bisexual (LGB) college students report significantly higher rates of sexual violence victimization than their heterosexual counterparts. The additional stressors (e.g., discrimination) that sexual minority populations face may impact their decision to disclose victimization and anticipated social reactions. Therefore, we compared rates of disclosure and anticipated social reactions of lesbian/gay, bisexual, and heterosexual community college students (n = 677) who reported at least one incident of sexual violence victimization since enrolling at their institution. Students who identified as bisexual reported victimization at higher rates (63.8%) than students who identified as lesbian/gay and heterosexual and were significantly more likely to disclose victimization. Bisexual survivors reported significantly lower well-being outcomes (i.e., mental health and life satisfaction) than heterosexual survivors. However, lesbian/gay survivors reported anticipating more negative social reactions than heterosexual survivors. These findings highlight the importance of offering support services to LGB students at community colleges. Implications for future research are discussed.

Comparing the Mental Health of Sexual Minority and Heterosexual Cancer Survivors: A Systematic Review.

Purpose: Sexual minority (SM) individuals are more likely to experience mental health concerns than heterosexual individuals. However, little is known to date about the psychological needs of SM cancer survivors. The objective of this systematic review was to identify whether SM cancer survivors experience disparate psychological outcomes compared with heterosexual cancer survivors. Methods: PubMed/MEDLINE, PsycINFO, CINAHL, Web of Science, and ProQuest databases were searched systematically to identify studies that compared mental health outcomes between SM and heterosexual survivors. A standardized data extraction form was used to extract data from eligible articles. The Joanna Briggs Institute Checklist for Analytical Cross Sectional Studies was used to assess study quality. Results: Twelve studies met the inclusion criteria and assessed distress, depression, anxiety, perceived stress, and mental and emotional quality of life (QOL). Most studies enrolled survivors diagnosed either with female breast cancer or with prostate cancer. Most studies reporting on mental health among women found no differences between SM and heterosexual survivors. Studies conducted among men found that SM survivors experienced higher distress, depression, and anxiety, and lower emotional/mental QOL than heterosexual survivors. Conclusion: The findings of the present synthesis suggest that mental health disparities may exist among SM men diagnosed with cancer, particularly prostate cancer. More research is required to identify mental health disparities among SM survivors diagnosed with other cancers, as well as predisposing and protective factors. In addition, mental health screening and interventions are needed for SM men after cancer diagnosis.

Dyadic stress of breast cancer survivors and their caregivers: Are there differences by sexual orientation?

The objective of the study is to assess dyadic stress among sexual minority cancer survivor and caregivers compared to heterosexual cancer survivors and their caregivers. We recruited 167 survivors of nonmetastatic breast cancer of different sexual orientations and their caregivers, who were interviewed via telephone after obtaining consent. We used inverse propensity score weighting to account for differences by sexual orientation in age and length of the survivor-caregiver relationship and simultaneous equation models consistent with the needs for analyzing dyadic data. Survivors and caregivers reported stress levels consistent with population norms, irrespective of survivors' sexual orientation. Accounting for covariates, survivors' and caregivers' stress did not mutually influence one another overall. However, differences by sexual orientation were noted such that caregivers' stress was influential for sexual minority survivors' stress, but not for heterosexual survivors' stress. Careful consideration should be given to caregivers of sexual minority survivors, an underserved group for whom currently no interventions exist.

Dyadic exercise to reduce depression and associated inflammatory cytokines among lesbian, gay, and heterosexual cancer survivors.

10069Background: Our previous research shows that lesbian/gay (LG) cancer survivors experience high rates of depression and that standardized aerobic and resistance exercise (EXCAP, Exercise for Cancer Patients) is efficacious in improving depression and inflammation associated with depression in heterosexual survivors. We have now conducted the first, to our knowledge, cancer control trial testing two exercise interventions to reduce depression and inflammation in both LG and heterosexual survivors and their caregivers (CGs). Methods: In this Phase I/II RCT, 42 LG and heterosexual survivors and their CGs were randomized as dyads to: Arm 1) dyadic exercise, involving both survivor and CG; or Arm 2) survivor-only EXCAP. Depression symptoms (from the CES-D) and cytokines (IFN-γ, IL-6, IL-8, IL-10) were measured at baseline and post-intervention (6 wks later). We used t-tests to assess baseline disparities, ANCOVA to assess the effect of dyadic vs. survivor-only exercise on depression and inflammation, and P...

Recruitment of breast cancer survivors and their caregivers: implications for dyad research and practice.

Breast cancer survivors' informal caregivers experience adverse health outcomes and could benefit from interventions. Studies of caregivers' participation in research, to date, have assumed heterosexuality. The aim of this study is to identify factors associated with caregiver participation among survivors with diversity in sexual orientation. We recruited breast cancer survivors into a telephone survey and asked them to invite a caregiver. Logistic regression identified factors associated with caregivers' participation. Among 297 survivors, 12 (4%) had no caregivers, 82 (28%) refused to provide caregiver information, 203 (68%) provided caregiver contact, and 167 (56%) had caregivers participate. Caregiver participation was more likely among sexual minority than heterosexual survivors (aOR: 1.89; 95% CI: 1.08, 3.32), dyads with higher cohesion, and among caregivers who were partners. Caregiver participation was less likely among survivors with lower education and higher comorbidity. Findings provide insight into recruitment of diverse dyads into cancer survivorship research that will ultimately inform intervention design.

Sexual Assault in Bisexual and Heterosexual Women Survivors

ABSTRACTIn cross-sectional studies, social support is related to sexual minority status and negative psychological impact among sexual assault survivors. However, longitudinal studies of this relationship are few or non-existent. Using a prospective design, the authors compared bisexual and heterosexual survivors on how different types of social support are connected to symptoms of post-traumatic stress disorder (PTSD) and depression. A community sample of bisexual and heterosexual (N = 905) women sexual assault survivors completed three annual surveys. Heterosexual women reported greater perceived social support and fewer negative reactions to disclosure of sexual assault than bisexual women, but there were no differences in frequency of social contact. Perceived social support and frequency of social contact were related to fewer psychological symptoms of PTSD and depression for all women. Heterosexual women had fewer psychological symptoms than bisexual women. Finally, perceived social support mediated the relationship of sexual orientation with depressive symptoms but not with PTSD symptoms. These findings suggest that social support and sexual orientation may explain women's post-assault adjustment.

A Dyadic Exercise Intervention to Reduce Psychological Distress Among Lesbian, Gay, and Heterosexual Cancer Survivors.

Studies have found disparities in psychological distress between lesbian and gay cancer survivors and their heterosexual counterparts. Exercise and partner support are shown to reduce distress. However, exercise interventions haven't been delivered to lesbian and gay survivors with support by caregivers included. In this pilot randomized controlled trial (RCT), ten lesbian and gay and twelve heterosexual survivors and their caregivers were randomized as dyads to: Arm 1, a survivor-only, 6-week, home-based, aerobic and resistance training program (EXCAP©®); or Arm 2, a dyadic version of the same exercise program involving both the survivor and caregiver. Psychological distress, partner support, and exercise adherence, were measured at baseline and post-intervention (6 weeks later). We used t-tests to examine group differences between lesbian/gay and heterosexual survivors and between those randomized to survivor-only or dyadic exercise. Twenty of the twenty-two recruited survivors were retained post-intervention. At baseline, lesbian and gay survivors reported significantly higher depressive symptoms (P = .03) and fewer average steps walked (P = .01) than heterosexual survivors. Post-intervention, these disparities were reduced and we detected no significant differences between lesbian/gay and heterosexual survivors. Participation in dyadic exercise resulted in a significantly greater reduction in depressive symptoms than participation in survivor-only exercise for all survivors (P = .03). No statistically significant differences emerged when looking across arm (survivor-only vs. dyadic) by subgroup (lesbian/gay vs. heterosexual). Exercise may be efficacious in ameliorating disparities in psychological distress among lesbian and gay cancer survivors, and dyadic exercise may be efficacious for survivors of diverse sexual orientations. Larger trials are needed to replicate these findings.