Improving cancer diagnosis and support services for Asian patients

There is a need to remove the major ethnic inequalities which still exist in access to cancer services and outcomes, according to the latest edition of Science & Public Affairs.

The first study of its kind has revealed that members of the UK South Asian community are far less likely than non-Asians to take up invitations for bowel or breast cancer screening, while other work has suggested that cancer diagnosis and treatment information should be tailored in a culturally sensitive manner as British Asian and White patients differ in their reactions to cancer diagnosis.

We need to understand how different ethnic groups cope with cancer and what beliefs they hold about the disease to avoid perpetuating the racial inequalities that currently exist with regards to cancer prevention, screening and treatment, says Karen Lord, Clinical Nurse Specialist at the Palliative Care Team, University Hospitals of Leicester.

In this month's Science & Public Affairs, she discusses the results from two pilot studies that reveal British Asian patients are more likely to disbelieve their diagnosis than British White patients, and also that the two populations differ in how they would prefer to be told they have cancer. A two-year study by researchers at the University of Leicester, with support from research charity Hope Against Cancer, now seeks to build on this work, with a view to improving psychological support services for our increasingly diverse population.

While 31 per cent of White patients in the preliminary study exhibited denial about their cancer diagnosis, this rose to 48 per cent in the British Asian population. Asian patients were also found to have a more fatalistic attitude towards their diagnosis. Such beliefs may have a detrimental effect on a patient's ability to cope with the experience of cancer, and denial was strongly associated with anxiety and depression.

In a second study looking at the informational needs of patients, it was discovered that Asian patients, in contrast to White patients, would prefer to receive the cancer diagnosis from their GP rather than the hospital consultant.

Over the next two years, 200 White and 200 Asian patients diagnosed with a variety of different cancers will be recruited from the Leicestershire Cancer Centre to further examine core concepts of distress and denial. They will be asked to complete a set of questionnaires over a period of nine months to investigate whether patients alter the way they cope over time and whether their use of denial as a coping strategy decreases. The study also seeks to understand the beliefs patients hold about the causes and curability of cancer - whether they differ between White and South Asian individuals, and whether cancer means different things in different cultures. For example, there is no similar word for cancer used in Gujarati.

'This research will help us to focus and deliver information about cancer and its treatment in a culturally sensitive manner,' says Miss Lord. 'The findings of this study should lead to improvements in support services for Asian patients suffering from cancer.'

In a related article in this month's magazine, Ala Szczepura, Professor of Health Services Research at the University of Warwick, comments on the need to promote racial equality for cancer screening. Her work has revealed that members of the UK South Asian community are only half as likely as non-Asians to take up an invitation for bowel cancer screening, and 15 per cent less likely to attend breast cancer screening. The research, which also highlights that uptake differs between South Asian groups, suggests that the inequalities are a result of cultural differences and language needs.

'It is the first study of its kind, and highlights the need for a national audit system to examine ethnic variations in screening uptake and five-year survival,'' says Professor Szczepura. 'Methods for improving uptake need to be identified.'