The Pain Experience of Hispanic Patients With Cancer in the United States

Juarez, Ferrell, and Borneman (1999) reported that Hispanics endured greater pain and poorer quality of life outcomes compared to Caucasians and African Americans. Anderson et al. (2002) indicated that Hispanic patients recounted severe pain and many concerns about pain management. Indeed, pain of Hispanic patients with cancer in the U.S., particularly Hispanic patients of lower socioeconomic status, seems to be undertreated (Delgado et al., 1995; Eley et al., 1994). Cleeland et al. (1997) found that Hispanic patients treated in ethnic minority settings were more likely to be undermedicated than patients seen in non-minority settings, and that they reported less pain relief and received inadequate analgesia dosages compared with patients from other ethnic groups. Anderson et al. (2004) also noted that physicians underestimated baseline pain intensity and provided inadequate analgesics for more than 50% of the Hispanic and African American patients with cancer in their study. In another study, Anderson et al. (2002) concluded that approximately 28% of Hispanic patients received analgesics insufficient in strength to manage their pain, and physicians underestimated pain severity for 64% of Hispanic patients. Several possible reasons could explain why cancer pain management of Hispanic patients with cancer is inadequate. One factor could be Hispanic patients' concern about potential addiction to pain medications and development of tolerance (Anderson et al., 2002; Cleeland, 1991; Cleeland et al, 1997). Another issue could be fewer resources and greater difficulty in accessing care and filling analgesic prescriptions, especially for patients of low socioeconomic status (Cleeland, 1991; Cleeland et al, 1997). A third reason could be difficulty for health care providers in assessing pain because of differences in language proficiencies and cultural backgrounds (Cleeland, 1991; Cleeland et al, 1997). The most common reason cited for noncompliance with pharmacologic treatment by Hispanic patients with cancer was inability to understand instructions (Juarez, Ferrell, & Borneman, 1998). Finally, stoicism largely based in religious beliefs and fatalism among Hispanic patients with cancer has been considered as another factor in play (Juarez, Ferrell, & Borneman, 1998; Luquis, Villanueva Cruz, 2006; Rifkin, Doddi, Karagi, & Pollack, 1999). In other words, Hispanic patients with cancer tend to perceive cancer as their destiny, and accompanied by a sense of powerlessness or helplessness, approach pain with stoicism. Thus, their lack of verbal and behavioral expression of pain does not indicate a lack of pain itself (Juarez et al., 1998). In addition to these possible explanations, studies have supported the idea that inadequate cancer pain management in Hispanic patients could be linked to the cultural attitude of familism (Blackhall et al., 1995; Orono et al., 1994; Marshall et al., 1998; Salazar, 1996). Familism, the (often Hispanic) cultural tradition of responsibility toward family at the expense of one's own needs, has been frequently discussed (Marshall et al., 1998; Salazar, 1996). Blackhall et al. (1995) reported that Mexican patients with cancer are less likely to be told (at the behest of the family) that their condition is terminal and that they tended to have family-centered models of decision making (Orono et al., 1994). Marshall et al. (1998) wrote of a similar finding among Latinos: families protected patients with cancer from a terminal diagnosis because the families did not want to “harm” the patients with the knowledge of their short life expectancy, believing that it was more merciful to withhold painful information (Marshall et al., 1998). While Caucasian patients with cancer tended to place the highest priority on their own individual experiences and interests and wanted to have control of their bodies and lives, Hispanic patients with cancer tended to emphasize the welfare of one's family over individual welfare (Pinquart & Sorensen, 2005). Consequently, Hispanic patients with cancer were more likely to seek support from family members, friends, and health professionals in the diagnosis and treatment process, which includes the management of cancer pain (Gonzales, Gallardo, & Bastani, 2005). Family thus plays a powerful role in treatment decision making (Maly, Umezawa, Ratliff, & Leake, 2006). Within this context of inattention to cultural/ethnic identity, coupled with a familism-style approach to managing cancer diagnoses, Hispanic patients' pain could not be adequately assessed and managed.