Hispanic Cancer Patients Suffer More Pain, Severe Sadness



MIAMI – Hispanic patients reported significantly higher rates of pain, numbness, cognition difficulties, vomiting, and severe sadness than non-Hispanics in a survey of 622 cancer patients awaiting appointments at three hospitals in the Bronx, New York City’s poorest borough.

"Hispanic patients consistently reported more emotional and practical complaints contributing to overall distress," Katie O'Callaghan reported at the annual meeting of the American Psychosocial Oncology Society.

"These are alarming results for us," she said.

Outpatients interviewed for the survey roughly reflected the demographics of the Bronx, a highly diverse, densely populated county where 5,000 new cancer cases are diagnosed each year. They were approached at Montefiore, Jacobi, and Lincoln hospitals.

With a mean age of 58 years (range, 18-100), the group included non-Hispanic whites (15%), African Americans (32%), and Hispanics (45%) with family origins in Mexico, the Caribbean, and South and Central America. Nearly three-quarters, 73%, were women. The most common cancers were breast (29%), gynecologic (14%), hematologic (10%), colorectal (9%), lung (7%), and prostate (3%).

Ms. O’Callaghan, research coordinator at Albert Einstein College of Medicine, New York, noted that among 256 Hispanics who completed the oral survey, 51% were Spanish-language dominant, reporting little or no English fluency. Communication barriers might be one explanation for the marked disparity in reports of physical symptoms, she suggested.

Indeed, on some measures, differences were seen between Hispanic patients who spoke English and those who did not. For example, 64% of Spanish-dominant Hispanics reported fatigue, compared with 49% of English-dominant Hispanic patients, a significant difference (P less than .05).

Spanish-dominant Hispanic patients also reported more practical problems (such as housing, transportation, and child care problems) as contributors to their distress (P less than .05).

But major differences persisted among the ethnic groups surveyed.

Overall, the same percentage – 49.5% – of Hispanic and white patients expressed clinically significant levels of distress – a composite measure that consists of 34 physical, practical, emotional, and spiritual/religious factors – compared with 42.5% of African Americans.

But 45% of Hispanic patients reported moderate to severe pain, more than twice the percentage of whites (20%) and substantially more than African Americans (37%). The differences among the three ethnic groups were significant (P less than .01).

Moderate to severe problems with cognition were reported by similar percentages of African Americans and whites (20% and 19%), but 31% of Hispanics, a difference significant at the P less than .05 level.

Sadness was reported as moderate to severe by 41% of Hispanics, and was significantly more distressful than in non-Hispanics in the survey (P less than .05). Again, about equal percentages of whites and African Americans reported great sadness (31% and 29%).

Divergence by ethnicity also was seen for moderate to severe numbness (reported by 39% of Hispanics, 30% of African Americans, and 20% of whites) and moderate to severe vomiting (reported by 13% of Hispanics and 8% of African Americans, but only 1% of whites).

"This psychological assessment study gives voice to the needs of Hispanic cancer patients who demonstrate greater distress and oncology symptoms [than other groups]," Ms. O’Callaghan said.

The silver lining in the study, she noted, was that Hispanic patients were also more likely than non-Hispanic patients, 26% vs. 21%, to be interested in receiving counseling for their emotional problems.

Coauthor Alyson B. Moadel, Ph.D., director of psychosocial oncology at the Albert Einstein Cancer Center, highlighted "a very big effort ... in terms of quality improvement," in part in response to the study findings.

One specific intervention is a volunteer companion program offering one-to-one support for cancer patients as they receive treatment for cancer, Dr. Moadel said, after Ms. O’Callaghan’s presentation at the meeting.

The study was funded by the Entertainment Industry Foundation; none of the authors reported any relevant financial disclosures.

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