Health & Medicine

How do you get a skeptical patient to test for cancer? UCD, health center target cultural barriers

Reducing ethnic cancer disparities proud moment for De Vere White

Dr. Ralph de Vere White, UC Davis cancer center director, describes efforts to reduce ethnic cancer disparities; including high rates of liver cancer among Asian Americans, breast cancer deaths among American Indian women and advanced-stage colon
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Dr. Ralph de Vere White, UC Davis cancer center director, describes efforts to reduce ethnic cancer disparities; including high rates of liver cancer among Asian Americans, breast cancer deaths among American Indian women and advanced-stage colon

Cancer kills more Asian Americans every year than any other disease. They, along with Pacific Islanders, have the highest incidence rates for liver and stomach cancers and are twice as likely to die from these cancers as whites, according to the National Cancer Institute.

Oftentimes, cancer is caused by infectious viruses such as hepatitis B and human papillomavirus, which can be prevented with a vaccine.

But, medical providers often face cultural barriers when it comes to cancer screenings and treatment, said J. Miguel Suarez, clinical director of a health center that serves about 10,000 Asian American patients in the Sacramento region.

"To a certain extent, we've done a lot to break down those barriers, but to a large extent there are cultural barriers to health screenings including a Pap smear, or a breast exam or even colon cancer screening," said Suarez, of the Health and Life Organization (HALO), a federally qualified health center. "So . . . it's very difficult to screen these patients when there are cultural barriers and familial attitudes that limit a patient’s willingness to be properly screened."

To tackle this issue, HALO and UC Davis Cancer Center are launching a three-year project to increase screenings and cancer treatment for Asian Americans in the primary care setting. The project is funded by a $750,000 grant from Bristol-Meyers Squibb.

HALO physicians and medical staff will be trained by UC Davis oncologists in the latest developments in cancer care, and strategies for delivering that information to patients who may be skeptical or unwilling to undergo treatment, said Moon Chen, an associate director at the Cancer Center.

Kazoua Heu, 31, said her father, a Hmong immigrant, expressed unwillingness to go through treatment when he was diagnosed with cancer in 2011.

"Most of the individuals who have migrated here from their respective countries because of the war-torn nature they were experiencing as well as the persecution, coming here they don't have the education," Heu said. "They live in areas where education is not a priority . . . so their education is based off of their ability to survive. And if that respect if they're ill, what are they going to do? What type of avenue, what type of resources are they going to seek out holistically as well as ritualistically to heal them?"

Muand Saeturn, an immigrant from Laos, said she lived far away from doctors, so she would have to go into the jungle to find plants for medicine. Even now, she has relatives send her packages of roots and herbs that she steeps in hot water and drinks for medicinal purposes.

Heu said she recalled a time when she hurt her ankle as a child and her mother wrapped it with herbs for weeks until it healed. She said she wanted to go to a doctor, but her parents didn't think it was necessary.

Heu's parents approached Sao's cancer with the same outlook, she said.

Sao had told his primary care physician that he was having trouble breathing out of his right nostril months before his diagnosis. His doctor told him multiple times to get a blood test and an MRI, but Sao refused.

He instead relied mostly on traditional medicines, drinking teas

He experienced fevers and night chills, and still he wouldn't go. He was having trouble breathing, so he went to the emergency room, where he was prescribed a nasal decongestant.

Meanwhile, the tumor in his face continued to grow. He lost vision in his right eye, couldn't hear or swallow.

Heu said it took months to persuade her dad to see a doctor to find out what was wrong. And when he was diagnosed, she struggled to explain it to him.

Language is another significant barrier, Suarez of HALO said. The medical terminology doesn't translate directly.

"When the translation of languages are done between English and say, Hmong, the words don't translate literally," Heu said. "In the Hmong language . . . there isn't a specific word that says' I have leukemia.' There isn't a specific word that says, 'I have Non-Hodgkin lymphoma.' I have to describe that back to my parents. I would have to describe it and say, 'Dad, you have this hard-like tumor in your face.' And how do I tell him it metastasized to his brain?"

"And in describing that to my dad, he actually downgrades the seriousness of it because he doesn't hear the seriousness of it," she said.

As a part of the new project, physicians who are already fluent in many Asian languages, will learn how to use written and schematic tools, such as pictures, to help patients understand diagnoses and treatments, Suarez said.

HALO's electronic medical record system will be upgraded to track patients' test results, prescriptions and doctor's visits.

"But, that problem can't be solved with just a patient encounter with a provider, Suarez said.

Asian Americans' mortality rates from cancer are in decline, but only a slow decline, according to data from the Centers for Disease Control and Prevention.

Heu pushed her father to go through cancer treatments to try to save his life. After a year of chemotherapy and radiation treatment, his cancer went into remission.

But a few months later, the cancer returned. He died in 2013 at age 66.

UC Davis and HALO's cancer project is already underway to treat patients. "We're trying to improve that access so people have it sooner," Suarez said.

Stephen Magagnini contributed to this report.

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