Differences in psychosocial stressors between black and white cancer patients
Background Screening patients with cancer for psychosocial distress enables providers to make referrals to resources early in the course of treatment. There is some evidence of differential impact of cancer on mental health between racial/ethnic groups, but the results are not consistent.
Objectives To examine differences in overall distress and individual psychosocial stressors between black and white cancer patients at first visit to the cancer center.
Methods This study included all invasive cancer patients from an urban, academic cancer center in the Midwest who completed the National Comprehensive Cancer Network (NCCN) Distress Thermometer from January 1, 2015 to February 19, 2016. Comparisons were made on overall distress score and for each individual stressor in the instrument. Categorical variables were compared using chi-square or Fisher exact test. Logistic regression was used to predict high distress by race adjusting for sex, age, and cancer type.
Results A total of 933 patients with invasive cancer completed the NCCN distress screening tool. The full sample was 16.9% black, and 32.6% of the sample indicated high distress on their first visit. There was no difference in overall distress score between black and white patients. Black patients more frequently identified housing, ability to have children, and loss of interest as sources of distress, whereas white patients more often identified treatment decisions and nervousness.
Limitations Limitations include limited capacity to explore demographic differences in our sample; some patients did not receive the distress screening tool thus some cancer sites are proportionally more represented in the sample.
Conclusions The findings do not indicate overall distress differences between black and white patients, but they do indicate differences in the source of distress, possibly indicating different resource needs or intervention strategies between black and white cancer patients.
Accepted for publication July 14, 2017
Correspondence Leslie Hinyard, PhD, MSW; hinyardl@slu.edu
Disclosures The authors report no disclosures/conflicts of interest.
Citation JCSO 2017;15(6):e314-e320
©2017 Frontline Medical Communications
doi https://doi.org/10.12788/jcso.0366
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Strengths
Despite the limitations, there are also significant strengths to this study. The NCCN tool is a widely accepted measure for the assessment of psychosocial distress in patients with cancer. The measure is a common and routine clinical instrument,20 and has also been used widely in research.18,21-24 Given the urban, academic environment of our clinical practice, our population is more racially diverse than other settings, allowing for initial examination of disparities between white and black cancer patients.
Clinical implications
Understanding differences in common psychosocial stressor between black and white cancer patients may allow for clinicians to strategically look for different types of stressors in order to facilitate faster referrals to appropriate services. It has been established in the literature that distress is correlated to cancer-related outcomes and distress screening is now considered standard of care when treating cancer patients. Identifying differences in psychosocial stressors among black and white cancer patients is paramount to ensuring that the appropriate resources are available to assist them through their cancer journey. The differences in type of stressor, may indicate fundamental differences in the way patients perceive their disease or the social and cultural implication of a cancer diagnosis. In this study, white patients were more likely to find distress in the psychological realm (nervousness, decision-making), whereas black patients were more likely to be distressed about social issues (housing, ability to have children, and loss of interest). The referral needs of patients may be quite different, even with similar levels of overall distress. More research is necessary to further characterize sources of distress for cancer patients, how this distress impacts a patient’s physical and emotional well-being and how health care providers can better identify these issues and make the necessary referrals to support the whole patient.
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