Understanding psychosocial implications, barriers, risks, and impacts.
Key Facts
Fastest-Growing Demographic
Hispanic/Latinx communities are the fastest-growing population in the US.
In 2023,the US Census Bureau reported that the Hispanic/Latinx community constitutes approximately 19.5% of the US population, making it the fastest-growing demographic group in the country. Among the 65.2 million Hispanic/Latinx individuals residing in the US, cancer accounts for 17% of deaths, making it the second leading cause of mortality in this population.1
Medication adherence is a critical determinant of quality of life and survival rates for individuals diagnosed with cancer. Treatment options vary depending on the type and stage of cancer and may include oral medications, intravenous therapies, targeted treatments, and surgical interventions. Each of these options presents distinct psychological factors and implications for adherence. However, elements such as race, ethnicity, and immigration status significantly influence medication adherence, regardless of the treatment modality.
Historically, research on medication adherence has focused on microlevel factors, such as behavioral and mental health components. Many studies, however, have been biased due to a lack of understanding of cultural factors, as well as the impacts of implicit bias, stereotypes, and systemic racism.2
Although behavioral and psychological factors are undeniably important, it is essential to recognize that many of these issues are manifestations of macrolevel components rooted in systemic disparities, such as health care inequities, social determinants of health, systemic racism, and historical trauma. Acknowledging these macrolevel factors not only reflects their influence on psychological well-being but also helps prevent the pathologizing of mental health symptoms linked to these broader systemic issues.
Medication adherence is a critical determinant of quality of life and survival rates for individuals diagnosed with cancer.
Health care providers can play a crucial role in identifying patients at risk of nonadherence and addressing tangible concerns that may hinder medication adherence among Hispanic/Latinx patients with cancer. By understanding the unique factors impacting this community, health care professionals can avoid perpetuating stereotypes and biases that affect the delivery of care to their Hispanic/Latinx patients.
Understanding The Impact Of Historical Events
Historical trauma is defined as a collective, multigenerational experience of emotional and psychological injury affecting specific racial, ethnic, or cultural groups.3 Past events can shape psychological factors, attitudes, and beliefs toward the health care system. Significant historical traumas—including slavery, colonialism, discrimination, racism, and forced migration—have contributed to widespread mistrust of the health care system within the Hispanic/Latinx community due to previous unethical and discriminatory medical practices and immigration policies that impact access to care.
Two notable examples are the birth control trials conducted on Puerto Rican women, which led to coercive sterilizations without informed consent,4 and the Tuskegee study, which involved Black men in the US and was later expanded to Central and South American countries, such as El Salvador, Panama, Costa Rica, and Guatemala, where participants were denied treatment without their knowledge.5
The impacts of these historical injustices are transmitted across generations, shaping individuals’ perceptions of the medical system. When patients encounter discrimination or receive substandard care, it reinforces existing mistrust. Medical mistrust significantly contributes to medication nonadherence; patients who lack trust in their providers are less likely to seek information about their diagnosis, voice concerns regarding treatment, or engage in shared decision-making.
Health Care Disparities And Social Determinants Of Health
Health care disparities refer to differences in access to services based on factors such as race, ethnicity, gender identity, sexual orientation, age, and geographic location. According to the US Department of Health and Human Services, Hispanic/Latinx individuals are twice as likely to be diagnosed with and die from liver cancer compared with non-Hispanic/Latinx White individuals. Additionally, they face higher rates of stomach cancer diagnosis and mortality, as well as a 40% higher likelihood of cervical cancer diagnosis compared with non- Hispanic/Latinx White women.6
These statistics reflect significant disparities in cancer care and are influenced by social determinants of health, which encompass the environmental conditions affecting quality of life. Key social determinants include socioeconomic status, language proficiency, literacy, access to education, safe housing, transportation, and health insurance coverage.
In the Hispanic/Latinx community, issues surrounding health insurance, which are often exacerbated by immigration status and limited health literacy, create substantial barriers to accessing care. Hispanic/ Latinx individuals have the highest rates of lack of insurance among racial and ethnic groups. Although the Affordable Care Act has improved coverage for some, many individuals still face limited access to preventive care, rehabilitation services, and specialist consultations. This leads to additional challenges in affording treatments, forcing patients to choose between out-of-pocket expenses and forgoing care altogether. Financial toxicity—stemming from the burden of health care and living costs—affects mental health and coping abilities, contributing to feelings of hopelessness, increased psychological distress, and medication nonadherence. Furthermore, many Hispanic/ Latinx patients encounter language barriers or lower literacy levels, complicating their understanding of diagnoses, treatment options, and the importance of adherence.7
Cultural Considerations
Cultural humility is vital in the context of patient-centered care and addressing medication nonadherence. It is essential to recognize that the Hispanic/ Latinx population is not monolithic, as it encompasses a wide array of cultures and racial backgrounds. However, certain cultural trends are common among individuals who identify as Hispanic/Latinx in the US. Familismo is a cultural value that emphasizes the importance of the family unit and decision-making.8 When faced with a cancer diagnosis, individuals often rely heavily on family input regarding treatment options and financial considerations. If family members disagree on treatment, it can create emotional distress for the patient, subsequently influencing their beliefs and adherence to prescribed therapies.
Medication adherence among Hispanic/Latinx patients with cancer is profoundly influenced by a combination of historical, cultural, and systemic factors. The legacy of historical trauma, alongside health care disparities and social determinants of health, shapes patients’ perceptions of the medical system and their willingness to engage in treatment. Understanding these multifaceted factors is crucial for health care providers seeking to improve adherence and outcomes in this community.
By acknowledging the unique cultural values and addressing the systemic barriers that contribute to medical mistrust and anxiety, health care professionals can foster more effective communication and support. Implementing care that prioritizes the specific needs of Hispanic/Latinx patients not only enhances adherence but also promotes overall health equity. As the Hispanic/Latinx population continues to grow, the health care system must evolve to meet their needs, ensuring that every patient receives equitable care that respects their cultural context and individual experiences.
References:
COVID-19 Pandemic Emphasizes Disparities in Cancer Care
September 17th 2021“We’ve had periods of time where things were shut down. We do have telemedicine, that was expanded, but telemedicine doesn’t work for everyone. If you don’t have internet access, if you don’t have the ability to understand the technology….”
