Coping with Cancer : a comparison of British South Asian and British White patients following referral to a UK Cancer Centre, a cross sectional study

Aim: To explore how British South Asian (BSA) and British White (BW) cancer patients coped during the nine months following referral to a UK Cancer Centre. Material and methods: This quantitative cross sectional study compared symptoms of anxiety and depression between 94 BSA and 185 BW patients at baseline, at three and nine months. Associations between mood and coping strategies and selected environmental factors (symptom burden, cancer beliefs and the therapeutic relationship) were analysed. Questionnaires, available in English, Gujarati and Hindi, were the Hospital Anxiety and Depression Scale (HADS), Patient Health Questionnaire (PHQ-9), Emotion Thermometers (inclusive of the Distress Thermometer and Problem Checklist), Cancer Insight and Denial Questionnaire (CIDQ), Mini MAC, Brief Illness Perception Questionnaire (BIPQ), Physician/Patient Trust and Cancer Beliefs. Results: BSA patients reported higher rates of depressive symptoms compared to BW patients longitudinally e.g. (HADS D≥8: baseline: BSA 35.1% v BW 16.8% p=0.001; 3 months BSA 45.6% v BW 20.8% p=0.001; 9 months BSA 40.6% v BW 15.3% p=0.004). A similar ethnic gulf was detected in rates of anxiety until 3 months (HADS ≥8 at baseline (BSA 54.3% v BW 36.2% p=0.006; 3 months BSA 47.4% v BW 32.6%; 9 months BSA 40.6% v BW 28.2% p=0.25). BSAs used potentially maladaptive coping strategies more frequently at baseline, e.g. hopelessness/helplessness (p=0.005), fatalism (p=0.0005), avoidance (p=0.005). The symptom burden was greater on BSA patients. This was reflected in an ethnic difference in depressive symptoms. Some cancer beliefs and preferences for the therapeutic relationship influenced how patients coped. Conclusion: Health professionals need to be aware of the greater probability of psychological distress occurring among BSA cancer patients and how this may present clinically if this ethnic disparity in mental wellbeing is to be addressed. Clinicians need to establish the cultural context in which an individual experiences cancer.