title: The relationship between ethnicity and the pain experience of cancer patients: a systematic review.
abstract: BACKGROUND
  Cancer pain is a complex multidimensional construct. Physicians use a patient-centered approach for its effective management, placing a great emphasis on patient self-reported ratings of pain. In the literature, studies have shown that a patient's ethnicity may influence the experience of pain as there are variations in pain outcomes among different ethnic groups. At present, little is known regarding the effect of ethnicity on the pain experience of cancer patients; currently, there are no systematic reviews examining this relationship.
  
  
  METHODS
  A systematic search of the literature in October 2013 using the keywords in Group 1 together with Group 2 and Group 3 was conducted in five online databases (1) Medline (1946-2013), (2) Embase (1980-2012), (3) The Cochrane Library, (4) Pubmed, and (5) Psycinfo (1806-2013). The search returned 684 studies. Following screening by inclusion and exclusion criteria, the full text was retrieved for quality assessment. In total, 11 studies were identified for this review. The keywords used for the search were as follows: Group 1-Cancer; Group 2- Pain, Pain measurement, Analgesic, Analgesia; Group 3- Ethnicity, Ethnic Groups, Minority Groups, Migrant, Culture, Cultural background, Ethnic Background.
  
  
  RESULTS
  TWO MAIN THEMES WERE IDENTIFIED FROM THE INCLUDED QUANTITATIVE AND QUALITATIVE STUDIES, AND ETHNIC DIFFERENCES WERE FOUND IN: (1) The management of cancer pain and (2) The pain experience. Six studies showed that ethnic groups face barriers to pain treatment and one study did not. Three studies showed ethnic differences in symptom severity and one study showed no difference. Interestingly, two qualitative studies highlighted cultural differences in the perception of cancer pain as Asian patients tended to normalize pain compared to Western patients who engage in active health-seeking behavior.
  
  
  CONCLUSIONS
  There is an evidence to suggest that the cancer pain experience is different between ethnicities. Minority patients face potential barriers for effective pain management due to problems with communication and poor pain assessment. Cultural perceptions of cancer may influence individual conceptualization of pain and affect health-seeking behavior.
authors.affiliation: School of Medicine, Cicely Sauders Institute, King's College London, London, United Kingdom.
authors.forename: Wingfai
authors.initials: W
authors.lastname: Kwok
authors.affiliation: School of Medicine, Cicely Sauders Institute, King's College London, London, United Kingdom.
authors.forename: Thakshyanee
authors.initials: T
authors.lastname: Bhuvanakrishna
keywords: Cancer; Culture; Ethnicity; Pain