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The Color of Cancer:

U-M Comprehensive Cancer Center works to eliminate racial, ethnic health disparities, con't

SPEAKING UP ABOUT PAIN

For minorities, women and older adults, cancer pain is less likely to be assessed, according to Carmen R. Green, M.D., a professor at the U-M Medical School and a pain medicine physician at the U-M Cancer Center. And even if it is, minorities and women are more likely to receive suboptimal treatment.

Green says the reasons for this are unclear: Are minorities, women and older adults less likely to complain about pain to providers? Do myths about pain prevent them from seeking treatment? Do they have less access to care? Are providers dismissing their complaints? One study has suggested that pharmacies in minority neighborhoods may be less likely to carry prescription pain medications, but more research is necessary to understand the full nature of the problem.

In the meantime, Green is seeking to educate people about the importance of pain management. Pain robs patients of their health and well-being, but many treatment options are available, from physical therapy to nerve blocks. Green encourages patients to talk to their providers about pain.

"We also need to be engaged in public policy at a national level," Green said. "Our country only spends a small percentage of research dollars on pain, and with more people surviving cancer, we're likely to see a pain epidemic. As a society, we need to hear firsthand from patients why this is an important issue."

IMPROVING COMMUNICATION

As Green's research indicates, communication breakdowns may be occurring between minority patients and their healthcare teams. Sarah Hawley, Ph.D., M.P.H., an associate professor of internal medicine at the U-M Comprehensive Cancer Center, has surveyed breast cancer patients to determine how much they understand about concepts related to their diagnosis.

Her study found that all patients had gaps in understanding, but it was worse among African-Americans and Latinas. In addition, a separate study of Hawley's has shown that Latina women -- many of whom primarily spoke Spanish -- who were less integrated into American society were more likely to be dissatisfied or regret treatment decisions.

"To make an informed decision about surgery or other treatment options, you have to be able to understand the risks and benefits," Hawley said. "We know that people of different cultures receive information differently. We know there are opportunities to improve the way healthcare providers communicate, even among the general population."

Hawley's group is piloting a Web-based intervention that will help patients at the U-M Cancer Center and the Karmanos Cancer Institute in Detroit consider the risks and benefits of treatment options. She is also working on another study to record doctor-patient conversations to analyze differences in communication styles among white, African-American and Latina patients.

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This article first appeared in the Winter, 2011 issue of Thrive.

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