QOL and Cultural Differences: US and Canada


Quality of life and understanding of disease status among cancer patients of different ethnic origin

N Tchen1,3, P Bedard1, Q-L Yi1, M Klein1, D Cella2, S Eremenco2 and I F Tannock1

1Princess Margaret Hospital and University of Toronto, 610 University Avenue, Toronto, Canada M5G 2M9

2Center on Outcomes, Research and Education (CORE) Evanston Northwestern Healthcare 1001 University Place, Suite 100, Evanston, IL 60201, USA

Correspondence to: Dr I Tannock, Department of Medical Oncology and Hematology, Princess Margaret Hospital, 610 University Avenue, Toronto, Canada ON M5G 2M9. E-mail: ian.tannock@uhn.on.ca

3Current address: Institut Bergoniť, Bordeaux, France


Patients managed in European or North American cancer centres have a variety of ethnic backgrounds and primary languages. To gain insight into the impact of ethnic origin, we have investigated understanding of disease status and quality of life (QoL) for 202 patients.

Patients completed questionnaires in their first language (52 English, 50 Chinese, 50 Italian, 50 Spanish or Portuguese), including the Functional Assessment of Cancer Therapy - General (FACT-G) QoL instrument, questions about disease status, expectations of cure and the language and/or type of interpretation used at initial consultation.

Physicians also evaluated their status of disease and expectation of cure, and performance status was estimated by a trained health professional.

The initial consultation was usually provided in English (except for 32% of Chinese-speaking patients); interpretation was provided by a family member for 34% of patients with limited English proficiency (LEP) and by a bilingual member of staff for 21%.

Patients underestimated their extent of disease and overestimated their probability of cure (P=0.001 and <0.0001, respectively). Estimates of probability of cure by the English speakers were closer to those of their physicians than the other groups (P=0.02).

English-speaking patients reported better and Italian-speaking patients poorer overall QoL (P<0.001 for Italian vs other groups). Performance status was correlated with QoL and most closely related with the extent of disease.

Understanding of cultural differences is important for optimal management of patients with cancer.

British Journal of Cancer (2003) 89, 641-647.

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