Love, Advocacy, and Acceptance in the Face of Cancer

Before Mary and Abby Kissiday-Diamond were married, they met regularly at a Cambridge church for discussion groups hosted by the lesbian civil rights group, Daughters of Bilitis. Through 1969 to the early 2000s, these meetings were organized as a safe place for members of the lesbian community to express themselves.

Mary was immediately intrigued by Abby. She was cute but quiet, and as their friendship grew, Mary fell in love with the fierce and multi-faceted personality behind that soft-spoken facade. In 2004, the Kissiday-Diamonds became one of the first same-sex couples to get married in Massachusetts.

Even as LGBTQ+ relationships have gained institutional acceptance in the United States, Abby and Mary still face a healthcare system that can sometimes feel unwelcoming. The quiet woman Mary met more than 40 years ago became a vociferous advocate for her partner as Mary faced open heart surgery.

“You don’t mess with Abby,” Mary says.

Abby agrees. “I’m very good in a crisis,” she says.

Over the course of their encounters with the health care system, Abby sometimes felt that providers questioned her role as a spouse. Feeling left out of conversations and decisions, Abby began asserting herself as primary caregiver and applied for power of attorney at every new healthcare facility out of an abundance of caution. “I don’t think the average married couple does that,” she observes.

Inequitable experiences

These subtle dynamics affected Abby and Mary to the point that they sometimes sought out new providers who respected and valued their partnership. Every meeting with a clinician came with uncertainty.

“There’s always this question of do they accept us,” Mary observes. “This is a person dealing with your life, you want someone who seems to be open enough.”

A 2024 poll by health-policy organization KFF revealed that members of the LGBTQ+ community are twice as likely to feel this uncertainty in comparison to their non-LGBTQ+ counterparts. This includes higher rates of negative experiences that caused their health to worsen, made them less likely to seek care, or caused them to switch providers. Six in 10 LGBTQ+ adults said they are concerned about being treated poorly by healthcare providers or staff or feel that they need to be careful about their appearance to be treated fairly.

Relief and acceptance

When a small growth was found in Mary’s breast during a routine mammogram, Abby prepared herself for more uncertainty. “She’s my worrying warrior,” Mary jokes, but behind the humor is some truth informed by their past experiences. At Dana-Farber Brigham Cancer Center at South Shore Health, Abby felt relief after meeting Medical Oncologist Shail Maingi, MD, and the team of providers and nurses.

“It’s about coming into the clinic with an open mind and earning trust,” says Maingi, who is also the liaison for Dana-Farber Network Health Equity and Inclusion. “As oncologists, we aren’t just treating a cancer, we are treating an entire person who comes to us with a unique perspective, background, family, and history.”

This part of her role is personal. Maingi conducts research exploring these disparities in experiences and how they can be eliminated. One survey of patients in the LGBTQ+ community with cancer identified that only one in every four felt comfortable sharing their gender identity or sexual orientation with their provider. Using feedback from this survey, Maingi and a team of oncologists developed a toolkit for clinics to create more inclusive environments.

Heard and valued

Throughout Dana-Farber Brigham at South Shore Health, small signals stood out to Abby, like signs and pins throughout the clinic that emphasized inclusion. Each staff member was willing to answer all their questions, and Abby was included in every conversation. It was clear that every member of the care team accepted, respected, and valued them.

“We’re in the right place,” Abby recalls telling herself.

Dana-Farber’s commitment to equitable, compassionate care is embedded in every aspect of patient care. A comprehensive list of policies support LGBTQ+ cancer care. Patients’ pronouns and gender are also easily identifiable to staff in the electronic medical record system. World-renowned specialists like Maingi provide comprehensive cancer care and offer unique clinical trials in the cancers and immunologic conditions for which the LGBTQ+ community is most at risk.

“Everyone was open to the two of us being there as a married couple and dealing with the situation together,” Mary says. “That’s what we wanted and that’s what we found.”

Through surgery and radiation, Mary and Abby felt completely supported by Maingi and their care team. “Cancer isn’t just life-threatening, it’s extremely emotional,” Abby says. “Dana-Farber did everything they could to ease those emotions.”

Promising future

Four years later, Mary is navigating survivorship. They have shared their perspective with two classes of Harvard Medical School students taught by Maingi, informing the future of cancer care. Through sharing their experiences, Mary realized that the future was bright.

“It was fascinating to see how accepting young doctors were about issues of gender and sexuality,” they observe. “How open they were to listen to us, ask great questions, and how aware they were that everyone’s different and that you’ve got to treat people as they are.”