Association of externalizing religious and spiritual beliefs on stage of colon cancer diagnosis among black and white multicenter urban patient populations

• Published in: Cancer Vol. 124; no. 12; pp. 2578 - 2587
• Main Authors: Polite, Blase N., Cipriano‐Steffens, Toni M., Hlubocky, Fay J., Jean‐Pierre, Pascal, Cheng, Ying, Brewer, Katherine C., Rauscher, Garth H., Fitchett, George A.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 15-06-2018
• Subjects: African Americans; Aged; Attitude to Health - ethnology; Black or African American - psychology; Black or African American - statistics & numerical data; Black people; Cancer; Colon; Colon - pathology; Colon cancer; colonic neoplasms; Colonic Neoplasms - diagnosis; Colonic Neoplasms - pathology; Colorectal cancer; Confidence intervals; Diagnosis; Female; Health care; health care disparities; Humans; Invasiveness; Male; Medical diagnosis; Metropolitan areas; Middle Aged; minority health; Multivariate analysis; Neoplasm Staging; Oncology; Patient Acceptance of Health Care - psychology; Patient Acceptance of Health Care - statistics & numerical data; Patients; Population studies; Problem solving; Race; Religion; Socioeconomic Factors; spirituality; United States; Urban Population - statistics & numerical data; Urban populations; White; United States; African Americans; minority health; colonic neoplasms; health care disparities; spirituality; religion
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.31351

BACKGROUND
This study explores whether externalizing religious and spiritual beliefs is associated with advanced‐stage colon cancer at initial oncology presentation and whether this association is stronger for blacks than for whites.
METHODS
Patients who had newly diagnosed, invasive colon cancer were recruited at 9 sites in the Chicago metropolitan area. Eligible patients were non‐Hispanic white or black, ages 30 to 79 years, and diagnosed with a primary invasive colon cancer. Patients were interviewed on prior screening and diagnosis. Social and attitudinal constructs were measured, including the God Locus of Health Control (GLHC) and Religious Problem Solving. The final response rate was 52% and included 407 patients.
RESULTS
The median age was 59 years (range, 30‐79 years), and 51% of participants were black. Cancer stage was available for 389 (96%) patients and was divided between late stage (stages III‐IV; 60%) and early stage (stages I‐II; 40%). Multivariate analysis indicated that patients in the highest tertile of scores on the GLHC were more likely have an advanced stage of disease at presentation (odds ratio, 2.14; 95% confidence interval, 1.00‐4.59; P = .05) compared with those in the lowest tertile. No significant interaction was identified between race and GLHC scores for stage at presentation (P = .78).
CONCLUSIONS
In a large sample of black and white individuals across diverse health care systems, higher scores on the GLHC predicted late disease stage at presentation. Although blacks had significantly higher GLHC scores, race was not associated with stage at presentation, nor was the association between GLHC and stage limited to blacks. Further work is needed to better understand this association and to develop interventions to better connect the religious and health care spheres. Cancer 2018;124:2578‐87. © 2018 American Cancer Society.
In a large cohort of black and white patients with cancer from the metropolitan Chicago area, strong religious beliefs, as captured by the God Health Locus of Control scale, are associated with advanced stage of colon cancer presentation.