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Cancer Survivorship and Latinos
Gregory A. Talavera, MD, MPH
Professor and Chair Division of Health Promotion
and Behavioral Sciences
Graduate School of Public Health
San Diego State University
National Hispanic Medical Association
Learning Objectives
• Identify the differences in cancer burden between Latinos
and Non-Latino Whites
• Recognize the psychological and emotional impact of
cancer survivorship from the patient perspective
• Identify strategies that clinicians can use to improve
quality of care and decrease disparities
Cancer
• Latinos have fewer cancers and fewer deaths from all cancers
combined, and from the four most common cancers (female
breast, prostate, colon-rectum, and lung).
• Latina women have nearly twice as many cervical cancers
compared with non-Hispanic white women.
• Latinos have more cancers of the stomach and liver.
• Latinos are less likely than non-Latinos to receive tests that find
cancer early such as a mammogram, Pap test, or sigmoidoscopy.
Who is a cancer survivor?
• A person diagnosed with cancer, from the time of
diagnosis and for the balance of life
• His or her family, friends, and caregivers
National Coalition for Cancer Survivorship, 2009
Who are cancer survivors?
• Over 12 million in the U.S. (up from 3 million in 1972)
• 66% of adults diagnosed with cancer expect to be alive
in 5 years up from 50% in 1976
• Majority (61%) are 65 and older
Differences in Cancer Burden between Latinos and NonLatino Whites
• Although Latinos have lower incidence and death rates than nonLatino whites for most cancers, they are more likely to be
diagnosed with a more advanced stage of disease.
• Cancer survival rates are generally similar among Latinos and nonLatino whites
• Differences in survival rates may reflect later stage at diagnosis,
less access to timely, high-quality treatment, and differences in
tumor biology
Cancer Experience
• Emotional Roller Coaster: Everyone rides during the cancer
experience
• Emotions surrounding a cancer diagnosis:
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Anger
Depression
Anxiety
Sense of being helpless, powerless or out of control
Grief: “healthy person”, loss of hair, loss of a breast
Impact of Long Term Survival
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Social
Psychological/Emotional
Spiritual
Physical
Social Impact
• Changes in social roles & relationships
• Family members may need to take on new responsibilities (e.g., cooking,
cleaning)
• Distress within family unit
• Cancer may have enhanced family tension
• Sexuality issues
• Insurance and financial concerns
• Employment
• taking time away from work
• Increased dependency on social networks/ support groups
Psychological/Emotional Impact
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Anger
Depression/Grief
Chronic Anxiety
Sense of helplessness/loss of control
Fear of relapse/fear of death
Relationship problems
Spiritual Impact
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“Who am I now”
Meaning of illness and life after cancer
Questioning the purpose of existence
Relationship with God/church support
Changing perspective on hope and future
Redefining one’s identity in the face of crisis
Physical Impact
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Long-term or delayed effects
Premature aging/organ failure
Fatigue and Nausea
Cosmetic changes (lymphedema, weight gain)
Difficulty in performing functional tasks
Sexual dysfunction
Cancer recurrence
So, what’s next?
• What can I do to take care of myself?
• Can I reduce the chances of the cancer
returning?
• Do I have the right to advocate for myself?
Survivorship Care
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Surveillance (follow-up care and testing)
Preventative services (i.e. nutrition and exercise)
Necessary interventions
Appropriate referrals (i.e. fertility specialists)
Coordination with primary care & specialists
Self Advocacy (obtaining resources, making healthy
lifestyle changes, establishing good relationships with
primary care physicians)
Sources of Support
• Social support has substantial benefits to psychological well-being with those
coping with a family member’s cancer
• Church or church members as a source of support (e.g., prayers and financial
assistance)
• Sometimes local agencies may help with cooking, shopping, transportation,
and housekeeping
• Health care professionals may become central to patient’s during the
treatment process-providing support in the form of information and
emotional support
• New relationships (e.g., support group members)
Communication with Family
1. Involve family members in medical appointments when
possible
2. Be clear about needs
3. Ask family members what he or she needs
4. Accept the fact that you may have different coping styles
5. Figure out what adjustments will be needed in the
household, and then ask for help together
6. Get professional help if you need it
Communication with Family
• Questions for maintaining clear and strong communication:
• “We have been focused on me and my illness, how is all this for your”
• What has been the hardest for you?
• What is the scariest?
• Hearing their concerns may open communication by letting them
know you recognize that they are affected by your illness as well.
Conclusion
• Efforts to enhance communication between patients and
their family members may help survivors and their
families cope with and overcome the challenges of cancer
survivorship
• Communication works best in the context of positive
communication
• Social support should not end after treatment