CULTURAL CONSIDERATIONS IN PEDIATRIC CANCERWendy N. Gray, Ph.D.

WHY STUDY CULTURE IN ONCOLOGY?

• Cancer is a family disease

• Families exist within a broader cultural system

• Increasing diversity within patients diagnosed with cancer

• Known health disparities

CULTURE IMPACTS THE CANCER EXPERIENCE

• Illness Representations

• Illness Disclosure

• Complementary and Alternative Medicine Use

• Coping

• End of Life/Bereavement

ILLNESS REPRESENTATIONS

• Illness stigma• High levels of stigma in Asian cultures. Why?• Implications of stigma?

• Illness conceptualizations• Hot-cold theory of disease• Implications?

• Illness attributions• Self-blame or guilt

IMPLICATIONS FOR CARE

• Stigma, guilt, self-blame can limit one’s ability to see out/utilize social support

• Western medicine – open dialogue vs. cultural beliefs• Undermine educational efforts

• Impact on treatment seeking behavior• Complementary and alternative medicine use

ILLNESS DISCLOSURE• Lower rates of disclosure

to child in some cultures

• Consequences of non-disclosure?

• Differences in amount of information disclosed

IMPLICATIONS FOR CARE

• Contrasting beliefs about disclosure can lead to conflict

• Culture of silence and impact on children

COMPLEMENTARY & ALTERNATIVE MEDICINE

(CAM)• Western medicine is 1st

line approach• CAM used as an adjunct

treatment• Prevalence• Type• Disclosure

GEOGRAPHIC DIFFERENCES IN CAM

Geographic Region Most Common Form of CAM

Asia, Middle East, Mexico Dietary & herbal supplements to counteract “hot” nature of cancer

Europe & North America (excluding Mexico)

Vitamins & “mind-body” treatments

CAM DISCLOSURE

• Disclosure to medical team uncommon

• Why?

• Implications of non-disclosure

COPING

• Coping styles

• Social support

• Somatization• Sleep difficulties (40-76%)• Loss of appetite (44-76%)• Weight loss (60-95%)• Headaches (47-77%)

IMPLICATIONS FOR CARE

• Provide culturally-acceptable sources of social support

• Revisit need for support over time

• Awareness of culturally-specific physical manifestations of stress = earlier intervention and support

END OF LIFE

• Communication surrounding death

• Reaction to death and expressions of grief

IMPLICATIONS FOR CARE

• Communicating difficult news in a culturally-appropriate way

• Cultural expectations for remaining in contact with family after child’s death

ROLE OF ACCULTURATION

• Individuals vary in their level of retention of their native culture

• Degree of acculturation varies across patients and within the same family

• Process of acculturation is its own stressor

CONCLUSIONS

• Limitations of existing literature• Culture issues given less attention in Western research

literature• Intersectionality