Abstract Recently, NCI called for research to effectively study small or rare populations relevant to cancer research. Sexual and gender minorities (SGM) are small populations at disproportionate risk for cancer but who have been under-researched in cancer studies. The principal challenge common across lesbian, gay, bisexual, and transgender populations is to develop effective methods to identify and recruit patients and survivors who are SGM into NCI cancer studies. Two technical advances have transformative potential to advance research on health disparities in SGM cancer patients. First, online recruitment has yielded large SGM samples in other areas of research (e.g., HIV primary prevention), but using online methods to recruit SGM cancer patients has not been rigorously studied. Second, cancer clinics have begun to include sexual orientation and gender identity (SOGI) data in the electronic medical record, but we need to test protocols on how to recruit SGM cancer patients using this data source. This application is based upon our recent success in overcoming challenges to recruit over 400 gay and bisexual prostate cancer patients into an R01 intervention trial of tailored rehabilitation for this population. We will replicate and expand upon these clinic-based and online methods to study how to recruit three small SGM populations – (1) sexual minority cisgender men, (2) sexual minority cisgender women, and (3) transgender and gender non-binary cancer patients - into cancer research studies. We have three specific aims. In Aim 1, we will document, in depth, SGM’s attitudes towards participating in NIH cancer research, identifying the facilitators and barriers that each group reports influences their willingness to participate. We will also investigate any impact poor cancer care and discrimination has on research participation. We will investigate these in cisgender SM men, cisgender SM women and gender minority cancer patients (n=15 per group) and compare experiences within these small populations and between SGM and a cisgender, heterosexual patient comparison group. In Aim 2, we will test the effectiveness, efficiency, cost, and workload in using two clinic SOGI-based strategies and three online strategies to recruit SGM small populations (150 each) compared to recruiting a sample of cisgender, heterosexual cancer patients. We predict size of the small population will negatively correlate with work, cost, and time involved, but positively correlate with yield. In Aim 3, we will conduct an online quantitative survey of willingness to participate in cancer research with 450 SGM cancer patients (150 per group) versus a cisgender heterosexual group (150 men and 150 women). Key measures assess facilitators and barriers to participation in NIH cancer research. To advance measures, we will assess performance of each group on five validated cancer scales to compare cancer care experience, discrimination in treatment, and outcomes. Finally, we will integrate and triangulate findings and assess intersectionality with race/ethnicity. This study will establish what recruitment strategies are effective across SGM populations, and which may be specific to each subgroup.

Narrative Because there are no studies comparing experiences in cancer care between cisgender, heterosexual cancer patients and sexual and gender minority cancer patients, first, we will conduct in depth interviews to identify key concerns related to recruitment. Then, we will test recruitment methods and conduct the first study to identify what would help or hinder these small populations to participate in cancer research.