Internationalcultural Perspectives On Quality Of Life

With the likelihood of cancer survivorship increasing, support and ongoing care for the survivors moves to the focus of care; however, survival and living with the deficits that the cancer and its treatment may have caused is colored by the culture within the individual survivor resides. Notably, until recently in Japan, physicians would not share a cancer diagnosis with a patient, feeling that such knowledge would have a dramatic psychological effect on the individual, thus harming their quality of life.29

What is meaningful survivorship in one culture may be very different in another, often defined as the cultural consensus on what quality of life means. For example, Chaturvedi found in a sample of Indian cancer patients, family members, and their caregivers the 10 most important factors related to quality of life.30 In this culture, she found that the level of individual functioning was not nearly as meaningful to them as was having "peace of mind," "spiritual satisfaction," "satisfaction with religious acts," and "happiness with family." These results contrast the values that most North Americans and Europeans have regarding the importance of the independence of the individual.

Similarly,Juarez et al.31 spoke with cancer patients who were ofMexican ancestry. Reporting on what quality of life meant to them, these patients equated quality of life with being happy, remaining in an active lifestyle, and interacting with family. The four domains of quality of life, physical, psychological, social, and spiritual, were all influenced by the role of the family and the Hispanic's faith in God. Pain was noted by many Hispanics as needing to be endured because it was a component of life that helps one reach heaven. Additionally, frequently the use of the word "cancer" is not even spoken, with many family members wanting to keep this from the patient believing they may die sooner if they knew. This then has implications for the type of support family members offer one another. Findings of this study identified the importance of considering the Hispanic culture in the care of survivors.

A more recent study conducted in Hong Kong to better understand the adaptation process of Chinese gynecological cancer survivors also illustrates the role of culture in cancer survivorship. It was reported that the Chinese women felt that the cause of these types of cancers, similar to other "sexual disorders," was a result of an imbalance of the Yin and Yang elements due to excessive sexual activity that has, in turn, weakened the female body.32 Other factors, such as education level,the patriarchal family structure, and the submissive role of women within the culture were also thought to influence beliefs about cancer.33 These factors were found in another study of 62 long-term gynecological cancer survivors where it was demonstrated that many of the women felt guilty for not being able to meet their husband's sexual needs and felt the disharmony in their sex lives.34 The Chinese women in this study defined quality of life as having mobility, accepting one's outlook, social support, and being able to eat. This focus on practical functional matters follows from the tendency that the breast in Asian cultures does not hold the same meaning on a sexual or body image level as it does in Western society.35

Some perceptions and cultural beliefs find the Chinese population to perceive that cancer is infectious, and related to certain excessive behaviors. In studies related to gynecological cancer, women believed that the cancer will recur if they have sex after treatment or that sex will cause the cancer to progress.32,36 On the other hand,most of time the traditional healers or folk practitioners are able to spend more time with their patients attending to personal and social issues of helping the individual, for example, regain the balance in life, the balance that Chinese healers believe becomes disrupted and seen as producing the tumor (Traditional Chinese medicine does not use the concept of cancer, but it does use the concept of tumor.)37 This time spent with the patient addressing this imbalance may culturally be more of what a cancer survivor may require.38 For example, folk healers are typically closer in social class to the patients they are working with, and the emphasis on explaining the medical problem more closely aligns with the patient's understanding of how disease and illness occurs (i.e, the imbalance of energy).38 In western nations various behaviors are ascribed to problems in health as well such as overeating, inactivity, smoking talk about need to look at attitudes and health across cultures and how to maximize health behaviors as per cross cultural risk factors for chronic illnesses or problems that occur secondary to cancer in cancer survivorship.

5.1. Developing Countries

It is well known the developing countries lag behind the industrialized nations on many fronts related to environmental health and health care,22 affecting their views on what cancer survivorship means. In most Third World countries, the focus of health care is on a basic, primary prevention and primary care level. For example, Africa views cancer as an emerging public health issue, partnering with the HIV/AIDS outreach programs to address the control of cancer, especially ones of growing incidence related to HIV-associated malignancies and cancers caused by exposures to carcinogens in the African environment.

The WHO's Millennium Development Goals included aspects of eradicating poverty and hunger, enhancing maternal health,reducing childhood mortality, and combating HIV/AIDS, malaria,and tuberculosis.39 These goals also included plans to increase sanitation levels, education rates, and the empowerment of women. Given the priorities and complexities of achieving the preceding goals, the role of cancer prevention, diagnosis, and treatment remains secondary. However, as discussed, these countries are now being included in world cancer registries to gain a better understanding of the magnitude cancer within their countries.

Basics of Spiritual Living

Basics of Spiritual Living

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