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A study presented at the ASH Annual Meeting explored racial disparities in cancer-related stress and coping strategies among patients with indolent blood cancers undergoing active observation. Observation, often the initial management for these conditions, can lead to psychological distress, which has been associated with poorer cancer-specific survival. Given that racial minorities in the U.S. experience disproportionate psychosocial stress, the study examined stress levels, coping mechanisms, and health behaviors in minoritized and non-minoritized racial groups.
Tammarah Sklarz, MD, and colleagues analyzed data from 233 participants enrolled between 2016 and 2020. The cohort included patients with chronic lymphocytic leukemia, follicular lymphoma, smoldering myeloma, or B-cell lymphoma. Participants completed measures assessing sociodemographic factors, cancer-specific stress (via the Revised Impact of Events Scale [RIES]), and psychological adjustment to cancer (via the Mental Adjustment to Cancer [MAC] scale). Minoritized groups—comprising Asian, Black, and Hispanic/Latinx patients—were compared to non-minoritized White patients.
Results showed no significant differences in cancer-specific stress levels between groups (mean difference: 0.06; P=.8). However, minoritized patients reported significantly higher fatalism scores on the MAC scale (mean difference: 1.8; P=.01), reflecting a stronger belief that cancer outcomes are uncontrollable and inevitably fatal. Additionally, minoritized patients had a markedly higher likelihood of being active smokers (odds ratio: 12.2; P=.01). No differences were found in physical activity levels between groups (P=.99).
The findings highlight critical disparities in higher fatalism among racial minorities that could hinder engagement in surveillance and treatment for indolent blood cancers, potentially worsening outcomes.
“These findings align with prior studies demonstrating that cancer fear and fatalism tend to be higher in ethnic minorities, leading to a perception that developing cancer is out of one’s control and death is inevitable,” they noted. “As fatalistic beliefs can hinder engagement in preventative health behavior, this may negatively impact the health outcomes of racially minoritized groups with indolent blood cancers who may be less inclined to follow-up for surveillance and participate in active treatment when necessary.”
Educational programs and psychological support addressing cancer-related beliefs and promoting healthier coping strategies are crucial for improving outcomes in these populations.
This study emphasized the importance of addressing psychological and behavioral factors as part of comprehensive cancer care, particularly for racially minoritized groups disproportionately affected by psychosocial stress. By mitigating fatalism and promoting preventive health behaviors, such efforts could bridge gaps in survival outcomes for patients with indolent blood cancers.
“To our knowledge, this is the first study to evaluate for racial disparities in the level of cancer-related stress experienced by patients undergoing active observation for indolent blood cancers,” Dr Sklarz and colleagues wrote. “These findings suggest that further steps must be taken, through both educational and psychological support, to address fatalistic beliefs about cancer in racial minority patients with indolent blood cancer.”
