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Cancer-related fear and fatalism are more prevalent in patients of racial minority groups with indolent blood cancer, potentially impacting outcomes.
Recent research published in Blood highlighted disparities in coping mechanisms and health behaviors among patients in racial minority groups who had indolent blood cancers and were undergoing active observation.
Indolent blood cancers, such as chronic lymphocytic leukemia, follicular lymphoma, smoldering myeloma, and certain B-cell lymphomas, are often managed with observation rather than immediate treatment. While this approach can delay the need for aggressive interventions, it may also lead to significant psychological distress, which is associated with poorer cancer-specific survival.
“In the US, there are significant racial disparities in survival for patients diagnosed with blood cancers, yet less is known about the basis for these differences,” explained Tammarah Sklarz, MD, and colleagues. “One potential contributor to disparities in survival is the differential impact of mental health comorbidities given that racial [minority groups] living in the US disproportionately experience more psychosocial stress.”
Therefore, the researchers sought to evaluate racial disparities in cancer-related stress and coping mechanisms among patients with indolent blood cancers, focusing on potential differences in psychological adjustment and health behaviors.
Disparities Identified
The study was conducted from April 2016 to November 2020. The researchers analyzed data from 233 patients, of whom 11% self-identified as Black/African American, 5% as Hispanic/Latinx, 1.3% as Asian, and 0.85% as multiracial.
The participants completed validated assessments of cancer-specific stress (Revised Impact of Events Scale), psychological adjustment to cancer (Mental Adjustment to Cancer Scale), and self-reported health behaviors, including smoking and physical activity. The investigators grouped patients into racial minority (Asian, Black, or Hispanic/Latinx) and non-minority (White non-Hispanic) categories for comparison.
The study found no significant differences in overall cancer-related stress levels between the groups. In addition, the two groups had no significant differences in physical activity levels (OR, 1.01; 95% CI, 0.46–2.22; P=0.99).
However, notable disparities emerged in coping styles and behaviors:
- Fatalistic Beliefs: Patients in racial minority groups reported significantly higher levels of fatalism, characterized by a belief that cancer outcomes are beyond personal control and that death is inevitable (mean difference, 1.8; 95% CI, 0.47–3.17; P=0.01).
- Smoking Prevalence: Active smoking was significantly more common among patients of racial minority groups (OR, 12.2; 95% CI, 2.0–72.7; P=0.01).
Clinical Implications
The authors wrote that their findings align with prior research indicating that cancer-related fear and fatalism are more prevalent in patients of racial minority groups, potentially hindering engagement in surveillance and follow-up care. Fatalistic beliefs can also drive maladaptive behaviors such as smoking, which may further compromise health outcomes.
The researchers added that addressing these disparities is critical for patients with indolent blood cancers, as fatalistic attitudes may diminish the likelihood of adherence to recommended monitoring and delay necessary treatment. Furthermore, smoking exacerbates cancer risk and overall morbidity, necessitating targeted cessation programs.
The researchers called for strategies such as:
- Educational Programs: Provide culturally sensitive education to address misconceptions about cancer prognosis and treatment.
- Psychological Support: Incorporate counseling to help patients develop adaptive coping mechanisms and reduce fatalistic beliefs.
- Behavioral Interventions: Implement smoking cessation initiatives and promote healthy lifestyle behaviors within these populations.
“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,” the authors concluded.
