When it comes to supporting cancer patients’ and caregivers’ well-being, considerations for approaches centered around cultural diversity could have a large impact. Patients with advanced cancer may struggle to cope with their diagnoses and have feelings of hopelessness and anxiety, which can contribute to worsened psychological distress and quality of life. Interventions to alleviate these feelings of distress, however, may not consider the cultural backgrounds of the patients they are intended for. When it comes to Latino patients, specifically, they are often at higher risk for psychological distress compared to non-Latino whites, emphasizing a need for culturally sensitive approaches to assist patients and their caregivers during these difficult periods. In fact, this need has already been voiced by Latino patients, yet there are currently limited standardized interventions that have been developed or that have been adapted from current ones.
To further exemplify the importance of these considerations, Dr. Megan Shen from the Hutch collaborated with Dr. Normarie Torres-Blasco in Dr. Eida Castros’ lab at Ponce Health Sciences University in Puerto Rico to publish a recent article in Supportive Care in Cancer. Despite the geographical distance, Dr. Shen commented that this collaboration made sense, given collaborative connections from her time at Memorial Sloan Kettering (in New York City) and due to her previous research on this topic, and so there was “a lot of overlap in the expertise that we have, and shared interests in supporting patients, specifically around end-of-life care topics, meaning making and planning for the future.” Both sites also serve a large number of Latino patients. Meaning making, or meaning centered psychotherapy, is a form of therapeutic intervention for cancer patients to help find meaning and spiritual well-being for cancer patients, but Dr. Shen explains, the original methods aren’t “well-tailored to patients who identify as Latino or Hispanic.”
In this article, the research group connects culturally important elements such as familism and spirituality with mental health outcomes in both advanced cancer patients and their caregivers. Familism is an important component of Latino culture and is represented by the strong obligation and responsibility to one’s family, and as such, patients often want to involve many family members as part of a broader social net of caregivers. Many Latinos are also religious, and their spirituality is often a source from which they can derive meaning and strength when coping with challenges such as an advanced cancer diagnosis. Understanding the relationship between these components of meaning-making and psychosocial symptoms such as depression and hopelessness was an important goal for the researchers, as they hope it could inform interventions for future utilization. To address this, the research team recruited patient and caregiver pairs from an oncology clinic in Puerto Rico and asked them to complete a cross-sectional survey to assess different components of mental health and importance of cultural values such as the ones discussed above. The team found a significant negative association between spiritual well-being and hopelessness in patients, and spiritual well-being with hopelessness and depression in caregivers. They also found an association between hopelessness and anxiety and depression.
The data from this study support how spiritual well-being may have an important effect on psychosocial symptoms for Latino advanced cancer patients and their caregivers. They also noted their data support other reports highlighting the connection between patients’ and caregivers’ mental health, and that caregivers often report anxiety and depression to similar degrees as patients, which may be reflective of the emphasis on strong family bonds. Dr. Shen added that, despite this data being collected in Puerto Rico, it is very likely these results can apply to Latino and Hispanic people living in the mainland US as well. She notes that, “these themes absolutely apply across groups in terms of the centrality of family, of spirituality and faith.” She goes on to emphasize that, potentially, the most valuable takeaway from this study is “how critically important, at least asking and addressing spirituality for patients with advanced cancers is, and also…to think about integrating their family members and caregivers directly into the treatment process.” But also “to not underestimate how important it is to be thinking about checking in on patients and seeing where they might need support, just given the critical role that variable seems to play in affecting patients mental and other psychosocial outcomes.” It is the research teams’ hope that the data presented here, as well as the building body of literature addressing similar questions, will help promote change and adaptation of current approaches to care management for Latino and Hispanic advanced cancer patients and their caregivers. Certainly, when considering the impact that core cultural values can have on individuals, these considerations should be integrated in compassionate and meaningful ways.
Torres-Blasco, N., Peña-Vargas, C., Costas-Muñiz, R., Rosario-Ramos, L., Shen, M. J., & Castro, E. (2024). Psychosocial symptoms associated with spiritual well-being in Latino patients and caregivers coping with advanced cancer. Supportive Care in Cancer, 32(3), 1-8.
This study was funded by the National Institute of Minority Health and Health Disparities, the National Cancer Institute, Memorial Sloan Kettering Cancer Center, and the American Cancer Society.
Fred Hutch/University of Washington/Seattle Children's Cancer Consortium member Dr. Megan Shen contributed to this work.