ArticlesPsychological morbidity and quality of life of ethnic minority patients with cancer: a systematic review and meta-analysis
Introduction
Disparities associated with cancer incidence and survival between minority and majority groups have been the focus of substantial research and policy making in many developed countries.1, 2 Reasons are thought to include culturally determined lifestyle and beliefs, and practical barriers to care, such as lack of language proficiency, unfamiliarity with health systems, discrimination, and poor cultural competence among providers.3 Importantly, lower socioeconomic status is also associated with poorer outcomes. The contribution of minority versus socioeconomic variables, however, is poorly understood.4
The growing numbers of minorities in developed countries demand attention to clinical and patient-reported outcomes, such as health-related quality of life (HRQoL) and psychological distress, which provide insight into how the disease and treatment affect daily life.3 Three previous reviews of psychological morbidity among minority cancer patients concluded that disparities exist, but they did not assess the degree of difference for specific minority groups.5, 6, 7 We did a systematic review and meta-analysis to investigate further which minority patients are most at risk.
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Data selection
In October, 2009, we searched Medline, AMED, PsycINFO, Embase, CENTRAL, CINAHL, PubMed, Sociological Abstracts, and Web of Science for English-language, full-text articles published in peer-reviewed journals from Jan 1, 1995, onwards, on any cancer type or stage (including disease free) in people of any age. We chose to keep the range of publication years narrow because of the dynamic nature of migratory patterns and cultural contexts.8 We used the following subject terms and keywords in
Results
We screened 1378 potentially relevant, non-duplicate articles. The κ score for concordance between reviewers rating the articles was 0·61–0·75. The final number of papers included in the meta-analysis was 21 (figure 1), which reported on 18 distinct datasets.19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39 Of these, ten included among their main objectives comparisons of psychological morbidity between minority and majority groups.19, 21, 22, 24, 27, 29, 30, 35
Discussion
Our analysis indicates that distress, depression, and overall HRQoL are significantly worse in patients from minority groups than in those from the majority. Overall, disparities seem to be driven by differences between Hispanic and majority patients in the USA. The effect sizes for distress, social HRQoL, and overall HRQoL suggested that these features might be clinically important. Heterogeneity between results for social and overall HRQoL, however, limits the interpretability of these
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