Disparities in Cancer and Health in General

Several recent reports documented disparities in cancer disease burden among different population subgroups. Even as the overall burden of cancer is steadily falling, the decline varies for groups of different racial/ethnic and socioeconomic backgrounds [1,2]. For example, African American males are much more likely to develop any type of cancer than are white males. The incidence rate among African American males for developing any type of cancer is 689.2 per 100,000 compared to 556.5 among white males [3]. A similar trend has been noted among American Indians and Alaskan Natives, in which the incidence of leukemia and colorectal, stomach, and pancreatic cancers continues to increase [4]. In addition to higher cancer incidence, minorities and people from lower socioeconomic groups also tend to have high rates of death due to cancer. Incidence rates of developing breast cancer are higher among white women than among African American women (141.7 compared to 119.9). However, African Americans are more likely to die from it (mortality rate of 35.4 compared to 26.4) [3].

We argue that disparities or inequalities in communication are one possible explanation for such disparities in cancer in particular and health in general. Communication plays a central role in promoting preventive behaviors and in influencing patient-provider interactions [5,6,7]. In patient provider interactions, communication helps patients manage symptoms, reduces distress, and improves adherence to, and compliance with, treatment regimes. It also increases the patient's sense of control [8]. Inequalities in communication among different subgroups may therefore potentially lead to disparate outcomes among them.

Focusing on Communication

Communication plays a critical role in both treatment and post-treatment stages of cancer. At the time they receive a diagnosis of cancer and for some time afterwards, patients are eager to have information about their illness, status or the stage of disease, different treatment options, including complementary and alternative therapies, potential side effects of cancer treatment, and symptom management [9]. In the recovery and survival/post-treatment phase, they may seek information on prognosis, secondary prevention, quality of life and personal finances [10,11]. Patients may respond differently to these needs based on personality, on intellectual, monetary, and social resources, and on access to information.