Developing identities in the context of cancer: LGBTIQ+ adolescents and young adults (AYAs)

This chapter examines the cancer experiences of LGBTIQ+ adolescents and young adults (AYAs), drawing on survey and interview data from the Out with Cancer Study. It highlights how a cancer diagnosis during this formative life stage disrupts not only physical health but also identity development, relationships, and future plans. For LGBTIQ+ AYAs, these disruptions are further shaped by heteronormative and cisnormative assumptions within healthcare and survivorship narratives. Participants described cancer as a significant interruption to the process of coming out, exploring sexuality or gender, and forming relationships. Treatment-related changes to the body, including hair loss, scarring, fertility loss, and hormonal impacts, were experienced as particularly distressing in the context of identity formation and self-image. Many reported feeling isolated, not only due to their diagnosis, but also because LGBTIQ+-specific needs were rarely recognised or addressed in clinical settings or peer support environments. Normative expectations of adolescence and young adulthood, such as dating, independence, or parenthood, were disrupted by cancer and further compounded by experiences of social exclusion. Trans and non-binary AYAs faced difficulties navigating gendered treatment settings and accessing affirming care. Despite these challenges, participants described moments of resilience, creativity, and connection that helped support their wellbeing. The chapter calls for more inclusive and developmentally appropriate cancer care for LGBTIQ+ AYAs. This includes recognising the intersecting impacts of age, sexuality, gender, and illness, creating affirming spaces for identity expression, and providing targeted psychosocial support. Addressing these gaps is essential to improving outcomes and fostering a sense of belonging and hope amongst LGBTIQ+ young people with cancer.