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National Cancer Institute

Culture and Survivorship

Marjorie Kagawa-Singer, Ph.D., M.N., R.N.
School of Public Health and Asian American Studies Center

  • Current generalizations about cancer survivorship pertain mainly to whites, because minority sample sizes usually are too small to perform typical analyses and draw conclusions. There is a significant lack of survivorship studies on the needs of ethnic minority and medically underserved groups.
  • An important issue in studies of minority cancer experiences is the aggregation of groups. For example, the "Asian/Pacific Islander" ethnic group as a whole has the lowest cancer incidence and mortality rate among ethnic groups in the United States. When broken into groups based on country of origin, however, incidence rates among these groups differ widely, with some individual group incidence rates approaching those of other ethnic groups and surpassing those of the group as a whole.<
  • Although access and health insurance may be equal, race-based differences in care exist. These differences may be attributed to multiple barriers, such as deficits in culturally sensitive care on behalf of health providers, language barriers, lack of knowledge about or access to state-of-the-art treatments and ways to mitigate side effects, and low rates of participation in clinical trials. Community-based participatory research will help recruit minorities to clinical trials.
  • End-of-life and palliative care also differ by ethnic group. Eighty-five percent of hospice patients are white; only 8 to 10 percent are African American, and less than 2 percent are Asian. Lack of care at the end of life helps perpetuate the image among certain ethnic groups that to die of cancer is to die a horrible, painful death.
  • Cultural differences can affect concepts of health, pain experience, drug metabolism, emotional responses, decision-making styles, communication patterns, coping styles, and social support. For example, a study of pain perception found that Asians reported increased physical and psychological pain but had less desire for pain intervention than other ethnic groups. Decision-making in some groups also may prioritize group welfare instead of individual life, in contrast to Western health choices.

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