A total of 82 Asian and 117 randomly selected white Caucasian patients at the Leicestershire Cancer Centre were assessed using measures of coping and adaption to cancer. On the Mental Adjustment to Cancer (MAC) scale, Asian patients were more fatalistic ( P <0.0001) and had more significant hopeless/helpless scores ( P =0.007). The two ethnic groups answered the three questions thought to assess denial differently. Caucasians were more likely not to dwell on their illness (73 vs 55.5%, P <0.0001) and agree with the statement ‘I have difficulty believing this is happening to me' (73 vs 60.5%, P <0.0001). However, Asian patients were more likely to agree with the statement ‘I don't really believe I have cancer' (48.2 vs 31.3%, P =0.019). Within both groups there was an association with denial and anxious preoccupation ( P <0.001). On the Hospital Anxiety and Depression (HAD) scale, there was no difference in anxiety scores between either sexes or between the Asian and Caucasian groups. However, Asian patients were more depressed ( P =0.001). Although denial was significantly related to the presence of both depression ( P <0.0001) and anxiety ( P =0.001) in the entire patient population, there were different predictors of denial in each subgroup. On multiple regression analysis depression was linked with denial in Caucasians, whereas Fighting Spirit (minus helplessness/hopelessness) was linked with denial in Asian patients. There are definite differences in coping styles in British cancer patients according to ethnicity. While significant numbers in both groups employ denial in some form, Caucasian patients appear to adapt to the psychological pressures of cancer more successfully than Asian patients at a particular point in time. Further work is required to elucidate longitudinal relationships between denial and adaption to cancer.

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ObjectivesThis cross-sectional survey investigated whether there were ethnic differences in depressive symptoms among British South Asian (BSA) patients with cancer compared with British White (BW) patients during 9 months following presentation at a UK Cancer Centre. We examined associations between depressed mood, coping strategies and the burden of symptoms.DesignQuestionnaires were administered to 94 BSA and 185 BW recently diagnosed patients with cancer at baseline and at 3 and 9 months. In total, 53.8% of the BSA samples were born in the Indian subcontinent, 33% in Africa and 12.9% in the UK. Three screening tools for depression were used to counter concerns about ethnic bias and validity in linguistic translation. The Hospital Anxiety and Depression Scale (HADS-D), Patient Health Questionnaire-9 (both validated in Gujarati), Emotion Thermometers (including the Distress Thermometer (DT), Mini-MAC and the newly developed Cancer Insight and Denial questionnaire (CIDQ) were completed.SettingLeicestershire Cancer Centre, UK.Participants94 BSA and 185 BW recently diagnosed patients with cancer.ResultsBSA self-reported significantly higher rates of depressive symptoms compared with BW patients longitudinally (HADS-D ≥8: baseline: BSA 35.1% vs BW 16.8%, p=0.001; 3 months BSA 45.6% vs BW 20.8%, p=0.001; 9 months BSA 40.6% vs BW 15.3%, p=0.004). BSA patients used potentially maladaptive coping strategies more frequently than BW patients at baseline (hopelessness/helplessness p=0.005, fatalism p=0.0005, avoidance p=0.005; the CIDQ denial statement ‘I do not really believe I have cancer’ p=0.0005). BSA patients experienced more physical symptoms (DT checklist), which correlated with ethnic differences in depressive symptoms especially at 3 months.ConclusionsHealth professionals need to be aware of a greater probability of depressive symptomatology (including somatic symptoms) and how this may present clinically in the first 9 months after diagnosis if this ethnic disparity in mental well-being is to be addressed.

The aim of this questionnaire survey was to find the information needs of British Asian cancer patients. An additional objective was to find the extent of family involvement when the patient was given the cancer diagnosis and the patients' views about information disclosure. We interviewed 82 Asian patients and 220 random white control patients. More white British patients gave positive answers to the statement 'I want as much information as possible' than Asian patients (93.1 vs 77.5%, Pp0.001). However, 92.6% of Asian patients wanted to know if they had cancer. Many more Asians (66.2 vs 5.1%, Po0.001) indicated the general practitioner (GP) as the preferred source of information. This may be because 56% of English-speaking Asian patients would prefer to discuss their illness in their mother tongue. In Leicester, many Asian patients have Asian GPs. The vast majority of both Asian and British patients agreed that family or friends should be present when patients are given the cancer diagnosis. However, Asians were more likely to be alone (24 vs 15%, P ¼ 0.008) when told they have had cancer. The majority of patients (both white British and Asian) want to control the disclosure of information to relatives and friends and would like to be present at doctor/family meetings. (Fallowfield et al, 1990). A 250 patient stratified sample typical of West of Scotland cancer patients (Meredith et al, 1996) and a more heterogeneous study of 2331 patients (Jenkins et al, 2001) showed the vast majority of British cancer patients want to know the diagnosis and specific details about treatment and prognosis. However, the information needs of British non-white ethnic minorities have never been studied.Leicester is a multicultural city of 280 000. The 2001 Census (Office for National Statistics, 2001) described only 63.9% of the population as white. The biggest minority population (25.7%) was described in the census as Indian, although some of these people would use a different name such as African/Asian to describe their origin. It has been predicted that by 2011, 50% of the population of Leicester will be of Asian origin (Rex, 1999).Cancer registration statistics collected between the start of 1990 and the end of 1999 for the city of Leicester showed that South Asian patients had a lower cancer incidence than non-South Asians (Smith et al, 2003a). When adjusted for age and socioeconomic deprivation, incidence rate ratio (IRR) was 0.61 for male and 0.75 for female population. This pattern changed significantly with age. Although older Asians had much lower rates of cancer than the rest of the population, younger Asians were at increased risk compared with non-Asians. Comparing incidence rate ratios between 1990 -1994 and 1995 -1999 there has been a marked rise in the incidence of colorectal cancer (IRR ¼ 2.33) and breast cancer (IRR ¼ 1.37) in Asian women. In contrast, these rates decreased in the rest of the population. There has also been a rise in the incidence of prostate cancer (IRR ¼ 1.71) and lung cancer (IRR ¼ 1.39) in ...