Ethnicity and cancer outcomes: Behavioral and psychosocial considerations.

Abstract

Cancer is the second leading cause of death in the United States (National Center for Health Statistics, 1993). The American Cancer Society estimates that one in three Americans alive today will be diagnosed with cancer at some point during their lives. With over 8 million Americans currently living with or surviving cancer (American Cancer Society, 1995), it clearly is a major public health concern.Although many studies examine behavioral and psychosocial factors relevant to how people survive cancer and the quality of that survival (e.g., see Holland & Rowland, 1989), the focus of this literature has been almost entirely on non-Hispanic Whites. The extent to which findings can be generalized beyond the majority population is unknown. This lack of information is particularly unfortunate in light of rapidly increasing ethnic diversity within the United States and the high cancer rates within some ethnic groups.Our goal in this review is threefold. First, we propose a framework to organize and summarize what is known about the links between ethnicity and two general cancer-related outcomes-adherence behaviors and responses to cancer and its treatments, including both survival and quality of life. Second, we consider socioeconomic, knowledge-attitudinal, and medical system-patient interaction variables that might mediate the relation between ethnicity and these outcomes. Finally, we identify gaps in the literature that may be especially useful to explore in future research. In each of these areas-outcomes, mediators, and recommendations-we draw on three distinct literatures from public health and psychology. Despite apparent connections, the literatures on screening-follow-up behaviors, survival, and quality of life-coping are not well integrated and are inconsistent in their coverage of issues related to ethnicity. Before presenting the framework, we discuss difficulties inherent in studying ethnicity in these literatures. Studying Ethnic Diversity and CancerThe 1990 U.S. Census describes the United States population of 249 million, using their labels, as 71.3% non-Hispanic White, 9.0% Hispanic, 12.1% Black, 2.9% Asian/ Pacific Islander, 0.8% Native American, and 4.0% "other race." Between 1980 and 1990, the Asiaoacific Islander population increased by 108%, the Hispanic population by 53%, the Native American population by 38%, the Black population by 13%, and the non-Hispanic White population by only about 7% (U.S. Bureau of the Census, 1990a). Notwithstanding that there may have been an undercount of various

From inside the bubble: migrants’ perceptions of communication with the cancer team

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The prognostic role of cancer-specific beliefs among prostate cancer survivors

“…Based on the theoretical model by Meyerowitz et al [26] linking cancer-related cognitions and adherence behavior with survival, and Andersen's biobehavioral model of adjustment to the stresses of cancer and disease course [27], we hypothesize that beliefs are associated with mortality in individuals diagnosed with PC after considering relevant sociodemographic, clinical, and behavioral factors. Based on these models, potential mechanisms of such associations include behavioral factors (e.g., health behaviors, adherence to medical protocols) and neuroendocrine factors (e.g., stress-induced effects on the immune response and gene expression of cells in the tumor microenvironment) [14,[28][29][30][31] which may affect response to treatment [32], disease progression [31,33,34], healthrelated quality of life [35], and early detection of recurrences.…”

Health-related quality of life in breast cancer: A cross-cultural survey of German, Japanese, and South Korean patients

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