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

Abstract

Purpose: 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. Methods: 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 ªÒ ); 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. Results: 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). Conclusion: 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.

Care delivery, patient experiences, and health outcomes among sexual and gender minority patients with cancer and survivors: A scoping review

“…We identified 14 studies that characterized the mental health impact and degree of adjustment to cancer . In 1 large survey study of individuals with a history of cancer that compared SGM with propensity score‐adjusted heterosexual peers, SGM survivors reported higher rates of depression and relationship difficulty .…”

“…SM status and gender appeared to interact with symptom reporting, such that worse symptoms were reported by SGM versus heterosexual men, but not by SGM versus heterosexual women . At diagnosis, higher levels of psychosocial stress and depressive symptoms among SGM survivors were reported in a few studies, including lesbian women with breast cancer, SGM survivors enrolled in an at‐home exercise program, and survivors participating in an online survey . However, 3 studies of women with breast cancer found that SGM survivors had comparable or even better adjustment than heterosexual survivors .…”

“…We identified 14 studies that characterized the mental health impact and degree of adjustment to cancer. 22,28,[38][39][40][41][42][43][44][45][46][47][48][49] In 1 large survey study of individuals with a history of cancer that compared SGM with propensity score-adjusted heterosexual peers, SGM survivors reported higher rates of depression and relationship difficulty. 22 SM status and gender appeared to interact with symptom reporting, such that worse symptoms were reported by SGM versus heterosexual men, but not by SGM versus heterosexual women.…”

The role of social support in physical activity for cancer survivors: A systematic review

“…Interventions ranged from three weeks to 24 months. Only three trials had intervention outcome data that addressed the aims of this review: two studies examining the effects of interventions with versus without a partner, and a study examining a team versus group context …”

Minority stress, psychosocial resources, and psychological distress among sexual minority breast cancer survivors.

“…Perception of and satisfaction with social support in turn could be related to discrimination, degree of outness and development of sexual minority identity through stronger bonds to the LGBT community, and could mediate the impact of these factors on psychological distress (Legate, Ryan, & Weinstein, 2012). Studies that examine psychological distress in sexual minority women specifically, and that incorporate both minority stress and psychological resources, would enable more accurate screening and better tailored interventions for this underserved and at-risk group (Boehmer et al, 2013; Kamen et al, 2016). …”