QUEERMUNITY: A GSRD-Informed Queer-Affirming Psychotherapy Support Group Within a Comprehensive Cancer Centre

1. Introduction

Sexually and gender diverse people affected by cancer (SGDc) have unique needs and challenges across the cancer care continuum that reflect the intersection of structural oppressions within cis-heteronormative systems of care. [6] Despite emerging health equity guidance from professional bodies and budding psychotherapeutic modalities such as Gender, Sex and Relationship Diversity (GSRD) therapy, most oncology services and resources – including psychosocial supports – remain implicitly oriented toward cisgender, heterosexual, and monogamous patients, leaving SGDc communities with unmet needs and limited access to affirming support [5].

Emerging literature highlights significant disparities in preventative care, treatment experiences, survivorship and recovery, and quality of life among SGDc patient populations [5]. Experiences of stigma, discrimination, and prior negative interactions with health care providers further compound such disparities. SGDc patients consistently report high levels of unmet physical, psychological, and social needs, and experience barriers such as lack of inclusive screening and assessments, subtle or overt discriminatory and heteronormative assumptions in clinical encounters, inadequate provider knowledge of SGDc health concerns, and the compounding effects of racism, classism, and other intersecting oppressions. [7,8,9]

These factors are especially prominent in cancers strongly associated with biological sex such as gynecologic, breast, and prostate cancers, where gendered norms and assumptions can intensify alienation or experiences of body and gender dysphoria for queer and trans patients [10,11,12]. On the ground, this is experienced when patients are misgendered, have their relationships or chosen family dismissed, or are minimized when highlighting an identity-related concern. Research indicates that during medical consultations, providers often made incorrect assumptions about gender, sexual orientation, pronouns, health choices, and experiences, generating feelings of invalidation, disrespect, distress, and dissatisfaction that impacted psychological and sexual health [6]. These experiences negatively impact relationships with health care providers and the likelihood of SGDc patients receiving preventative and responsive care.

Professional organizations such as Rainbow Health Ontario, [13] the American Society for Clinical Oncology, [14] and the Registered Nurses’ Association of Ontario [15] have developed guidelines for healthcare providers in delivering inclusive care for SGDc populations, yet there remains little published work translating these recommendations into concrete, evaluated psychosocial oncology interventions, especially within a group work context [16].

Theoretical frameworks such as minority stress theory, queer theory, and intersectional anti-oppressive practice provide a critical lens for understanding these disparities. Applying these in tandem helps to understand structural factors impacting an SGDc patient’s psychosocial experience, including experiences of discrimination, internalized stigma, impacts of cancer-related distress of identity and relationships; and informs how values such as community, modularity, and trust are important and central to healthcare interventions [17,18]. Within psychotherapy, GSRD therapy offers a framework counter to mainstream cis-heteronormative and monogamy-normative health systems by instead intentionally centreing gender, sexuality, and relationships as core clinical material for treating queer, trans, and diverse relational experiences. [19] This orientation provides a clear theoretical foundation for designing group interventions that are intentionally queer-affirming and relationally attuned.

Our own prior work has contributed to this emerging field in psychosocial oncology. Our 2023 narrative review of sexual and gender diversity in cancer care and survivorship synthesized 52 studies and highlighted both the breadth of SGDc disparities and the need for interventions that explicitly address minority stress, intersectionality, and structural inequities in oncology [26]. Our work on queer ageing and endings in 2024 provided a narrative lens into the relevant phenomena of queer loneliness, grief, and the central role of chosen family in mitigating isolation, and emphasizes the importance of a strong social foundation for queer cancer patient communities. [20]

Within this broader context, the SGDc Program at Princess Margaret Cancer Centre undertook a local needs assessment, which identified substantial concerns about discrimination, invisibility, and minority stress in cancer care, as well as a high-priority demand for a dedicated queer-affirming support group. Social support was repeatedly identified as a unique predictor of distress and a key protective factor in 2SLGBTQIA+ cancer survivorship [21]. At the same time, participants described vulnerabilities related to sharing their identities in cancer care spaces; often feel isolated or alienated in mainstream cancer support groups that do not explicitly address heterosexist assumptions and binary gender norms; and a critical desire for the involvement of queer-identified or visibly affirming health care providers in their psychosocial care [22] This underscores the need for a structured group intervention facilitated by SGDc-competent providers that could provide a safer, explicitly queer-centred space for connection, support, and collective meaning-making in the cancer context [3,23].

In response, we developed QUEERMUNITY, a queer-affirming psychotherapy support group within the SGDc Program conceptualized to provide specialized support that addresses the unique needs and challenges faced by 2SLGBTQIA+ people in terms of their cancer experience, guided by GSRD principles, queer and intersectional theory, and trauma- and shame-informed practice. This quality improvement project aimed to: (1) design and implement QUEERMUNITY as an accessible, queer-centred group intervention for SGDc people affected by cancer; and (2) evaluate its feasibility, perceived impacts, and accessibility as a psychosocial oncology intervention for SGDc patient populations by analyzing results from the pre-implementation needs assessment and a one-time post-implementation participant survey, complemented by qualitative feedback.

2. Methods

2.1. Design

This project was conducted as a pragmatic quality improvement (QI) initiative within the Sexual and Gender Diversity in Cancer Care (SGDc) Program at Princess Margaret Cancer Centre to develop, implement, and evaluate QUEERMUNITY, a queer-affirming psychotherapy support group for sexually and gender diverse people affected by cancer. The project received Research Ethics Board exemption through the University Health Network (UHN) Quality Improvement Review Committee (QIRC; QI ID#: 21-0275). The design comprised three linked phases: (1) a pre-implementation needs assessment survey to identify and prioritize supportive care needs and to determine demand for a queer-specific support group; (2) implementation of QUEERMUNITY; and (3) a one-time post-implementation participant survey roughly one year following its launch, supplemented by qualitative evaluation data. This QI approach was community-based and multi-method, integrating quantitative survey data with qualitative feedback from participants and facilitators.

2.2. Setting and Participants

The project took place at Princess Margaret Cancer Centre (University Health Network, Toronto, Ontario, Canada) within the SGDc Program, which focuses on sexual and gender diversity in cancer care and survivorship. The pre-implementation needs assessment survey was offered to SGDc patients receiving cancer care at the centre. 19 SGDc participants completed the needs assessment. QUEERMUNITY was subsequently offered as a group intervention within the same program, and a total of 31 SGDc participants attended at least one group session during the project evaluation period, of whom 25 completed the post-implementation survey (80.6% response rate). SGDc patients who attended at least one QUEERMUNITY session were eligible to participate in the post-implementation survey and were recruited by contacting the SGDc mailing list. Participant characteristics (e.g., age range, cancer type/stage, gender identity, sexual orientation) vary wonderfully, and there were no restrictions for age, race, or cancer type/stage to be eligible for this project or intervention.

2.3. Pre-Implementation Needs Assessment Survey

The purpose of the pre-implementation needs assessment was to systematically collect and code psychosocial and supportive care needs among SGDc patients at Princess Margaret and to identify priorities for new services, including a dedicated queer-affirming support group. The survey included items assessing: experiences of inclusion and exclusion in cancer care; comfort and safety in discussing sexual orientation and gender identity with health care providers; awareness and use of existing SGDc-related resources; and perceived importance and unmet need across a range of supportive care options (e.g., individual counselling, peer support, support groups, educational resources). Participants responded to Likert-scale to rate the importance of each option, and to open-ended questions to comment on additional gaps or desired supports. The key outcome of interest for this QI project was the priority ranking and endorsement of queer-affirming support groups as needed resources.

2.4. QUEERMUNITY Intervention

QUEERMUNITY was designed to be accessible to SGDc people with any cancer type, stage, age, and treatment status and to explicitly centre queer and trans identities, relationships, and experiences in the context of cancer, addressing needs identified in literature and local assessments [4,6,26]. The group was structured around four key goals: (1) building community, belonging, and connection as protective factors against the psychological effects of discrimination; (2) enhancing coping strategies including self and community advocacy skills within healthcare settings; (3) providing psychological support for cancer-related experiences through queer-specific and trauma-informed approaches; and (4) fostering queer joy and confidence to strengthen supportive factors through culturally-informed and community-driven practices central to queer histories.

Beginning in January 2025, the group was delivered twice a month with additional events and opportunities offered to participants throughout the year, including patient pride events, invitations to SGDc-related workshops, and social media campaigns. The group was open to SGDc patients at Princess Margaret and the University Health Network, designed as drop-in to accommodate treatment-related absences, and patients were referred or self-referred to the group by contacting the SGDc team. Outreach was completed through provider referrals, signage and use of hospital screens, website presence and other promotional features on queer healthcare pages provincially and nationally, and education & outreach workshops.

Sessions topics were prepared based on participant needs and interests; they combined psychoeducation, process-oriented group discussion, and experiential or arts-based activities (e.g., collective collage) and were informed by multiple, complementary frameworks, including GSRD therapy principles, minority stress and minority strengths frameworks, queer theory, narrative and emotion-focused therapies, psychodynamic and grief-focused approaches, and trauma- and shame-informed practice. Example session topics and group development considerations can be found in the discussion section of this article. Very little literature exists on centring queer identities in cancer care; in developing an emergent framework, facilitators utilized queer theory and queer borderlands theory to consider the unique needs, gaps, and experiences of queer cancer patient communities [5,27,28]. As an example, a session on body image made use of a collective collage to facilitate a discussion on the impacts of cancer on queer embodiment, gender expression, sexuality, and acquired disability, with opportunities to share commonly untold and un-explored experiences about queer sex and intimacy within the context of oncology.

Environmental indicators of inclusion included visible queer-affirming materials and decor, queer-themed exercises (e.g., queer affirmation cards, queer-focused meditations), a rotation of cultural delicacies or queer-inspired foods (e.g. fruit spread arranged into a lesbian flag), and access to all-gender washrooms. Facilitators, guest speakers, and students introduced themselves using their names, pronouns, connection to cancer or cancer care, and, where appropriate, sexual and gender identities, modelling authentic leadership and signaling openness to identity-related discussion. Collaborative group guidelines emphasized shared expertise, mindful and respectful conversation, attention to power dynamics and intersectionality, collective responsibility for meeting the accessibility needs of group members, and consistent accountability when non-inclusive comments or mistakes occurred. Feedback about inclusion and safety were regularly sought out, and flexibility was an important component in co-creating a space where participants could change their name and pronouns, discuss current events, and take ownership for guiding the space.

2.5. Post-Implementation Participant Survey

Roughly one year following the launch of QUEERMUNITY, group members were invited to complete a one-time cross-sectional post-implementation survey about their experience. Each participant was asked to complete the survey once, regardless of the number of sessions attended. The survey included 12 Likert-scale items (1 = strongly disagree to 5 = strongly agree) assessing the following dimensions: perceived sense of community, belonging, and safety; perceived impact on identity, meaning-making, insight, coping, well-being, and queer pride; accommodation of needs; content relevance and clarity; and overall likelihood of recommending the group to others. Three open-ended questions invited participants to describe their experiences of perceived connection within the group, any changes they noticed in how they coped with cancer or discrimination, and suggestions for improving the group.

2.6. Additional Qualitative Data Sources

In addition to survey data, qualitative information was drawn from unsolicited feedback (e.g., email comments, social media messages) from participants about their experiences in QUEERMUNITY, in-session qualitative evaluation tools on key takeaways or felt differences following participation, and from facilitators’ field notes and reflective memos documenting group processes, emergent themes, and observed changes over time. These materials were used to contextualize and deepen understanding of the survey findings.

2.7. Data Analysis

Quantitative survey data from the pre-implementation needs assessment and post-implementation participant survey were analyzed descriptively. For each item, we report frequencies and percentages for categorical variables and means or medians for ordinal variables as appropriate. For the needs assessment, we summarize the proportion of respondents who rated queer-affirming support groups as high-priority or very important supportive care needs and their ranking relative to other options. For the post-implementation survey, we present distributions of ratings for safety, relevance, perceived impact, and satisfaction.

Qualitative data (open-text responses, emails, social media comments, facilitator notes) were analyzed using a thematic analysis approach, informed by minority stress, intersectionality, existential-relational, and GSRD frameworks. Two team members independently reviewed the data to identify initial codes, met to refine a coding framework, and organized codes into broader themes capturing perceived needs, experiences of safety and inclusion, impacts on coping and community, queer joy and existential themes, and suggestions for refinement of the group model. Integration of quantitative and qualitative findings was used to develop an overall interpretation of QUEERMUNITY as a feasible, acceptable, and impactful intervention in oncology.

3. Results

3.1. Pre-Implementation Needs Assessment

19 SGDc participants completed the pre-implementation needs assessment survey. Patient support groups specifically for 2SLGBTQIA+ patients and caregivers were rated as very important or important by 15 of 19 respondents (78.9%), with more than half (52.6%) selecting "very important." Age-specific queer groups were also highly prioritized: 14 of 19 respondents (73.7%) rated an adolescent and young adult (ages 15–39) 2SLGBTQIA+ group as very important or important, and 13 of 19 (68.4%) did so for a group for 2SLGBTQIA+ older adults (ages 70+).

Other SGDc-specific supports showed similarly strong endorsement. Dedicated psychiatry and psychology support for 2SLGBTQIA+ patients and caregivers was rated very important or important by 17 of 19 respondents (89.5%), while dedicated social work support and support from other healthcare providers were endorsed as very important or important by 15 of 19 (78.9%) and 14 of 19 (73.7%) respondents, respectively. Together, these findings indicate that queer-affirming, GSRD-informed group-based interventions and SGDc-specific professional supports were perceived as high-priority needs in this SGDc cancer population and directly informed the decision to implement QUEERMUNITY within the SGDc Program.

3.2. Post-Implementation Survey and Qualitative Feedback

Of the 31 SGDc participants who attended at least one QUEERMUNITY session during the evaluation period, 25 completed the post-implementation survey (80.6% response rate). All 25 respondents consented to participate. Two respondents consented but did not complete any survey items and were excluded from analysis. The effective quantitative sample comprised 23 respondents. One respondent who had only attended virtually selected "neutral" on all Likert items and noted they could not "evaluate the experience properly" without attending in person; this respondent is included in the quantitative sample but their pattern of responding should be noted when interpreting ratings. Open-ended responses were provided by 21, 22, and 20 respondents across the three qualitative items, respectively, including substantive qualitative contributions from the virtual-only respondent.

3.2.1. Feasibility, Safety, and Satisfaction

Across all 12 survey domains, the grand mean rating was 4.42 out of 5.00 (where 5 = strongly agree), indicating strong overall agreement. The highest-rated items reflected relational and evaluative dimensions of the group experience: recommendation to others was endorsed as agree or strongly agree by 22 of 23 respondents (95.7%; M = 4.74, Mdn = 5.0), community and support by 22 of 23 (95.7%; M = 4.61, Mdn = 5.0), and queer joy and pride by 22 of 23 (95.7%; M = 4.52, Mdn = 5.0). Future engagement (i.e., willingness to attend again) was endorsed by 21 of 23 (91.3%; M = 4.65, Mdn = 5.0), and safety and comfort by 21 of 23 (91.3%; M = 4.57, Mdn = 5.0). No respondents selected "strongly disagree" on any item except coping with cancer as SGDc (n = 1; 4.3%), and only one respondent selected "disagree" (relevance and clarity; 4.3%).

Belonging and inclusion, accommodation of needs, and emotional well-being were each endorsed as agree or strongly agree by 20 of 23 respondents (87.0%), with means of 4.61, 4.57, and 4.43, respectively. Insight and self-reflection (78.3%; M = 4.26) and relevance and clarity (78.3%; M = 4.13) received slightly lower endorsement. The items with the most modest agreement rates were coping with cancer as SGDc (69.6%; M = 4.09) and identity and meaning-making (60.9%; M = 3.91), though both remained well above the scale midpoint. This pattern of strongest endorsement for relational and community dimensions, with somewhat more modest ratings for intrapsychic change, is consistent with the drop-in group format and variable attendance, where relational experiences may be more immediately accessible than the longer arc of identity-related insight.

3.2.2. Community, Belonging, and Identity Validation

Qualitative responses elaborated the quantitative findings on community, belonging, and safety. Across all three open-ended items, the most pervasive theme was the experience of being recognized and validated as a whole person — queer and living with cancer — in ways participants had not experienced in mainstream cancer settings. Respondents described relief at not having to navigate cis-heteronormative assumptions to discuss their cancer experience alongside their identities:

“It's made a huge difference to be seen and heard in the fullness of my queer identities. I appreciate how everyone is invited to share and no one person hogs space. I feel respect, and I love the emphasis on creating small moments of queer joy, and that we can celebrate each other's wins.”

“Being part of any minority community can feel lonely, and with medical websites being non-queer-focused, it is refreshing to know that someone is looking at things through this particular lens, which improves confidence that my care takes all aspects of my life into consideration.”

Participants frequently described the group as a form of chosen family and identified the experience of "not being the only one" as fundamentally comforting and counter to the isolation of cis-hetero-mono-normative cancer care:

“This group/community feels like a family without being blood related. No matter how down you feel or bad experience you have, coming to this group you get joy, laughter and a sense of peace. Through my entire cancer journey this group has been the best part.”

“I came away comforted but not knowing I needed it... From a circle of strangers bound together at the heart by two life altering dimensions of our selves. I wanted to listen to everyone speak at length. There was so much wisdom in the room.”

Several participants expressed deep attachment to the community, with one noting "the absolute worst part of me having to move back to BC [British Columbia] was losing this incredible community," and another expressing a wish that the group meet weekly rather than twice a month. One trans respondent offered a particularly striking account of what representation means in a gendered cancer system:

“Being a trans man with gyne cancer in a gendered cancer system is challenging. Don't fit in. Without SGDc — trans people would feel they don't matter. Are not important. Aliens... It has been a life line for me and people like me, who are people not accommodated for otherwise.”

3.2.3. Queer Joy, Pride, and Celebration

A distinctive finding was the centrality of queer joy — not merely satisfaction or symptom relief, but an active experience of pride, celebration, and connection to queer culture as therapeutic. Nearly all respondents (95.7%) endorsed experiencing a greater sense of queer joy and pride. Open-ended responses described the group as a space where joy was intentionally cultivated alongside more difficult material:

“Confidence and positivity, safe space, never believed I would be happy excited to come to PM [Princess Margaret]!”

One participant noted that QUEERMUNITY's Pride celebration was the only Pride event they attended, suggesting the group served a community-cultural function that extended beyond the clinical setting.

3.2.4. Perceived Impact on Coping and Minority Stress

Several participants described concrete shifts in how they understood and navigated the intersection of cancer and queer identity. These accounts ranged from enhanced coping and self-understanding to new capacities for emotional expression:

“I can approach things with more nuance and confidence — the experience of having cancer and being queer — can now make sense of the messiness, contradictions.”

“Sharing my personal experiences mirrored what other members experienced. This made me realize a) I wasn't losing my mind b) provided me with coping skills c) I wasn't alone.”

While quantitative endorsement of coping (69.6%) and identity and meaning-making (60.9%) were lower than relational items, the qualitative data suggest that, for participants who did experience shifts in these domains, the impact was described as meaningful and transformative.

3.2.5. Content Relevance and Suggestions

Respondents commented on specific group activities and processes. Several highlighted the value of the group's warm and inclusive facilitation style, including welcoming check-ins, open conversation, and inclusive activities. Individual activity preferences varied, reflecting the diversity of the group: some participants preferred discussion-based formats over arts-based activities, while others valued the creative modalities. One respondent specifically requested more attention to cancer-related side effects affecting identity — "loss of identity due to things like losing ovaries, breasts, erectile dysfunction or prostate and the important roles that positive sexual and other relationships can play" — underscoring the demand for GSRD-informed content addressing sexuality, embodiment, and gender expression in the cancer context.

When asked what interfered with their experience, the dominant barriers were logistical and structural rather than relational: geographic distance and transportation difficulties, scheduling conflicts with work, school, or cancer treatment, and health-related limitations. Several respondents explicitly requested a virtual participation option to address geographic and physical barriers. Suggestions for enhancement included increasing the frequency of sessions, offering virtual access, and balancing cancer-focused content with opportunities to "talk about the good things happening in our lives." Despite these suggestions, participants overall found the group experience valuable enough to warrant the effort of attending, with one noting: "Sometimes it's a challenge to get out of bed but pushing through to get to the group meetings is always worth it."

4. Discussion

Key themes emerging from the pre-implementation needs assessment highlighted concerns and experiences with: discrimination adding to mental health distress; felt impacts of cis-heteronormative assumptions and biases from health care providers when seeking out or receiving services; individual isolation and lack of inclusion of chosen family in cancer care; and not feeling informed about what inclusive care could look like. The proposal of a queer-specific support group and SGDc-tailored psychosocial supports was highly valued by SGDc patients as protective and suitable services critical to their cancer care and mental health needs. This aligns with documented evidence about social support being a key predictor of quality of life and wellbeing for 2SLGBTQIA+ cancer patients, as well as the role of GSRD support group models in establishing social support [33,34].

The post-implementation survey findings indicated that QUEERMUNITY was a feasible and acceptable intervention. Of the highly relational benefits, 95.7% of SGDc patients valued the community, support, queer joy, and pride central to the group, appreciating the space enough to recommend it to others. Tangible feelings of safety, comfort, and willingness to attend again were endorsed by 91.3%. From a group development perspective, belonging and inclusion, accommodation of needs, and emotional well-being were each endorsed by 87.0%. Together with the pre-implementation needs assessment, these findings suggest that a structured, GSRD-informed support group can effectively address documented gaps in supportive care for sexually and gender diverse patient populations in oncology.

Crucially, QUEERMUNITY was intentionally designed to counter cis-heteronormative and mono-normative assumptions in mental health care and understood identity, relationships, and community as central clinical material [35]. Theoretically, GSRD, anti-oppressive, trauma-informed, queer, feminist, and relational frameworks were integrated into all aspects of the group, including the development of tailored discussion prompts, group content and materials, and core group activities. In practice, this meant facilitators lovingly worked from a strengths-based lens to explicitly focus on being abundantly queer. This was done by continuously considering the following during each group session planning phase: how queer identities were being centred; if there were any missing considerations relevant to queer cancer experiences; how intersecting identities like race, neurodiversity, and ability-level connected to the queer or cancer-related topic for each session; and brainstorming how to "queer up" all components of the group, from food to activities. These factors were carefully integrated into group topics and agendas, where original and creative content was developed, and often co-developed with group participants' input or feedback. Groups were planned around specific theme relevant to or requested by SGDc patients, with a mixture of psychoeducation sessions such as "Queering Trauma" and "Queer Shame", discussion-based groups on "Coming Out in Cancer Care" and "Surviving in a System that Doesn't Always Include You", and creative or joyful sessions like "Queer Activism and Button-Making", "Finding Queer Joy", "Celebrating Chosen Family", and "Connecting to Queer Magic".

The consistently high satisfaction for safety, relevance, and identity validation reported by participants suggest that applying GSRD principles in a cancer care group context is both clinically meaningful and personally valuable to participants. Participants’ qualitative feedback – which emphasized appreciation for found-community, shared humour, and a sense of "finally not being the only one" – described feeling seen and understood in ways they had not experienced in cancer care settings prior. Open-ended comments highlighted participants' relief of not needing to negotiate and manage cis-heteronormative assumptions to talk about cancer and their queer and/or trans identities. Facilitator field notes highlighted learnings around participant diversity and strategies for inclusion; modelling the importance of leading with authenticity and humility; and the collective power of centring queerness and community in all phases of the group process. This supports the argument that there is value in moving beyond surface-level inclusion of SGDc patients and providers in mainstream cancer care, and towards specialized psychosocial services and spaces where queer and trans experiences are central rather than peripheral.

The findings of this project provide important directions for clinical practice and education. The development and delivery of QUEERMUNITY emphasized the criticality of queer-centred environmental indicators, planning and collaboration processes, and SGDc-competent clinical care. Prioritizing SGDc identities and relationships by being mindful and inclusive of biological and chosen family dynamics; embracing the fluidity of sexual and gender identities and expressions; and integrating relevant cultural and identity-oriented factors into therapeutic interventions were research-backed, highly valued components of this group intervention that are useful for advancing inclusive care for SGDc communities. As well, findings from this approach support the idea that improving competency in SGDc-specific care can improve healthcare outcomes for all by countering normative barriers that affect patient support networks, healthcare biases, and choice around bodily and social autonomy in cancer care settings. Systemically, the strong demand for specialized SGDc services and resources reinforce broader calls for equity-focused education, research, and clinical intervention in cancer care contexts to equip providers and patients with high quality, evidence-based information and supports.

In terms of project strengths, the project and data itself are fundamentally community-driven and firmly attuned to the needs of the SGDc patient community to which it was delivered as it drew from a local needs assessment with deep consultation between SGDc patients and SGDc Program staff with shared identities. Integrated theoretical frameworks and a mixed-method QI approach described and captured rich qualitative experiential accounts and relevant quantitative information. Delivering the project in a large, comprehensive cancer centre strengthens the foundation for a reproducible group model that can be scaled to implement across a variety of care settings.

Limitations include a modest sample size within a single setting, limiting generalizability and nuanced quantitative analysis. Two of 25 survey respondents consented but did not complete any items, and one respondent who attended only virtually selected "neutral" on all items, noting they could not evaluate the in-person experience fairly; these patterns may reflect the challenges of capturing evaluation data in a drop-in group format with variable attendance. Self-selection into the needs assessment, group, and post-survey may have favoured patients who were already interested in seeking specialized queer supports, possibly inflating reported levels of satisfaction. While the drop-in nature of the group was important for accessibility, attendance was often inconsistent, so qualitative evaluation tools were kept brief to focus on perceived impact and satisfaction. Items assessing intrapsychic change, such as identity and meaning-making (60.9% agreement) and coping with cancer as SGDc (69.6%), received lower endorsement than relational and community dimensions, which may reflect challenges in assessing longer-term outcomes of identity-related insight relative to the more immediately accessible experience of community and belonging. We did not compare outcomes with SGDc patients who did not participate in QUEERMUNITY, so we cannot draw causal conclusions about clinical outcomes. Lastly, despite having access to other participant characteristics (e.g. race, age, cancer type), this project did not specifically investigate the potential benefits or differences across such intersections as they relate to group-based interventions. Despite these limitations, QUEERMUNITY offers a promising model for a practical support group intervention that delivers highly valued psychosocial care for SGDc patients and other equity-deserving patient populations in cancer care.

5. Conclusions

QUEERMUNITY is a feasible and highly valued queer-affirming psychotherapy support group for SGDc people affected by cancer within a comprehensive cancer centre. Within a deeply gendered, cis-mono-heteronormative cancer system, creating safe and inclusive spaces for our communities becomes critically necessary and increasingly important. This SGDc group model fills a current gap in our cancer care system, promoting inclusive care, and its accessibility and feasibility suggests the potential of replicating this group model for other SGDc or equity-deserving communities in oncology.

Pre-implementation needs assessment data showed strong demand for queer-specific group-based supports and SGDc-specific services and programming. Post-implementation findings suggest that such a group can provide safety, support, community, and enhanced coping in a cancer care context that is predominantly designed to serve cisgender, heterosexual patients and often excludes, erases, or renders queer identities as dismissible.

Providing queer-inclusive care in a group setting offers a community-driven modality that promotes equity within the cancer care system and centres values of connection, belonging, and healing. Bringing together opportunities for the growth of queer resilience, pride, and joy through queer psychosocial frameworks offers a promising pathway toward more equitable, affirming cancer care for SGDc communities.