We Don't Talk about It: Cancer Pain and American Indian Survivors

The Landmark Series: Surgical Oncology Care in Native Americans-The Indian Health Service

American Indian and Alaska Natives (AI/ANs) are a heterogeneous group of people living throughout the USA with some of the highest cancer incidence and highest cancer-related mortality in the country. This landmark series seeks to highlight cancer care in this population by providing a historical context of the largest healthcare delivery system serving AI/ANs, the Indian Health Service (IHS). We will highlight how the dynamic nature of this population creates unique challenges and the need for dedicated resources to help eliminate cancer care disparities.

Great Plains American Indians' Perspectives on Patient and Family Needs Throughout the Cancer Journey

PURPOSE

To explore the perspectives on patient and family needs during cancer treatment and survivorship of American Indian (AI) cancer survivors, caregivers, Tribal leaders, and healers.

PARTICIPANTS & SETTING

36 AI cancer survivors from three reservations in the Great Plains region.

METHODOLOGIC APPROACH

A community-based participatory research design was employed. Postcolonial Indigenous research techniques of talking circles and semistructured interviews were used to gather qualitative data. Data were analyzed using content analysis to identify themes.

FINDINGS

The overarching theme of accompaniment was identified. The following themes were intertwined with this theme: (a) the need for home health care, with the subthemes of family support and symptom management; and (b) patient and family education.

IMPLICATIONS FOR NURSING

To provide high-quality cancer care to AI patients in their home communities, oncology clinicians should collaborate with local care providers, relevant organizations, and the Indian Health Service to identify and develop essential services. Future efforts must emphasize culturally responsive interventions in which Tribal community health workers serve as navigators to accompany patients and families during treatment and in survivorship.

Beyond Pain Scales: A Critical Phenomenology of the Expression of Pain

In this paper, we discuss the qualitative dimension of painful experiences by exploring the role of imagination and metaphorical association in the conceptualization and expression of pain. We employ an engaged critical-phenomenological approach to offer original analysis influenced by the perspectives of people in pain. The paper is organized into three parts. Part 1 reviews literature on the expression of pain, its communication, and its reception-attending in particular to the emphasis on verbalizing pain in healthcare contexts. We here discuss benefits and limitations of standard methods aimed at facilitating the meaningful expression of pain (such as "pain scales") from the perspectives of patients and practitioners, respectively. We suggest that these methods might be importantly complemented by facilitating creative expression of painful lived experiences with respect to personal lifeworlds. Part 2 deals with the role of imagination and metaphorical association in making sense of pain. We explore how imagination is a cognitive and affective mode of experiencing the world which plays a crucial role in determining how pain is experienced, as well as helping to make sense of pain figuratively in relation to the lifeworld. In Part 3, we draw from principles of engaged phenomenology to foreground case studies in which projects have been able facilitate the intersubjective expression of pain. These examples demonstrate the value of attending to the contours of painful lifeworlds in their specificity, affording both agency and accessibility in their communication, while remaining mindful of the complex power relations which govern perceived legitimacy and testimony relating to the transformation of pain. The overall paper aims to contribute to literature on qualitative pain research on both theoretical and practical levels. By exploring the expression of pain through phenomenology, we aim to enrich current debate on the qualitative experience of pain. We also seek to critically highlight the socio-political dimensions which frame painful experiences, their expression, their lived significance, and their treatment.

American Cancer Society's report on the status of cancer disparities in the United States, 2021

In this report, the authors provide comprehensive and up-to-date US data on disparities in cancer occurrence, major risk factors, and access to and utilization of preventive measures and screening by sociodemographic characteristics. They also review programs and resources that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. The overall cancer death rate is 19% higher among Black males than among White males. Black females also have a 12% higher overall cancer death rate than their White counterparts despite having an 8% lower incidence rate. There are also substantial variations in death rates for specific cancer types and in stage at diagnosis, survival, exposure to risk factors, and receipt of preventive measures and screening by race/ethnicity, socioeconomic status, and geographic location. For example, kidney cancer death rates by sex among American Indian/Alaska Native people are ≥64% higher than the corresponding rates in each of the other racial/ethnic groups, and the 5-year relative survival for all cancers combined is 14% lower among residents of poorer counties than among residents of more affluent counties. Broad and equitable implementation of evidence-based interventions, such as increasing health insurance coverage through Medicaid expansion or other initiatives, could substantially reduce cancer disparities. However, progress will require not only equitable local, state, and federal policies but also broad interdisciplinary engagement to elevate and address fundamental social inequities and longstanding systemic racism.

Trends in Participation Rates of the National Cancer Screening Program among Cancer Survivors in Korea

Simple Summary

Cancer survivors with a fear of cancer recurrence and a second, primary cancer after treatment take part in cancer screening as a self-care strategy. In other countries, the need for cancer screening guidelines for cancer survivors was identified by the participation rates of cancer screening among cancer survivors. However, there is no report of cancer screening practices among cancer survivors in Korea. Therefore, this study explored the participation rates of the cancer screening program among cancer survivors. The results of this study provide information on how many cancer survivors were screened for cancer and indicate the need for appropriate cancer screening guidelines for cancer survivors.

Abstract

The study aimed to describe the participation rates of the National Cancer Screening Program (NCSP) among cancer survivors in Korea. The NCSP protocol recommends that all Korean men and women should be screened for cancer. Cancer survivors were defined as those registered for any cancer in the Korea Central Cancer Registry by December 31 of the year prior to being included in the target population of the NCSP. In this study, the participation rates for the NCSP were calculated as the percentage of people who participated in four kinds of cancer screening programs, independently. The average annual percentage change was assessed. The participation rates of the general population and cancer survivors were higher than 40% in stomach, breast, and cervical cancer screening. These rates were higher than that of colorectal cancer screening in 2014. In addition, the participation rates in the NCSP in 2002–2014 increased for all cancer types. The NCSP participation rates of the cancer survivors indicate the high demand for cancer screening. Further research may investigate the effect of the NCSP on second cancer occurrence or mortality in cancer survivors and the significance of cancer screening guidelines for cancer survivors.