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Alberta Cancer Foundation

Patient ethnicity a predictor of distress in cancer care – the 6th vital sign

Research by Alberta Heritage Foundation for Medical Research Fellow Bejoy Thomas, PhD finds that among those undergoing cancer care in Calgary, visible minorities and people with English as their second language had consistently higher distress scores.

“We asked two big questions. How do we define ethnicity? And, how does that impact cancer outcomes?” says AHFMR Fellow Bejoy Thomas, PhD, Department of Psychosocial Oncology, Tom Baker Cancer Centre (TBCC) and University of Calgary Faculty of Medicine. “Our findings prove that someone who looks ‘different’ and speaks English as a second language is at greater risk of being depressed or in distress during his/her cancer care.”

The Canadian Partnership Against Cancer, and Accreditation Canada recognize distress as the 6th vital sign in cancer care. Thomas’ research, Cancer patient ethnicity and associations with emotional distress – the 6th vital sign: a new look at defining patient ethnicity in a multicultural context, appears in the August 2009 print edition of the Journal of Immigrant and Minority Health. The paper analyses the surveys of 2402 people in Calgary who were treated for cancer in 2003. It is co-authored by both AHFMR Health Scholar Linda Carlson, PhD, the Enbridge Research Chair in Psychosocial Oncology, and Barry Bultz, PhD, Director of Psychosocial Oncology, TBCC and University of Calgary Faculty of Medicine.

“From this research, and the many one-on-one interviews we have done since, we know that visible minorities are accessing bio-medical treatments but not optimally using all of the supports they need to help them heal from cancer,” says Thomas. “In fact, instead of getting better over time, many of these people experience a surge in their symptom burden – distress, anxiety, depression, pain, fatigue – six months after their diagnosis of cancer.” The paper notes that untreated distress tends to lead to higher costs for the health system because people in distress have a greater uptake of health services such as visits to the emergency room, and repeat hospital admissions.

“We have an excellent cancer care system here in Alberta. At the same time, we always welcome opportunities like this to make it even better,” says Barbara Cameron, a cancer survivor and patient representative for TBCC and Southern Alberta cancer sites.

“These findings help remind us that the cancer journey is very personal. We have found that barriers stem from differences of culture, beliefs, and language – which can lead to people not getting full access to health care. We need to be able to adjust our approach to ensure that everyone gets what they need to heal,” says Cameron.

“The Americans are tracking cancer by age, gender and ethnicity. At present, the Canadian system does not track ethnicity related to cancer diagnosis and care at all,” says Thomas. “These findings compel us to call upon hospitals and cancer care centres across Canada to track specifically who they are treating for cancer. Once we know where the gaps are, we can adjust our resources to fill those gaps.”

The research establishes a framework for cancer clinicians and researchers – specific to Canada’s multicultural context. It recommends defining ethnicity within four quadrants:
1. People who look “white” and speak only English
2. People who look like a visible minority and speak only English
3. People who look “white” and speak proficient or limited English
4. People who look like a visible minority and speak proficient or limited English

To read the study: http://www.springerlink.com/content/03438t1311157605   
The team’s findings also appear in the August 2009 edition of Ethnicity & Health in a paper titled Patient ethnicity: A key predictor of cancer care satisfaction.
Go to http://www.informaworld.com/smpp/content~db=all~content=a909273857  
This research was supported by AHFMR, Enbridge Inc., the Canadian Cancer Society’s Alberta/NWT Division, and the Alberta Cancer Foundation.