Cancer Outcomes in Hispanics/Latinos in the United States: An Integrative Review and Conceptual Model of Determinants of Health

Abstract

Cancer is the leading cause of death among Hispanics. Compared to non-Hispanic Whites, Hispanics are more likely to be diagnosed with advanced stages of disease and experience poor quality of life following a cancer diagnosis. Cancer outcomes are influenced by a confluence of social, cultural, behavioral and biological factors. Yet, much of the behavioral and psychosocial research in oncology has focused on non-Hispanic Whites, thus limiting our understanding of the potential web of factors that can influence cancer-related outcomes among Hispanics. Furthermore, features of Hispanic ethnicity and culture may influence and interact with, social, psychosocial, health care, disease-specific, and medical factors known to influence cancer-related outcomes, yet very few studies have integrated Hispanic cultural processes when addressing cancer-related outcomes for this ethnic group. Guided by the extant literature in oncology, Hispanic culture and health, and previously established models of determinants of minority health, we present a conceptual model that highlights the interplay of social, cultural, psychosocial, disease-specific, health care, and medical factors as determinants of cancer outcomes (morbidity, mortality, quality of life) and review key evidence of how features of Hispanic culture may influence cancer outcomes and contribute to the disparate outcomes observed in Hispanic cancer samples relative to non-Hispanic Whites. Finally, we conclude with a discussion of future research opportunities and existing challenges to researching oncology outcomes among Hispanics.

Keywords: Cancer; Culture; Hispanic; Psychosocial; Review.

Figure 1

Conceptual model of determinants of cancer outcomes in Hispanics. Socioeconomic and cultural factors are interrelated and indirectly contribute to cancer outcomes through a series of modifiable factors such as psychosocial factors (e.g., coping, support, behaviors), cancer disease-specific factors (e.g., tumor characteristics), health care factors (e.g., cancer treatments, patient-physician communication), and medical factors associated with cancer (e.g., infectious agents and obesity).