DESCRIPTION (provided by applicant): Survivorship after a diagnosis of colorectal cancer, the third most common cancer in men and women, has many challenges. Research has shown that colorectal cancer survivors have unmet needs and worse physical and mental quality of life compared to individuals without cancer. Medically underserved populations are known risk groups for poor survivorship care, poor quality of survival, and poor quality of life after colorecal cancer. Sexual minority populations are medically underserved, according to a recent Institute of Medicine Report, yet at present their survivorship care and their quality of life after a diagnosis of colorectal cancer is unknown. The proposed study will determine whether disparities linked to sexual orientation exist in colorectal cancer survivors' health care and quality of life. We will obtain a population-based sample of colorectal cancer survivors who differ by sexual orientation, applying our previously tested recruitment method, which uses cancer registry data from geographic areas with an above average density of sexual minority individuals. After collecting survey data on health care and quality of life, from heterosexual and sexual minority survivors, we will test three study hypotheses: 1) Sexual minority survivors will have poorer quality health care compared to heterosexual survivors, even after controlling for disease and non-disease factors. 2) Heterosexual survivors' quality of life will be better than sexual minority survivors' quality of life, even after controlling for disease and non-disease factors and quality health care. And 3) Sexual minority survivors who are at ease with their sexual minority identity will have better quality health care and quality of life than sexual minorty survivors who have difficulty with their identity. This study will be the first to comprehensively examine sexual minority colorectal cancer survivors' health care and quality of life, illuminating the mechanisms that influence health care and quality of life. The findings will consist of modifiable and non-modifiable factors associated with sexual minority and heterosexual colorectal cancer survivors' health care and quality of life. Researchers, health care providers, and policy makers can then intervene to address the modifiable factors identified by this study to facilitate improvement in diverse colorectal cancer survivors' health care and quality of life. Thi research is critically needed to realize the Institute of Medicine's goals of improving survivorshi in this special population.

PUBLIC HEALTH RELEVANCE: Results from this study will provide information about the quality health care and the quality of life of colorectal cancers survivors of different sexual orientations. From the individual interviews with lesbian, gay, and bisexual survivors of colorectal cancer, we will derive salient factors to be included in our survey questionnaire. Using quantitative survey data obtained from lesbian, gay, bisexual, and heterosexual survivors of colorectal cancers, who were recruited from three cancer registries, we will determine whether there are disparities by sexual orientation in colorectal cancer survivor's quality health care and quality of life. Ultimately, this population-based approach to lesbian, gay, bisexual, and heterosexual colorectal cancer survivorship is a necessary step on which we expect to build with follow-up research that will use the findings of this study for the development and testing of interventions to improve the needs of lesbian, gay, and bisexual colorectal cancer survivors.