Symptom control in underserved Chinese American cancer patients

Abstract

Chinese Americans are the largest Asian subgroup in the U.S. and many are recent immigrants. Cancer is the leading cause of death for these patients but there are few culturally-relevant pain interventions. This ongoing community study aims to: 1) develop and test a rapid-cycle quality improvement (QI) intervention for pain and other symptoms in underserved Chinese American cancer patients, and 2) identify cultural and psychological factors that may influence the uptake of the intervention. During the baseline phase, 306 cancer patients were screened in an oncology practice; 37% reported persistent pain and 18% reported other “severely distressing” symptoms (10% sleep disturbance; 8% fatigue; 6% lack of appetite). Eligible patients (n=46) had “new” or “worsening” cancer pain and completed translated validated measures assessing pain and other variables. Most (65% women; M age=55 years, SD=8.5) had low acculturation to the English language, a high school education or less (89%), and ≤ $20,000 annual income (76%). The mean subscale scores for fatalistic pain beliefs (2.4, SD=1.5) on the Barriers Questionnaire Taiwan and for reticence to express pain (3.3, SD=0.5) on the Pain Attitudes Questionnaire were comparable to previous samples. Psychological morbidity was high, with 50% reporting severe distress on the Chinese Health Questionnaire-12. While 46% had worst pain ≥ 7/10 (M=6.1, SD=2.2), only 39% reported prescription pain medication use. Following this baseline phase, the QI cycles will have four goals: pain screening, strategies for follow-up and treatment, referral for specialist care and clinician education. The primary outcome will be the proportion of patients who receive timely pain control over a two-week period. The QI intervention may alleviate the high pain and symptoms rate in this population, and clarify specific cultural and psychological factors that are related to symptom control outcomes. Supported by the American Cancer Society 117416-RSGT-09-201-01-PC.