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National Cancer Institute

Older Under-served Populations across the Cancer Continuum

Merle Mishel, Ph.D. and Barbara Germino, Ph.D.
School of Nursing
University of North Carolina at Chapel Hill

  • Many barriers exist to participation of older African Americans in clinical trials. Many members of this group have a sense of fatalism surrounding cancer (i.e., it cannot be cured), fear and mistrust the medical system based on cultural history, believe it will cost them in time and money, and have difficulties obtaining access to a research site. Ethnic, cultural, and racial differences between researchers and potential study participants also are a major barrier to participation.
  • To increase minority participation in clinical trials, the research team's understanding of African American's attitudes toward research must be expanded. Recruitment and retention of African-American cancer patients can be improved by including African-American co-investigators, involving African-American religious or community leaders who themselves are cancer survivors, and easing access to trials by contacting potential participants in their communities and developing satellite trial centers.
  • Using these strategies to increase minority participation, a psycho-educational intervention was performed to increase knowledge of how to manage problems faced by Caucasian and African-American women with breast cancer. Those receiving the intervention showed enhanced cancer knowledge and problem solving abilities, better success in obtaining information from physicians and nurses, significant decreases in symptoms and fatigue, and increased participation in work and recreational activities.
  • An intervention aimed at managing uncertainty in men with localized prostate cancer found that African-American men who received the intervention developed a more positive attitude about their disease, enhanced problem-solving ability, better control over urine flow, and a decrease in the number of debilitating symptoms suffered. A similar intervention in Caucasian and African-American long-term breast cancer survivors analyzed events that triggered thoughts of recurrence (i.e., new aches or symptoms, information from the media, annual mammogram, and anniversary of diagnosis). Women who received the intervention experienced a decrease in catastrophizing, improved attitude, and gains in cancer knowledge and symptom information.

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