The Voice

“Tienes cáncer de pulmón”
(You Have Lung Cancer)

By Karen Hamel

“You have lung cancer” is difficult to hear in any language. For Hispanic Americans, this frightening news can be compounded by a number of barriers that make it hard to access high quality lung cancer information and care. (We also address this topic in our Backstage at Upstage podcast “¿Está el doctor?”.)

To begin with, the Hispanic population, which makes up approximately 17-18% of the US population, is not a singular group but includes people who trace their heritage to more than 20 Spanish speaking countries. Each of these countries has its own traditions, beliefs and cultural factors that can lead to barriers in access and affect how a person approaches health issues and medical care. For example, among Hispanic Americans there is a strong sense of family obligation and people often don’t want to burden their families with disease or health concerns. Family attitudes may also impact whether someone even goes to a doctor or seeks a diagnosis in the first place. A belief in folk healing as well as religiosity and spirituality among many Hispanic Americans are also important factors. In Mexican culture, for example, there is a strong conviction that life is in God’s hands and that natural remedies using herbs are the most effective way to heal illness.

Close knit hispanic family
Hispanic Americans have a strong sense of family obligation and people often don’t want to burden their families with disease or health concerns.

Language is often another barrier to excellent medical care. Federal law requires hospitals to provide linguistic services for people who only speak Spanish or who have limited English proficiency. However, in practice many patients find themselves in situations without qualified medical interpreters and may rely on family members for interpretation. Poor communication between patients and providers can contribute to errors, compliance issues and disparities in outcomes for Hispanic Americans. Or cultural attitudes may limit how much information the family member even shares with the patient. Even with a qualified medical interpreter available, it can be difficult for a patient to trust a third party stranger in the room, and the quality of interpretations can vary. In addition, there may be less opportunity for the provider to ask non medical questions that might help build rapport with the patient and provide additional insights into the patient’s situation.

Compounding these cultural and language factors are high poverty and low literacy levels – approximately 24% of Hispanics in America live below the poverty line and 35% have less than a high school education, which can affect their health literacy. Hispanic adults are less likely than other Americans to have health insurance and to receive preventative medical care, which can make them less likely to receive an early diagnosis, when cancer is more easily treated or cured. A further complication exists for those without permanent legal residence. Fears of deportation can lead to reluctance to seek help in the first place.

The good news is that there is growing awareness that more needs to be done and interest in addressing these barriers. Medical schools provide training in which students learn to ask questions that cover all aspects of meeting with patients, including taking their social history for information about occupation, marital status, living arrangements, hobbies, pets, and use of substances including tobacco and alcohol. Medical students also receive training about the social determinants of health, which are non-medical factors that can influence health outcomes. Social determinants of health include income and social protection; education; unemployment and job insecurity; working life conditions; food insecurity; housing; basic amenities and the environment; early childhood development; social inclusion and non-discrimination; structural conflict; and access to affordable health services of decent quality.

Some cancer centers have Spanish language networks and support groups for patients. In addition, there are Spanish language resources available that can help Hispanic patients and caregivers access information about lung cancer to better understand their disease and the treatment options available.

The following government, medical and patient organizations have Spanish-language lung cancer resources and information available; those that offer Spanish-language hotlines are noted with “linea telefonica.”