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Wednesday, June 13, 2018

World Elder Abuse Awareness Day and Reaching Out to Socially Isolated Older Adults

June 15th is World Elder Abuse Awareness Day - the National Council on Aging is working to raise awareness about the different kinds of abuse that older adults experience.

Most cases of elder abuse are unreported and untreated. A report on elder mistreatment from the National Institutes of Health estimates that only 1 in 14 cases of elder abuse are reported. That's less that 10%.

Lately, I have been interviewing service providers in my area who work with older adults, and they are confirming what we see in the literature about elder abuse.  That the most prominent factors that put seniors at risk of abuse are social isolation and mental impairments like dementia.

Nationally, in about half of reported incidents of elder abuse and neglect, the person responsible for the abuse is a family member, usually a spouse or adult child. The research also indicates that the abusing party is often the only source of care or support the victim has, and so they are reluctant to tell anyone what is happening, for fear that the will lose that relationship and end up completely alone or in a nursing home.  This is certainly what my interviews are reporting so far.

So, how do we identify older adults around us who are socially isolated, and how do we break that isolation?  The National Council on Aging suggests 4 steps:

1. increase communication with isolated older adults - if they are family, reach out to them more than you have been; if they are neighbors, make an effort to get to know them, invite them out for coffee or a meal, or ask if you can help them with yard work or accompany them on a walk; engage other neighbors in reaching out to them as well

2. offer to accompany them to social activities at a local church or senior center

3. explore their interests and hobbies - are they a gardener? maybe you can ask their advice about your garden or invite them to help pick out plants for you at a local garden center; are they a reader? you can ask them to join a book club with you;

4. help them identify opportunities for support whenever they need it - if they are online, they can access a support community through Mental Health America; if the prefer talking on the phone, give them the number for The Friendship Line: 1-800-971-0016. This is a nationwide 24/7 warmline and also a crisis intervention hotline, that specifically serves older adults or adults living with disabilities.  They also reach out to their callers on a regular basis, to monitor their health and well being.

In addition to these ideas, you may want to reach out to the person or persons who are caring for an isolated older adult. Sometimes they are just as isolated, and it is that stress and isolation that can lead to some kinds of elder abuse.

If they are family, what can you do to assist them in caregiving? Are there ways you can offer them respite, or time off from their caregiving responsibilities? Can you stay with the older adult while they take time for themselves or run personal errands? Is there a way to help them take a vacation? Can you connect them with services through your local Office or Aging or Alzheimer's Association chapter? Perhaps they would benefit from learning about challenges faced by other caregivers - this can be accomplished by attending a caregiver support group relevant to their loved one's condition, or they could access online resources like Caregiver Matters of CNY, where I provide links to articles and resources related to caregiving, or videos about issues faced by caregivers.

If they are not family, perhaps you can introduce yourself to them as a neighborly resource, interested in helping them and their loved one. Offer to put some of the above ideas in place for their loved one, or ask them if there is anything specific that you can do for them. Maybe you can help with mowing the lawn or shoveling their snow; perhaps you can offer to check in on grocery days to see if they need anything from the store. After establishing trust by proving yourself to be reliable and consistently engaged, you may be able to offer them opportunities for respite as well.

Sunday, April 29, 2018

Who Said Life Was Fair?

Nobody who has ever had cancer, that's for sure. Or who has loved someone who had cancer. Or lost someone to cancer.

Today I found out that a friend who has been incredibly successful at surviving longer than medicine  originally predicted he would may not be with us much longer...

I don't know why some of us get cancer and some do not, or why some who get cancer get to have a "curable" cancer and others do not. Or why good people die and bad people don't, or some people with children and grandchildren to love and watch grow die, and some do not.  I have lost a beloved mentor to the same cancer I had, I have lost friends to the same cancer I had, and I don't know why I was able to survive it and they were not.

Everyone diagnosed with cancer, any cancer, is given their odds - odds of a cure, odds of survival, odds of recurrence.  Odds. Statistics. Numbers. Numbers that may mean something, or may not. And you have a choice, fight the odds or believe that they dictate your future. Statistics may not reflect individual experience. Unless they do.

After my first biopsy in 2002, I was given excellent odds - very small chance that the atypical tissue they found would be breast cancer. Except that it was. Early stage, DCIS, but there it was. Once you have DCIS, you are at risk of getting it again. But not necessarily of getting invasive cancer. Unless you do. Which I did in 2007. Again, the odds of getting it were lower than the odds of not getting it, but the odds betrayed me.  Now, I live with incredibly small odds of recurrence, and because I did everything I could to lower even those small odds, according to the medical understanding at the time, I work at training my brain not to worry about it.

I think most of us, when first diagnosed, feel hopeless. Maybe we believe the odds are too great. Maybe we consider the treatment too frightening. The future in front of us is suddenly uncertain, or we are just painfully aware of how uncertain the future really is. What if we can't beat it? What if we can? What if it comes back? What if it doesn't?

When my friend was first diagnosed, he almost didn't fight because he was told his odds of survival, even with treatment, were incredibly low. But then he decided to fight, for his kids, for his wife, for their future. Treatment made him so sick, he almost gave up. But then he didn't. And after months of chemo and radiation, he bought himself years of survival that the statistics said he would not have.

Some of us beat it, and some of us don't. There is no way to know which we will be. And beating it once doesn't mean it won't come back or that you will beat it again if it does. Some people who develop late stage or metastatic disease can enjoy long periods of remission after treatment, but not everyone. And nobody seems to be able to predict who will fall into which group.

For the patients and their loved one, this uncertainty can be unbearable. Or you find a way to bear it.

And then some other damn thing like an infection finds it's way in to your body because of the treatment that has been keeping you alive. And there it is. Suddenly you are losing the fight, and it's the fighting that makes you lose. You can follow all medical advice, and take every possible precaution, and there's nothing you can do to predict if or how it will happen. It ambushes you, it ambushes your family. All are powerless in the face of it. No matter how brave you are, or how determined, or how loved, or how worthy. Even knowing  this a disease that can kill you, there is no way to really be prepared for losing the fight. It's maddening, maddening and heartbreaking. 

It is heartbreaking knowing that the world is going to lose someone who is a good person, who has children and (soon) grandchildren to love and watch grow up, who has fought bravely and beaten horrible odds to live this long.  Heartbreaking and infuriating.  And unfair.

Tuesday, January 30, 2018

Foster Kids and State Support for Tuition

Wisconsin aims to become the 29th state to offer some form of tuition support to foster youth.
 
I hope they are able to pass the legislation. Research shows that between 31% and 46% of foster kids experience some period of homelessness between "aging out" of foster care at 18 and their mid-twenties. They either live on the street, in homeless shelters, or "couch surf" in their friends homes. 
 
College gives foster kids (my siblings and I entered foster care system when I was 13) a chance to develop as independent young adults, to be competitive in the job market, and in many cases, to rise above the poverty we grew up in. According to the Education Commission of that States, there are now 28 states that offer foster kids varying levels of financial support for college (tuition waivers, grants, or scholarships), and New York is one of them through the Foster Youth College Success Initiative established by McKinney's Education Law section 6456. This bill provides grants to SUNY schools (and CUNY schools in the NYC area) to cover tuition, fees, books, transportation, housing, and summer college prep, including advising, tutoring and academic assistance. So financial and academic support, to better ensure their success.

These supports were not available when I graduated from high school in the early 1980s. The rare foster kids who dared pursue a college education (of the 75 kids who lived with my foster mother during her career as a foster parent, only 3 of us went to college, and only my brother and I graduated from college) back then had to make our own way. Our family was rare; three of us were still in foster care when we graduated from high school and we all went on to college. All of us relied on some combination of scholarships, financial aid, student loans to pay for school. 
 
To apply for financial aid back then, foster kids had to provide financial data from their parents, even if they had no relationship with them or access to that information or access to those resources. In my case, my parent's poverty helped me get some financial aid I might not otherwise have gotten, so it worked in my favor that I had enough of a relationship with them to get that information. But they only gave me a total of $75 towards my college expenses, so not much financial support there.
 
I was 17 when I graduated high school, so unlike many foster kids, I would have been able to continue in foster care until the next fall when I turned 18.  That might have been enough time to get a job and save some money so I could afford a place to live, but for many foster kids, it isn't enough. Which is how they end up homeless or in jail. However, I didn't have to find out what would happen to me if working and being on my own at 18 was my only option, because I was able to go to college. 
 
The Big Breaks That Allowed Me To Succeed
Because I went on to college, my Medicaid coverage was extended from my 18th birthday until my 21st birthday, and my foster mother got her monthly stipend for my room and board until I was 21. Legally, that money was hers, but every month college was in session she deposited it into a shared checking account so that I could use it for expenses at school. My first, and perhaps most important, big break. Without that extra money, I don't know what I would have done. And because she was still getting that stipend, she also allowed me to continue to stay with her during college breaks and summers, although I had to bring everything I owned with me back and forth to school, or store it in a barn while I was away. And everything stored in that barn became water-damage by my junior year.

I turned 21 during the fall of my senior year of college, and that's where my health insurance and my foster mother's support stopped. I had minimal coverage through the health center on campus, so I didn't really notice the loss of health insurance. But without that monthly stipend, I had to pick up a second job to help cover my rent. I was already doing 20 hours a week at a work study job. The second job did not last; it was too much to keep up with school work and my first job, my social life, and also get enough sleep, so I was fired for missing a mandatory, unpaid staff meeting at the second job on one of my days off. Retail - horribly abusive to their employees. As a result of not being able to manage a second job, I fell behind in rent. 
 
My second big break was that two of my brothers were able to loan me some of the money I needed to keep up with my rent the first half of senior year. Even so, by the end of senior year, I was five months behind in rent.  
 
This was where I got my third big break - my landlord let me carry that debt until I had a full-time job and could pay her back.  She even rented to me again for the following year, deferring the required first month's rent and a security deposit until I found a job, so that I had somewhere to live after graduation. I paid her back in full as soon as possible that first year.
 
Without these big breaks, I don't think I would have finished school or had anywhere to live senior year. In other words, I would have become homeless. And that possibility was always there in my mind during my early 20s, when I was living paycheck to paycheck, paying back my debts from senior year, and barely scraping by. But instead, because a handful of people were willing to provide needed financial support, I was able to finish school and find a job, and become successful.

And now, in 28 states across the country, foster kids have a chance to do just that, without having to hope that the people around them will come through in a crisis. This is good news for foster kids in those 28 states, but we need the rest of the country to catch up.

Thursday, January 5, 2017

Balancing Survival and Serenity in Trying Political Times - How Are YOU Doing it?

What is the balance between awareness and resistance, which seem necessary for survival, and peace of mind, also necessary for survival? Any ideas? I'm open to comments!

In A.A. we often talk about accepting that you are powerless (over alcohol, over other people's actions, over the future), doing the footwork, and not projecting about future outcomes. So, do what you need to do next to achieve a goal, but don't worry about whether that goal will be achieved. 

Just as I have always had to be vigilant about my sobriety, however, I feel that I need to be vigilant about tyranny, like a President who believes he can violate the Constitution to suit his own financial gain and a Congress that appears to support that behavior, and political maneuvering to strip vulnerable Americans of basic protections, like freedom of speech, the right to dissent, and access to affordable healthcare.

Sobriety happens one day at a time. You cannot be sober on Saturday night if it's only Thursday morning; you can only be sober on Thursday morning. But you can plan to be somewhere Saturday night that doesn't put you at risk of drinking, and you can coordinate with someone who will respect your sobriety on Thursday morning to be there with you on Saturday night. Do the footwork with the intention of staying sober on Saturday night, but not project about how Saturday night will turn out.

That approach I understand, and after all these years it's like second nature. I don't drink, I don't plan to drink, but I do that one day of sobriety at a time.

All of the steps, principles, and suggestions of A.A. should be transferable to any life problem, concern, event, relationship, job, and usually they work for me no matter what the situation. My dissertation? Write it a day at a time, have a deadline for finishing a draft, don't think ahead to that deadline, just decide what you need to get done today to move in the direction of the goal.  When my Dad was on Hospice? Monitor the situation one day at a time, do or say whatever you need to today in order to be at peace with him and within yourself , and to make sure that he is getting good care, so that when the day comes you have minimal regrets. But know you cannot predict that day or really know what it will be like until it arrives. 

I'm not perfect at it, and some days it is harder than others, but most days I can "work my program" so that I am accepting life on life's terms, taking whatever actions I need to, and feeling generally calm and able to enjoy life.

So, then, I should be able to apply these principals to the transition from my favorite President of all time to someone who I believe is a liar, a con artist, and a threat to democracy and the civil rights of most Americans.  But so far, I haven't been able to do that. Every day, there is something more outrageous than the last, more appointees who would shred consumer protections and corporate regulations; blatant indicators that Presidential favors are for sale on an unprecedented level; attempts to undermine the Office of Congressional Ethics; proposed legislation to cut security for US embassies after years of being obsessed with Benghazi, when security had been underfunded by Congress but the outcomes were blamed on the State Department; reviving archaic rules from the 1800s that allow Congress to devalue Federal workers and agencies on a whim; or the Senate beginning the process to repeal the Affordable Care Act without a plan to replace it.

Every time I choose to pay attention, it takes only minutes for my head to start spinning with anger, apprehension, and anxiety. But when I choose to look away, it is with the knowledge that even more outrageous things ARE happening or COULD BE happening, and I dread being taken unawares. It's sort of like the last few years of my Mom's life, when I would take a break from paying attention to the daily details of her care, only to be called while away on vacation because she had a fall or an ER visit or some other crisis; so I never really stopped worrying about her even if I wasn't actively engaged. It feels like that, only on a much larger and more frightening scale.

So, I don't know how to make the move from this constant state of apprehension and anxiety to the one day at a time approach to surviving this new administration. But I'm working on it.

How are YOU managing it?

Friday, February 26, 2016

When will we realize that ALL Black lives matter?

The #BlackLivesMatter movement is focused on the many "ways in which Black citizens are intentionally left powerless at the hands of the state (BlackLivesMatter.com/about/" around the U.S.  Most of us who have peripheral relationships to the Black community, or who even just follow this movement in the news and social media, understand the movement as focusing on violence committed against Black Americans by representatives of the state, or the ways in which the state ignores violence against Black Americans and denies justice to the Black community. The faces of the movement, to many of us on the outside of it, are young men like Trayvon Martin, whose murderers are acquitted while their victims are blamed for their own murders, or women like Sandra Bland or Joyce Curnell, who die preventable deaths in police custody.

However, there are so many other ways that we as a nation deprive Black Americans of their "basic human rights and dignity (BlackLivesMatter.com/about/" that are so much more subtle than outright violence or refusal to take action against the individuals committing that violence. As a social gerontologist, when I think of specific Black lives that matter, but whose human rights and dignity are ignored by our larger culture, I tend to think about the lives of older Black Americans. Older Black Americans, as the result of a lifetime of social inequality, discrimination, and unequal access to appropriate healthcare, face greater risk of diabetes, high blood pressure, heart disease, stroke, and dementia.  And the people that take care of older Black Americans in the community, their families and neighbors who we in gerontology refer to as "informal caregivers", do not have access to the same supports as White informal caregivers. This unequal access can be the result of a history of discrimination which prevents Black caregivers from asking for services, or it can be the result of their not even knowing what services are available because the agencies providing these services do not actively promote their agencies in the Black community.

Now, most agencies feel like they are doing outreach to the Black community because they do outreach in general. What they fail to realize is that people who have endured decades of institutional discrimination is not going to assume they are welcome in your agency. You need to specifically reach into their community, build relationships and trust, and make sure that your services are offered in a way that are compatible with that community's culture. We call this "culturally competent" practice, and it's an important concern whenever someone from the dominant culture is providing services or supports to people from an historically marginalized culture.  And because most of the people working in social service agencies are White, we really have to work at developing cultural competency when we are offering services to people who are not White.  But most of us don't perceive ourselves as needing training in cultural competency, simply because we do not think of ourselves as "racist" (or classist or homophobic, etc.).

It's not that simple.  There are so many ways that we, as Whites, can be blissfully ignorant of how our thoughts and actions effect, and are perceived by, our colleagues or clients who are not White.  That is what growing up in a culture of White privilege does: it blinds you to any experience outside of the White experience.

The reason I am blogging about this today is because I have this brilliant and dedicated colleague (whose name I will not mention here because I don't have her permission), who has been a public health educator for decades, and who has been very successfully providing faith-based public health education and intervention programs to the local Black community for over 20 years. She has won national awards for this work, and has been funded by a variety of local and regional foundations for programs targeting different health conditions in the local Black community.  She is Black, as are the pastors and churches she partners with to deliver her programs. For the past couple of years, I have been fortunate enough to be able to work with her on these programs. I generally stay behind the scenes doing work like writing grants, evaluating outcomes, and writing reports to our funders. She is the founder and face of the program, and the community has known her and trusted her for a long time.

This week, we had a meeting with a potential funder, locally known for it's commitment to the same neighborhoods in which my colleague has been doing her great work, about a new program targeting Black informal caregivers of people with dementia.  My colleague, myself, and another representative from our University attended this meeting. Two of us are White, and my colleague is Black. The representatives from the potential funder were also White.

When we take meetings with outside groups, I defer to my colleague because of her leadership in this initiative and because she has so many more years of experience doing this work. As a junior colleague, I do sometimes have useful information to add to the conversation, but I generally do not interrupt or assume anything; I follow her lead as best as I can. Which gives me the opportunity to observe the dynamics in the room.

Here's what I noticed in this meeting: my colleague, the award-winning public health educator and founder of this program did most of the talking, as was appropriate. The funder's representatives sat across the table from her focusing on their tablets.  They asked questions, but barely looked at her while she spoke. When they asked a question that I had the information to answer, I answered. And they looked up and made eye contact with me for as long as I spoke. Then my Black colleague would start speaking again, and they would look back down at their tablets. Until our other White colleague spoke, at which point they would look up and make eye contact with her until she finished speaking. Then my Black colleague would start talking again, and they would look back down at their tablets. This happened consistently for the full length of the meeting.  Ostensibly, they were using their tablets to take notes about what was being said. But why did they both need to take notes while she spoke, and why did they only need to take notes while she spoke, and not when I or my White colleague spoke?

To be honest, at first I didn't even notice the pattern. At the same time as I was observing their behavior, I was also struggling with my frustration at their general lack of interest in our program and their failure to even read the description we sent them in preparation for the meeting.  Most of the time, I was thinking: How can they not be interested in what she is saying about the program? When I should have been thinking: Why is it that they aren't looking at the one Black person in this room when she speaks about a program that is successful within the Black community? Why does it feel like they give more weight and credence to what I say about this program, than to what the person who created it and makes it successful says about this program?

When I spoke about this dynamic with my colleague this morning, she smiled at me and said: "It happens all the time; we cannot let ourselves be distracted by it." I know she is right that she cannot let herself focus on dynamics like that. She has to keep her eye on the ball - what is important about the work and how we can get it done. But as her ally, I don't think I can just let these things pass. I wish I had done something proactive while we were in that meeting. Like asked them to pay better attention to her, or something. She thinks it was fine to let it go, but I don't feel good about letting that happen. At the very least, I need to bring it to the attention of our other colleague in the meeting, and they to get her to notice dynamics like that in future meetings with other colleagues.

And I want to make you think about it, too. How often do you or other White people in the room pay closer attention to each other than to any Black person in the room? What can you do to change that dynamic the next time you see it?

This experience definitely reminds me that when we think about how much #BlackLivesMatter, we White liberals need to broaden and deepen our understanding of what Black lives matter (all of them) and in what settings (most of them) White privilege is blinding us to those lives and how they matter.

Friday, February 5, 2016

Scanxiety or Opportunity?

I woke up this morning at 4:30am, wide awake, thinking what if instead of choosing to be filled with anxiety about my annual breast MRI, I instead take this opportunity to revisit my mortality and think about the quality of my life in the face of that mortality?  Similar to what you reflexively do when you are first diagnosed with cancer.  Except that now, you are NOT facing a horrifying diagnosis, you are just being forced to think about it a little, until you get the next all-clear.

Onondaga Lake March2012

It's been eight years since my bilateral mastectomy and reconstruction - January 30th 2008, and the completion of chemotherapy - April 30th 2008.  Every year I have a breast MRI, and every year it's a stressful experience.  There's the stress of having to face the possibility of recurrence, which on most normal days you can pretend isn't there. There's the stress of going through the scan, laying face down on that weird foam form, and how painful it can be, the feeling of the contrast as it enters your veins, the way the contrast in your body afterwards reminds you of the way that chemo felt in your body. And for me there's the additional stress of having trouble getting the IV in.  This year, it took 3 needle sticks - one by the tech in the crook of my elbow and the 2 other by the IV specialist in the middle of my forearm and finally, the one that worked, on the side of my wrist. I've had worse - 2 years ago it took 5 needle sticks; I felt like a pincushion.

The day of the test is always a rough day for me physically, but it's hard to separate that physical stuff from the emotional stuff. So I spend a day or two leading up to the test in a state of anxiety, as well as the week between the test and my follow up with my breast surgeon. Who, most likely, will say "all clear."  Of course, knowing that is the most likely outcome would not be causing me anxiety; instead, that anxiety comes from my fear of the other, less likely announcement. The one that, for whatever reason after all these years, is easier for me to imagine.  The "it's back" announcement.  After all, it's happened before. 

In 2007, what should have been a routine mammogram after 5 years of being free from my first breast cancer turned into a repeat of the diagnostic nightmare from 2002, only this time it was invasive cancer.  So that's always there, the possibility that it could happen again.

I have tried over the years to turn this annual scan into "my annual clean MRI" with mixed success. I think I have less anxiety in the days leading up to the test, but I'm still way more freaked out than I want to be. But this 4:30am wake-up was reality-shifting. What if this IS just an opportunity for me to remember what's really important about my life, what I love about it, what I want to change, what adventures I want to have, how satisfied am I with the work I am doing now, what is the quality of my relationships... lots of things to think about that I CAN do something about, rather than focusing on the one thing I canNOT do anything about. I can't know if cancer is in my body, and I can't predict what my surgeon will see in these MRI images. So how can I find a way to focus on something else?

So here's what I can say about my life. It's a great life.  I'm healthy and active, and have the good fortune of getting older. My wife is absolutely the best partner in the world for me. I'm so grateful that I found her when I did, and that she has been with me through all of the trials we have faced in the last 16 years.  Her family, my in-laws, are totally awesome. Her Dad is the best Dad you could ever hope for, and somehow I get to have his support and help. I am so grateful that I got to know her Mom as long as I did. Her siblings are really loving, caring people and completely hysterical at the same time. As are their spouses. And I love my nephews and niece - just the one - on that side of our family. Love watching them grow up, seeing the kind of young people they are becoming. As much as I love knowing and watching the nieces on my side of the family. My relationship with my youngest sister is supportive and encouraging for both of us. I have a good relationship with my older brother. I have great friends. I choose to focus my energy on the relationships that are positive in my life, which I have not always been able to do. I love my job, and the work I get to do in that job. I love the amount of choice I have in my work, and that I can make a decent living doing it. I enjoy the mutual respect between myself and the senior faculty in the institute. I am fortunate enough to have long-standing relationships with like-minded colleagues around the country, and the chance to travel to conferences multiple times a year where I get to interact with those colleagues.

It's all good. This year, we visited Nova Scotia for the first time. I still want to visit Alaska and New Zealand. And Ireland again, always Ireland again! I still dream about traveling around the country in an RV with my wife - although not in that off-the-grid way that braver women than I are living (you know who you are!).

                             20130620-083006.jpg

Whatever may or may not have shown up on this scan, my life is good, and I choose to focus on that. And I will make that choice, as often as I need to, for the next 6 days until I can confirm the results of the scan. 

Thursday, December 10, 2015

Why should we care about sexual minority women with breast cancer?



I have said this in previous blog posts, and it bears repeating: when an entire body of cancer-related literature basically ignores a particular community of women, we all remain ignorant of the experiences of that community, even those of us who are a member of it.
To try to shed some light on the breast cancer experiences of sexual and gender minority women (lesbians, bisexual women, queer women, women who have sex with women, gender queer and trans women - MTF and FTM, intersex people), I am conducting a study of social support and sexual and gender minority (SGM) women with breast cancer.  So far, recruitment has been fairly slow, as this is a difficult population to find. So to directly access a larger number of women and improve response rates, I am using crowd-funding to raise money to recruit potential subjects through the Susan B. Love Foundation's Army of Women.  Please donate for this important study!
Over a series of blog posts, I am sharing detailed sections from my original research proposal, so that you can see what my thinking was in choosing this topic and what I hope to accomplish with the study.  I hope you find my argument compelling enough to make a donation to my Indiegogo campaign and to share the study link with any women you know who might qualify or know someone who qualifies.  
Today's post is about the background of my study - a discussion of the existing literature on breast cancer and non-heterosexual, non-cisgendered women.  I hope you will read it, and post any questions you have in the comments.

Study Background
The invisibility of sexual minority women in breast cancer literature is incongruent with what researchers have identified as differential levels of breast cancer risk among women based on SGM identity, and a greater risk for fatal breast cancers among SGM women. Based on these greater risks, one would expect to find more representations of the breast cancer and survivorship experiences of SGM women.
This invisibility in the breast cancer literature, combined with experiences of heterosexism and homophobia in health care settings, and barriers to health insurance and access, may contribute to under-utilization of breast cancer screenings by lesbian and bisexual women. Increasing the visibility of breast cancer in the lesbian community, and improving understanding of the experiences of SGM women with breast cancer  could improve utilization of breast cancer screenings and reduce heterosexism and homophobia in health care settings.
Previous studies of lesbian and bisexual women cancer survivors indicates the importance of social support in negotiating the cancer experience, as well as the sense of isolation experienced by SGM women, many who do not personally know other SGM women who have had cancer.  Some studies of female SGM cancer survivors indicate that for sexual minority women, sexual identity is not as important to the cancer experience as one might expect, and female SGM cancer survivors may not be experiencing higher levels of anxiety or depression than heterosexual or traditionally-gendered women.
Other research indicates that older women living with female partners are generally more likely to need some assistance with activities of daily living than those living with men . More specific to cancer survivors, female bisexual survivors are more likely to smoke but less likely to report physical inactivity then female heterosexual cancer survivors, and  lesbian and bisexual female cancer survivors report poorer self-rated health than heterosexual female cancer survivors. Other research has identified perceived discrimination and perceived social support as impacting the quality of life of female sexual minority breast cancer survivors . The diversity of findings from the handful of studies of sexual minority women with breast cancer indicates that additional research is needed to understand the stresses experience by this population, and of the supports needed by, and available to, them as they navigate breast cancer treatment and survival.