Cancer Pain Experiences in Caucasians vs. Minorities

Introduction

In spite of the attempt by the healthcare providers to provide cancer patients with ‘effective analgesia’, pain as a result of the disease continues being suboptimaly treated and also under recognised. Nearly 18 million new diagnosis of cancer have been made in the United States since 1990. In 2008, approximately 553,768 Americans were projected to succumb to cancer. This represents 22.9 percent of the entire deaths that took place in the United States (Castel, Saville & DePuy, 2008). At such a level, cancer has been projected at least from the United States, to be a major cause of death, coming only second to heart disease. With these types of numbers, what this indicates is that cancer has becomes an enormous disease, both in terms of mortality and morbidity.

Moreover, the psychosocial and physical manifestations that are presented by cancer impact on nearly all the aspects of the lives of patients. Amongst one of the main manifestations of cancer that has thus far been subjected to profound attentions from professional organizations, various disciplines within the healthcare department and agencies of the government, is that of pain that caner patients experiences. Despite the fact that at the moment therapies that are available are capable of being effective in a majority of the cases, episodes of under-treatment have also not been uncommon. In addition, close to 30 percent of all the patients that suffers from cancer has been shown to hardly achieve enough relief (Green et al, 2003).

Discussion

There have been a number or reports in literature on ethnic differences in as far as the experience of cancer pain is concerned (Beck 2000; Anderson et al, 2002).Specifically, cancer patients of the African American descents have been shown to present with worse clinical features of cancer as opposed to the white patients, in addition to worse prognosis, relative to their white counterparts suffering from cancer. Besides, the pain that African Americans suffering from cancer has been reported to be not only under-treated, but also underestimated (De Pheils, 2005). According to Cleeland and others (2001), the authors managed to establish that cancer patients who received their treatment within ethnic minority settings had could be subject to thrice as much chance to experience under-medication, as compared with those patients who attends treatment within non-minority settings. In as much as not a lot may not thus far be known as regards the pain experiences of cancer patients from the African American descent, the limited number of research studies that have been completed indicates that the cancer experiences of this particular race is both different and unique, relative to the rest of the races.

Cancer patients of the African American descent have a tendency to present with severe pain. In addition, pain management has also been another issue of concern by members of this race. According to Gonzales, Gallardo and Bastani (2005), a majority of the cancer patients from the African American descent have reportedly been shown to look at pain as a cancer index. There are also other studies that have documented profound differences in as far as the management of pain is concerned between on the one hand, the African Americans and on the other hand, the rest of the ethnic groups. Tolerance development, stoicism and the possibility of opoid medication, and the associated addiction, have been recognized as some of the factors that could be at play in terms of influencing the management of pain that African American cancer patients goes through. Furthermore, the experience of pain that African Americans with cancer go through has also been associated with the perceived attitudes by these patients as regards the cancer (Bates et al, 1997).

In addition, pessimism and fatalistic ideas as concerns the cure or prevention of the cancer have also surfaced. Further, the impact that cancer pains may have on the personal relationships of women of African American descent have also been shown to impact on such patients, and their lack of enthusiasm towards seeking for treatment. Furthermore, there are also a number of studies in which several women of African American descent have reportedly been shown to connect cancer with stigma out of their tendency to harbor a belief of cancer being a contagious disease (Luquis & Villanueva 2006). Moreover, cancer patients’ survivors from the African American race have been shown to rely on religious beliefs.

As research into cancer, especially breast cancer continues, a lot more doctors have indicated that different races shows diverging experience to cancer. For instance, it has been indicated through research findings that in relation to their Caucasian counterparts, women the occurrence of breast cancer amongst women of the African American origin have a tendency to receive a diagnosis at a relatively younger age (JCR Staff, 2003). In addition, there is also a higher likelihood that this race could receive a diagnosis at a time when the cancer has really advanced, with the result that they shall undergo through more painful experiences than would have been the case, had the diagnosis been made at an earlier stage. Besides, breast cancer has also been shown to be quite fatal for this particular race even at an early stage, as opposed to the Caucasian race (Portenoy et al 2004).

About 30 percent of all the patients suffering from one form cancer or another have been shown to suffer from recurrent or chronic pain, while between 60 and 90 percent of cancer patients presenting with advanced stage of the disease have also been seen to suffer from pain. Race, age, genetics, cancer type, culture and psychosocial context have all been shown to impact on the manner in which cancer patient experience pain during their illness. This findings are as per a study that was conducted at North Carolina University by Dr. Liana Castel and others, with results revealing that women of non-Caucasian origin are not only faced with a higher risk of experiencing more pain due to cancer, they are also faced with a higher chance of their pain worsening as the disease progresses, relative to women of the Caucasian origin. This study involved 1,124 women who presented with breast cancer at an advanced stage, to the extent that it had also now affected the bones. In addition, the patients were also the recipients of standard treatment. According to the research findings of this study, it was revealed that patients who were of non-Caucasian origin possessed a 2.52 times chance of undergoing through a several and painful experience of cancer. These findings are a further confirmation to the already published evidence; the fact that the patients from the ethnic minority races are faced with a higher risk towards pain due to breast cancer. Race aside, the pain experience of every cancer patient may be said to be quite unique.

Some of the observable difference in as far cancer pain is concerned has to do with genetics. Further, research has it that a number of these differences might also have come about as a result of the variation in the medical care that the patients receives. There is a possibility that the differences by virtue of genetics between on the one hand, the African American cancer patients and on the other hand, those from the Caucasian race, could play a significant role in the ensuing difference in pain management between these two races. Miscommunication between healthcare providers and cancer patients has been cited as one of the barriers to these patients receiving adequate management of their pains that has been occasioned by the fact that they are cancer victims. Lately, differences in terms of race has come to be regarded as a contributors to pain descriptions by cancer patients variations with regard to ethnicity has been evidenced with regard to pain expression,. Pain expectations, pain expressions pain tolerance, as well as practices with regard to healthcare provision.

According to a study that was carried out by Lagana and Gonzalez (2003), it was revealed that cancer patients from the ethnic minority were seen to report far more pain as opposed to cancer patients of the white origin. Separately, Cohen and McChargue (2003) have indicated that cancer patients from the African American descent tended to exhibit far higher pain intensities, significantly elevated levels of stress as a result of their pains. Further, these African American patients were also seen to report interference associated with their cancer pains, as opposed to the White patients. On the other hand, a study by Maly, Umezawa, Ratliff and Leake (2006) indicates that Chinese patients may very well fail to complain of nay perceived pain, in addition to not wishing to bother their nurses so that they may be provided with pain medication. Another author, McDonald (1994) has also shown that Mexicans could wish to be relieved of their pain in the shortest time possible, in addition for their desire to utilise words as a way of describing the kind of pain that they could be going through, as opposed to the use of numbers.

Whereas it may not be in doubt that there does exist ethnic as well as racial barrier disparities in as far as the issue of pain experiences to cancer is concerned, nevertheless health care professionals appear not to have laid more emphasis on the necessary mechanisms to put in place in order to ensure that such a disparity is checked. A study that was commissioned by the American Cancer Society in 2002 documented the experiences of cancer patients amongst the minority races. According to the findings of this research study, it was revealed that 75 percent of all the patients that took part in this survey reported that they usually experienced very severe pains during the course of their illness. In addition, these patients confessed that they usually obtained a lot of information pertaining to the experiences of cancer patients, but they were also quick to pint out that they mainly depended on their doctors to enlighten them on the possible levels of pain that they could expect to go through. According to Karen Anderson, a leading author with the Houston based Anderson Cancer centre, “Patients may be reluctant to talk about their pain. Doctors and nurses don’t always do a good job of asking about it.” (Anderson & Cleeland, 2001).

This is an indication therefore that most of the times, patients with cancer usually undergo through untold pain as a result of a lack of communication with their doctors, something that Anderson has projected to be more widespread amongst the minority races, as opposed to the Caucasians race. The problem, Anderson notes, is because of the failure by the nurses and the doctors alike to bring up this topic at a time when they are treating their patients, usually, the cancer patients shall be in a lot of pain, and trauma, with the result that they may not quite succinctly describe the extent of their pain to their doctors. The onus is therefore on the healthcare providers to guide these patients through the various levels of pain that they may expect to experience, so that they are at least prepared. In addition, it would also help if the health care practitioners might devote more time and attentions into the issue of finding ways and means of at least alleviating these painful experiences to their patients.

A study that was conducted by Castel and others (2008) to asses the disparities between races with regard to the issue of cancer pain experiences indicate that the whites were more likely to report and discuss the issue of pain at a time when they were meeting their doctors. On the other hand, the African Americas were more likely not to bring up this topic, because according to some of the patients interviewed, they were of the opinion that they could bear with this kind of pain. Consequently, they ended up experiencing more pain due to cancer, without even sharing it out with anyone, not even their doctors. Furthermore, their silence, in addition to the lack of doctors to enquire about their pain meant that they were less likely to have their pain alleviated through medication.

When pain goes unrelieved for a prolonged period of time, the result of this is that the life quality of a majority of the individuals that are suffering form cancer gets impaired ( ). In spite of many years being dedicated to addressing this specific problem by researchers and clinicians alike, we still witness cancer patients not fully utilizing analgesic medications that have been availed to them. This has been attributed to a lack of information, on the part of he patients, possibly dues to held beliefs concerning the issue of pain reporting and the associated utilization of analgesics. Some of the most common beliefs entail possible side effects as a result of the use of analgesics, in addition to widely held misconceptions regarding the control of pain, which has been perceived by (Anderson, Syrjala & Cleeland, 2001) as a form of exaggerated fear. Again, this kind of exaggerated fear appears to be more profound amongst the minority races, as compare d to their white counterparts, as reported by (Tompson et al, 2001).

There are several attitudinal barriers that have come to be associated with the management of pain for cancer patients along the racial divide. One such barrier is concerned with the fatalistic belief; a belief in the inability to control cancer pain, and the fact that this form of pain is quite inevitable (Sherwood et al 2000). Fatalistic beliefs regarding the management of pain associated with cancer has been largely attributed to a lack of enough information concerning the disease, in this case cancer. The Caucasian race has been shown to have far more information as concerned cancer and its management. In addition, the Caucasians have also been shown to enquire more with their doctors about possible ways to manage their pain. This could therefore act as an explanation to the fact that their level of pain experience, when compared to that of he minority races, appears to be far much less.

According to an article that featured on MedWise News (2007), it was indicated that women with breast cancer and who are non-Caucasian usually suffer far worse pain as compared with the Caucasian women. This is a farther illustration of the fact that there exists a racial disparity in as far as strategies for pain control is concerned (IM Eun-Ok et al, 2007). The findings to this particular research study received a publication in the medical journal cancer. The study was part of a post hoc assessment for a potential assessment that consisted of some 1124 women, all of whom had presented with bone metastases as well as metastatic breast cancer. These women received treatment in the form of intravenous biphosphonates. Additionally, these patients were also the recipients of a standard therapy that cancer patients are usually subjected to. Thereafter, the women were evaluated for pain through the use of BPI (Brief Pain Inventory) for a period of 12 months, as a follow-up.

The baseline data findings indicated that cancer patients of the non-Caucasian descent were more likely to present with several forms of pain, in addition to additional pain interference as they underwent their everyday activities. On the other hand, the pain experiences of the Caucasian women was seen to be far much less than that of their non-Caucasian counterparts. Liana Castel, who is a co-author to this report, and a lecturer at the North Carolina university concurred, “Our findings demonstrate that race is a… risk factor for pain; non-Caucasian women have higher hazards of pain severity and pain interference in daily activities,” (MedWire News 2007).

Conclusion

The kind of information that has been provided by researchers into the area of experiences of pain by cancer patients across the races in the United States needs to be utilized for purposes of enlightening health care professionals on individual prognosis, in additional to assisting in a designing of educational clinical as well as physician-patients modes of communications and ultimately, to come up with modes of intervention that are geared towards the enhancement of pain management for cancer patients, not to mention the reduction of the observed disparities from one race to another. Furthermore, there is also a need to ensure that the minority races receive enough information on the causes, complications and possible ways to manage cancer pain, as available literature appear to suggest that they seems less informed on such matters, when compared to the Caucasian race. This way, it would be possible also to help them discard the widely held attitude amongst the minority races that cancer pain is both uncontrollable and unavoidable. Researchers and health professionals in the United States have made headways in as far as the issue of management of pain, especially for such terminal illnesses as cancer is concerned (Annya Hernandez & Sachs-Ericsson, 2006). It is only proper if all the various races get to share in the available means of alleviating cancer pain in an equitable manner.

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