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April is National Minority Cancer Awareness Month: Achieving cancer health equity

Note: This post is written by the team of The ONE Group (Oncology – Nutrition – Exercise) at Penn State College of Medicine as part of a first-person blog about their work. Learn more about the group here.

There is growing urgency to address cancer health inequities in the United States, including among our Hispanic or Latino population.

Hispanics are the largest ethnic minority group in the country with 57 million people, and 1 million call Pennsylvania their home. Cancer is now the leading cause of death among U.S. Hispanic men and women, and approximately 30% will be diagnosed with cancer at some point in their lifetime. Compared to non-Hispanic Whites, Hispanics are more likely to be diagnosed with advanced stages of disease and experience poor quality of life following a cancer diagnosis. As a result, they also experience disparities in cancer symptom severity and management.

A meta-analysis on psychological morbidity among U.S. ethnic minority groups, many of whom were diagnosed with breast cancer, found that Hispanics experienced significantly greater distress, worse social well-being, and worse overall quality of life compared to other ethnic minority groups.

Cancer outcomes in the general public are influenced by a range of interconnected socioeconomic, cultural, psychosocial, disease-specific, health care and medical factors. Unfortunately, a majority of Hispanics enjoy little socioeconomic resources and experience high stress exposure caused in part by social disadvantage, leading to observed poor cancer outcomes. Additionally, cultural factors among Hispanics, like language and cancer-related beliefs, are associated with cancer outcomes through access to health care and adherence to healthy behaviors like physical activity.

Of note, Hispanics are less physically active and experience higher rates of comorbid conditions when compared to non-Hispanic whites. We know that exercise prevents and reduces an array of health conditions, including risk of certain cancers. However, Hispanic cancer survivors also face unique challenges and barriers to exercise despite knowing benefits of physical activity and are underrepresented across exercise oncology trials.

The Oncology, Nutrition and Exercise (ONE) Group is leading a transformation in cancer care by establishing evidence-based physical activity and nutrition interventions as the standard of care; we acknowledge that this transformation cannot happen without our Hispanic cancer patient population.

To make progress in this area, The ONE Group is involved in activities to understand the causes of cancer health disparities among minorities in our catchment area and how best to culturally adapt and test evidence-based interventions for improving physical activity and nutrition.

A major focus of our group is to incorporate the needs and preferences of those individuals for whom our interventions are being developed. In this way, cancer patients, including those from a Hispanic heritage, are involved in all aspects of studies providing feedback to study content, materials and procedures for cultural appropriateness. When developing interventions or adapting existing ones, we look for maximizing surface and deep structure characteristics.

Surface structure adaptations involve changes that address observable and superficial aspects of the target population’s culture. On the other hand, deep structure adaptations involve changes based on deeper cultural, social and psychological factors that influence behaviors.

With these decisions, we intend to address potential intervention features that are culturally incompatible or require modifications to be more appealing to the new or underserved populations. We always aim to strike a balance between community needs and preferences and scientific rigor.

Looking ahead, we are not only positioning The ONE Group as a national leader in exercise oncology research, but also leading the way to achieve cancer health equity in our region. As a team, our premise is that every project should include an equity focus to ameliorate the cancer disparities observed in Pennsylvania. Equity begins with us.

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