Hospice residents' interest in complementary and alternative medicine (CAM) at end of life: a pilot study in hospice residences in British Columbia.

While complementary and alternative medicine (CAM) can improve quality of life at end of life, little research exists on hospice residents' interest in using and sharing CAM experiences with a partner/friend/other family member. A pilot study conducted in British Columbia, Canada explored the extent of hospice residents' interest and openness to CAM use. A convenience sample of 48 hospice residents from 9 hospice sites completed questionnaire-based interviews. The majority of participants were Caucasian women over 60 years old. 81 percent expressed interest in receiving CAM; 79 percent used CAM prior to entering the hospice setting. 50 percent of those interested in using CAM felt their partner/friend/other family member would also be interested in receiving CAM, and half of that 50 percent reported personal interest in sharing the experience. Reasons reported for CAM interest were to enhance well-being, relaxation, and for pain relief. Further research could explore how resident-caregiver dyads may benefit from shared CAM experiences over the illness trajectory.

Breast cancer treatment and ethnicity in British Columbia, Canada.

BACKGROUND: Racial and ethnic disparities in breast cancer incidence, stage at diagnosis, survival and mortality are well documented; but few studies have reported on disparities in breast cancer treatment. This paper compares the treatment received by breast cancer patients in British Columbia (BC) for three ethnic groups and three time periods. Values for breast cancer treatments received in the BC general population are provided for reference. METHODS: Information on patients, tumour characteristics and treatment was obtained from BC Cancer Registry (BCCR) and BC Cancer Agency (BCCA) records. Treatment among ethnic groups was analyzed by stage at diagnosis and time period at diagnosis. Differences among the three ethnic groups were tested using chi-square tests, Fisher exact tests and a multivariate logistic model. RESULTS: There was no significant difference in overall surgery use for stage I and II disease between the ethnic groups, however there were significant differences when surgery with and without radiation were considered separately. These differences did not change significantly with time. Treatment with chemotherapy and hormone therapy did not differ among the minority groups. CONCLUSION: The description of treatment differences is the first step to guiding interventions that reduce ethnic disparities. Specific studies need to examine reasons for the observed differences and the influence of culture and beliefs.

Understanding Canadian Punjabi-speaking South Asian women's experience of breast cancer: a qualitative study.

BACKGROUND: Knowledge of women's experience with breast cancer is based on studies on middle-class Caucasian women. Generalizations are drawn from the few studies of South Asian women such as lack of desire to discuss personal and family issues. The purpose of this qualitative study was to understand the experience of Canadian Punjabi-speaking South Asian women in order to inform health care practices. DESIGN: Twenty women were recruited mainly through the local cancer center and word of mouth to participate in four focus groups conducted in Punjabi. All women spoke Punjabi and/or English, were involved in/or had completed cancer treatment and lived within driving distance of the local Cancer Center. FINDINGS: The themes that emerged from focus group data were all psychosocial: spiritual beliefs, patient inclusion, family systems, psychosocial distress and emotional expression. All women: (1) formed a strong spiritual connection, believed that it was fate or karma and that their cancer diagnosis was the will of God and women used this strength of spirituality to help them cope and (2) women were distressed by the diagnosis and prior to being exposed to cancer believed that cancer equals death. There was in-group difference amongst the women with the remaining themes: being alone to hear the diagnosis alone versus having family members present and feeling supported by family members versus being stressed by family and degree of inclusion desired in the decision-making process. The key findings which are contrary to previous research, is the women's desire to discuss their experience openly and the variation in experience within the group. The implication for practice for all professionals is not to make assumptions regarding therapeutic interactions with patients but to individually assess the clients and learn about their specific values and beliefs and incorporate spirituality in health care delivery.

Ethnic differences in survival for female cancers of the breast, cervix and colorectum in British Columbia, Canada.

BACKGROUND: Chinese and South Asians are among the fastest growing minority populations in Canada; however little is known about the burden of cancer in these populations. OBJECTIVE: The objective is to examine survival rates for breast, cervical and colorectal cancers in women within these two ethnic populations, as compared to the BC general population. METHODS: Survival rates were calculated for three time periods in the Chinese, South Asian and BC general populations, using the BC cancer registry. Ethnicity within the registry was determined using surnames. RESULTS: Survival rates for female breast, cervical and colorectal cancers have improved over time in all three population groups, however general differences were found among the groups. Chinese women had higher survival rates than both South Asians and all BC women for breast and cervical cancer, and intermediate survival rates between South Asians and all BC women for colorectal cancer. South Asian women had the highest survival rates for colorectal cancer, similar survival rates to all BC women for breast cancer, and lower survival rates for cervical cancer. INTERPRETATION: Differences in the observed survival rates may be explained by variations in screening and early detection, treatment practices, and cancer biology. This is discussed more fully for each cancer site.

The impact of acculturation on the use of traditional Chinese medicine in newly diagnosed Chinese cancer patients.

GOALS OF WORK: This study assessed the impact of acculturation on the prevalence of traditional Chinese medicine and other complementary and alternative medicine (TCM/CAM) use in newly diagnosed Chinese cancer patients. The individual determinants of TCM/CAM use among patients were also investigated. MATERIALS AND METHODS: A consecutive sample of Chinese cancer patients treated at the British Columbia Cancer Agency was surveyed at admission using a 15-item questionnaire. Items included TCM/CAM use, sociodemographics, as well as medical and cultural factors. Data were analyzed using bivariate methods including Pearson's X (2) test and Student's t test. As well, multiple logistic regression was used to obtain the final causal model. MAIN RESULTS: Of the 230 respondents, 57% completed the survey in Chinese and 94% were immigrants. The average age was 59. Participants had a mean disease duration of approximately 2 months and 79% had already received at least one conventional treatment. Overall, TCM/CAM was used by 47% of respondents. Herbal remedies, vitamins/minerals, and prayer were the most commonly used therapies. Multivariable analysis showed that prior TCM/CAM use (p < 0.001), having received conventional treatment(s) (p = 0.029), and being less acculturated (p = 0.028) were associated with TCM/CAM use. CONCLUSIONS: Prevalence and type of use were found to vary as a function of the degree of acculturation. Health care practitioners would be well advised to discuss TCM/CAM use with their patients, especially those who are less acculturated to Western society, since they are the most likely users of TCM/CAM.

Cancer incidence in Indians from three areas: Delhi and Mumbai, India, and British Columbia, Canada.

BACKGROUND: Studies of immigrants have provided unique opportunities for examining disparities in cancer screening and the impact of lifestyles and environmental exposures on cancer risk. Findings have been useful for planning cancer control strategies and generating etiological hypotheses. Although India is a leading source of immigration to British Columbia (BC), Canada, little is known about the cancer profiles of Indo-Canadians, information needed for planning health services and health promotion initiatives for this population. METHODS: Using data from three population-based cancer registries, cancer incidence was compared for four population groups (in each of Delhi and Mumbai, India; Indo-Canadians in BC, Canada; and the BC general population) over three time periods (1976-1985, 1986-1995 and 1996-2003). BC Indo-Canadians were identified by using Indian surnames. RESULTS: Age-standardized incidence rates (ASRs) for all cancers combined were lowest for men and women in Delhi and Mumbai, intermediate for BC Indo-Canadians, and highest for the BC general population. Ranking of common cancer sites and ASRs for Indo-Canadian men and women more closely resembled those for the BC general population, rather than those for either Delhi or Mumbai. ASRs and rankings of common cancer sites are presented by gender for the four population groups. CONCLUSIONS: Cancer incidence patterns in BC Indo-Canadian men and women differed from those in India, being more similar to the BC general population.

Development and validation of a psychosocial screening instrument for cancer.

BACKGROUND: We are reporting on the development of a psychosocial screening tool for cancer patients. The tool was to be brief, at a relatively low reading level, capture psychological variables relevant to distress and health-related quality-of-life in cancer patients, possess good reliability and validity, and be free of copyright protection. METHOD: Item derivation is described, data on reliability and validity as well as norms are reported for three samples of cancer patients (n = 1057; n = 570, n = 101). RESULTS: The resulting 21-item psychological screen for cancer (PSCAN) assesses perceived social support, desired social support, health-related quality-of-life, anxiety and depression. It has good psychometrics including high internal consistency (alpha averaging .83, and acceptable test-retest stability over 2 months (averaging r = .64). Validity has been established for content, construct and concurrent validity. CONCLUSION: PSCAN is considered ready for use as a screening tool and also for following changes in patient distress throughout the cancer care trajectory. It is freely available to all interested non-profit users.