Minority Cancer Patients Research Articles

The Racial Disparity Gap in Pediatric Leukemia and Lymphoma Survival Has Been Eliminated in Children but Not in Older Adolescents and Young Adults.

Overcoming disparities in the successful treatment of minority cancer patients has been a major challenge. In particular, blacks/African Americans face a higher likelihood of developing and dying from each of the four most common malignancies in the United States (breast, prostate, colon, and lung cancer) as well as from other cancers. Among children, leukemia and lymphoma have also shown a worse outcome in black patients versus whites. Given the success of the Children's Oncology Group (COG) in reducing the racial deficit in leukemia and lymphoma, we examined national survival data from the U.S. Surveillance, Epidemiology and End Results (SEER) program for trends in survival difference between white and blacks with leukemia and lymphoma, as a function of age at diagnosis. The annual 5-year relative survival rate trends during 1975 to 2000 for all leukemia and all lymphoma (including Hodgkin lymphoma) showed convergence in white and black children (age <10), comparable trends in 10- to 19-year-olds, and divergence in those 20 to 29 years of age with blacks doing progressively worse than whites. The age dependent patterns were qualitatively similar for acute lymphoblastic leukemia, acute myelogenous leukemia, and non-Hodgkin lymphoma, with convergence in <10 year-olds and divergence in 20- to 29-year-olds apparent in each type of leukemia and lymphoma. For the year 2000, the trends in 20- to 29-year-olds project a 20 to 25% survival deficit for blacks versus whites for acute myelogenous leukemia and a 5 to 10% deficit for other leukemia and lymphomas. The fact that the deficits between white and black patients with leukemia and lymphoma have been overcome for pediatric patients in the United States indicates that this can also be achieved in young adults and older adolescents. A major solution would be access to clinical trials through COG or other clinical trials for the next older age group. The current National Cancer Institute Progress Review Group offers recommendations that are relevant to these disparate outcomes observed in this study; these will be reviewed. [Display omitted]

Translation and validation of the SF-36 Health Survey for use among Turkish and Moroccan ethnic minority cancer patients in The Netherlands

In this study, the SF-36 Health Survey was translated into two oral Moroccan languages and the existing Turkish version was culturally adapted for use in The Netherlands, and was tested among 79 Moroccan and 90 Turkish cancer patients. There were normal levels of missing item responses but a higher administration time. With minor exceptions, the scale structure of the SF-36 was confirmed and the reliability of the scales met the 0.70 criterion for group comparisons. The questionnaire distinguished clearly between subgroups formed on the basis of performance status and was responsive to change in performance status over time. Some evidence of differential item function (DIF) was found in both ethnic groups. These results support the use of the SF-36 among Turkish and Moroccan cancer patients in The Netherlands. Additional studies are needed to confirm the psychometrics of the questionnaire when used among these ethnic minority groups in other Western European countries.

Translation and validation of the EORTC QLQ-C30 for use among Turkish and Moroccan ethnic minority cancer patients in the Netherlands

The purpose of this study was to validate the core EORTC quality of life questionnaire, the QLQ-C30 (version 3.0), for use among Turkish and Moroccan cancer patients in the Netherlands. The questionnaire was translated into two oral Moroccan languages , and the existing Turkish version was culturally adapted for use in the Netherlands. Ninety Turkish and 79 Moroccan patients completed the questionnaire. Administration of the questionnaire proved feasible, with low levels of missing questionnaires (4%) and missing items (on average, 1.5–2.4%). With one minor exception, the evidence of convergent validity was strong for all multi-item scales. Internal consistency reliability was above 0.70 for all scales except the cognitive functioning scale in the Turkish sample. The questionnaire was able to distinguish clearly between subgroups formed on the basis of performance status and comorbidity, and was moderately responsive to change over time in performance status. These data support the use of the QLQ-C30 among Turkish and Moroccan cancer patients residing in the Netherlands. Additional studies are needed to confirm the psychometrics of the questionnaire when used among these ethnic minority groups residing in other Western European countries.

Pain Education for Underserved Minority Cancer Patients: A Randomized Controlled Trial

Pain Education for Underserved Minority Cancer Patients: A Randomized Controlled Trial

Pain Education for Underserved Minority Cancer Patients: A Randomized Controlled Trial

Pain Education for Underserved Minority Cancer Patients: A Randomized Controlled Trial

Increasing Minority Participation in Cancer Clinical Trials: The Minority-Based Community Clinical Oncology Program Experience

The National Cancer Institute's (NCI) Minority-Based Community Clinical Oncology Program (MBCCOP) seeks to enhance minority participation in cancer clinical trials by building clinical trials outreach and management capacity in healthcare institutions serving large numbers of minority cancer patients. This article examines temporal trends in MBCCOP accruals to cancer prevention and control (CP/C) and cancer treatment trials and the racial distribution of study participants, along with the major factors affecting minority enrollment. We used NCI databases to analyze temporal trends in overall accruals and accruals by race. We analyzed transcripts from an NCI-sponsored meeting with MBCCOP principal investigators and data from a follow-up survey to identify factors affecting minority enrollment. Between 1992 and 2003, annual patient accruals to treatment trials increased 39% despite little change in the number of MBCCOP grantees. During this same period, annual participant accruals to CP/C trials more than doubled. Between 1995 and 2003, minorities comprised 51% to 67% of the MBCCOP patients accrued to cooperative group treatment trials compared with < or = 23% of the patients accrued by other cooperative group members and affiliates. Major factors affecting minority enrollment include the availability of "clinically relevant" protocols, regulatory requirements, characteristics of the patient population, and the level of support from sponsoring institutions and community physicians. MBCCOPs have demonstrated their ability to facilitate the participation of racial/ethnic minorities in clinical trials. However, the contributions that they could make to the design and conduct of minority-focused research studies merit further exploration.

Pain Education for Underserved Minority Cancer Patients: A Randomized Controlled Trial

Previous studies found that African American and Hispanic cancer patients are at risk for undertreatment of pain. We evaluated the efficacy of a pain education intervention for underserved minority patients. Ninety-seven underserved African American and Hispanic outpatients with cancer-related pain were enrolled onto a randomized clinical trial of pain management education. The patients in the education group received a culture-specific video and booklet on pain management. The control group received a video and booklet on nutrition. A research nurse met with each patient to review the materials. We measured changes in pain intensity and pain-related interference 2 to 10 weeks after the intervention, as well as changes in quality of life, perceived pain control, functional status, analgesics, and physician pain assessments. Physicians underestimated baseline pain intensity and provided inadequate analgesics for more than 50% of the sample. Although the ratings for pain intensity and pain interference decreased over time for both groups, there was no statistically significant difference between groups. Pain education did not affect quality of life, perceived pain control, or functional status. African American patients in the education but not the control group reported a significant decrease in pain worst ratings from baseline to first follow-up (P < .01), although this decrease was not maintained at subsequent assessments. Brief education had limited impact on pain outcomes for underserved minority patients, suggesting that more intensive education for patients and interventions for physicians are needed.

Decision-making issues for randomized clinical trial participation among Hispanics.

Despite large numbers of eligible patients, accrual into randomized cancer clinical trials (RCTs) remains low.1 Little is understood about reasons for low RCT accrual of ethnic minorities. Hispanic participation in RCTs is far below their representation in the general population.2,3 When comparing Hispanic and non-Hispanic cancer incidence and mortality, Hispanics carry a higher burden due to cervix, stomach, and liver cancer, and the death rates for easily detectable cancers (eg, breast) are decreasing more slowly for Hispanics than for non-Hispanics.4,5 Without an ethnically and culturally representative sample in RCTs, the generalization of findings becomes questionable for minority cancer patients.6 To date, we have insufficient information from the patient perspective about what is needed to make an informed decision about enrollment in cancer RCTs.7-9 It is therefore critical that local cancer providers realize the diverse needs of our community. The purpose of this project was to better understand RCT decision-making issues among Hispanics.

Depression Among Latina Cervical Cancer Patients

This study was designed to begin to address gaps in the literature on psychological adjustment in minority cancer patients. We interviewed 50 indigent, Latina cervical cancer patients who were being treated in a large, urban, county hospital. The goals of the study were to describe patients' cancer-related and contextual experiences and to determine whether aspects of patients' experiences could predict depression. Patients reported high levels of depression and of stress related to socioeconomic and immigration status. Although patients appeared to have good social support overall, most wanted additional access to cancer-related support. As hypothesized, contextual variables, general social support and stress, were significant predictors of depression. Additionally, some cancer-related variables, specifically physical symptoms associated with radiation and practical barriers to receiving treatment, added significantly to the prediction of depression

Minority cancer patients and their providers

BACKGROUND The goals of the current studies were: 1) to determine the pain treatment needs of socioeconomically disadvantaged African-American and Hispanic patients with recurrent or metastatic cancer and 2) to assess the attitudes of health care professionals who treat them. METHODS In the first study 108 African-American and Hispanic patients with metastatic or recurrent cancer and pain completed a survey about their pain intensity, pain interference, and attitudes toward analgesic medications. Physicians also rated their patients' pain and the adequacy of the patients' current analgesic prescriptions was assessed. In the second study 55 physicians and nurses who treat these patients completed a questionnaire regarding cancer pain and its management in their practice settings. RESULTS Approximately 28% of the Hispanic and 31% of the African-American patients received analgesics of insufficient strength to manage their pain. Although the majority of patients received appropriate analgesics, 65% reported severe pain. Physicians underestimated pain severity for 64% of the Hispanic and 74% of the African-American patients. Physicians were more likely to underestimate the pain severity of female patients than male patients. Inadequate pain assessment, patient reluctance to report pain, and lack of staff time were perceived as barriers to pain management. CONCLUSIONS Although the data suggest recent improvements in analgesic prescribing practices for African-American and Hispanic cancer patients, the majority of patients reported high levels of pain and limited pain relief from analgesic medications. Inadequate pain assessment remains a major barrier to optimal cancer pain treatment. Cancer 2000;88:1929–38. © 2000 American Cancer Society.

Minority cancer patients and their providers

The goals of the current studies were: 1) to determine the pain treatment needs of socioeconomically disadvantaged African-American and Hispanic patients with recurrent or metastatic cancer and 2) to assess the attitudes of health care professionals who treat them. In the first study 108 African-American and Hispanic patients with metastatic or recurrent cancer and pain completed a survey about their pain intensity, pain interference, and attitudes toward analgesic medications. Physicians also rated their patients' pain and the adequacy of the patients' current analgesic prescriptions was assessed. In the second study 55 physicians and nurses who treat these patients completed a questionnaire regarding cancer pain and its management in their practice settings. Approximately 28% of the Hispanic and 31% of the African-American patients received analgesics of insufficient strength to manage their pain. Although the majority of patients received appropriate analgesics, 65% reported severe pain. Physicians underestimated pain severity for 64% of the Hispanic and 74% of the African-American patients. Physicians were more likely to underestimate the pain severity of female patients than male patients. Inadequate pain assessment, patient reluctance to report pain, and lack of staff time were perceived as barriers to pain management. Although the data suggest recent improvements in analgesic prescribing practices for African-American and Hispanic cancer patients, the majority of patients reported high levels of pain and limited pain relief from analgesic medications. Inadequate pain assessment remains a major barrier to optimal cancer pain treatment.

Management of pain in elderly patients with cancer. SAGE Study Group. Systematic Assessment of Geriatric Drug Use via Epidemiology.

Cancer pain can be relieved with pharmacological agents as indicated by the World Health Organization (WHO). All too frequently pain management is reported to be poor. To evaluate the adequacy of pain management in elderly and minority cancer patients admitted to nursing homes. Retrospective, cross-sectional study. A total of 1492 Medicare-certified and/or Medicaid-certified nursing homes in 5 states participating in the Health Care Financing Administration's demonstration project, which evaluated the implementation of the Resident Assessment Instrument and its Minimum Data Set. A group of 13 625 cancer patients aged 65 years and older discharged from the hospital to any of the facilities from 1992 to 1995. Data were from the multilinked Systematic Assessment of Geriatric Drug Use via Epidemiology (SAGE) database. Prevalence and predictors of daily pain and of analgesic treatment. Pain assessment was based on patients' report and was completed by a multidisciplinary team of nursing home personnel that observed, over a 7-day period, whether each resident complained or showed evidence of pain daily. A total of 4003 patients (24%, 29%, and 38% of those aged > or =85 years, 75 to 84 years, and 65 to 74 years, respectively) reported daily pain. Age, gender, race, marital status, physical function, depression, and cognitive status were all independently associated with the presence of pain. Of patients with daily pain, 16% received a WHO level 1 drug, 32% a WHO level 2 drug, and only 26% received morphine. Patients aged 85 years and older were less likely to receive morphine or other strong opiates [corrected] than those aged 65 to 74 years (13% vs 38%, respectively). More than a quarter of patients (26%) in daily pain did not receive any analgesic agent. Patients older than 85 years in daily pain were also more likely to receive no analgesia (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.13-1.73). Other independent predictors of failing to receive any analgesic agent were minority race (OR, 1.63; 95% CI, 1.18-2.26 for African Americans), low cognitive performance (OR, 1.23; 95% CI, 1.05-1.44), and the number of other medications received (OR, 0.65; 95% CI, 0.5-0.84 for 11 or more medications). Daily pain is prevalent among nursing home residents with cancer and is often untreated, particularly among older and minority patients.

Council Giving Voice to Minority Cancer Patients

Council Giving Voice to Minority Cancer Patients