Lung cancer today causes more deaths in the United States than any other malignancy. As in many diseases, socially disadvantaged people who develop lung cancer face greater mortality risks than the advantaged. This article examines relationships of selected social factors to treatment and survival in early-stage non-small cell lung cancer. Patterns of treatment and survival within this relatively homogeneous subgroup of lung cancer patients raise issues pertinent to the current debate over health care delivery in the United States.Reports
While several investigators have reported relationships between ethnic background and expression of pain, such relationships are in fact highly problematical. Few studies of pain and ethnicity have used quantitative measures of pain combined with multivariate methods of data analysis. Most have focussed on populations which, unlike many in the United States today, are characterized by highly distinct ethnic groups. The study reported here interviewed 536 persons recently treated for forms of cancer known to cause significant pain. Pain was assessed using standard, well validated instruments, including Graphic Rating Scales anchored in several alternative time-frames and the McGill Pain Questionnaire. The study took place in an area with a low proportion of recent immigrants and only small concentrations of distinct ethnic minorities. No statistically significant relationships were observed between ethnic identity and measures of pain sensation. However, pain described in affective terms according to the McGill Pain Questionnaire did vary among ethnicities. This observation suggests that cultures associated with specific ethnic identities still condition individual expression of pain despite the high degree of assimilation that has occurred among ethnic groups in the United States.
Although pain is widely recognized as a major problem in cancer patients, most studies have concentrated on pain among those with advanced or terminal cancer in specialized treatment settings. The study reported here gives a more complete picture of the problem of pain among cancer patients by providing data generalizable to those in early as well as late stages of the disease, and receiving care in the community as well as specialized treatment centers. Having included measures of several distinct features of pain, this study also provides a more complete understanding of the cancer patient's day-to-day pain problem than earlier investigations. The findings presented here indicate that serious pain may occur in all cancer stages, and often represents an ongoing medical problem. The data suggest that many patients may benefit from earlier and more aggressive use of available antipain treatment methods.
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