Alberta Cancer Foundation

Adding Colour to the Sixth Vital Sign


Dr. Bejoy Thomas, University of Calgary researcher.

Photos by Drew Myers
Canada may have universal health care, but it doesn’t always translate into equal access to treatment and support programs. When it comes to cancer, visible minorities are not tapping into the full spectrum of health-care services and are consistently suffering from higher levels of distress than other segments of the population.

While most cancer patients suffer from a variety of emotional and physical complications like anxiety, pain, fatigue and depression, those symptoms are 30 per cent more prevalent with minorities, according to the results of a 2009 study spearheaded by Dr. Bejoy Thomas, research fellow in the department of psychosocial oncology at the Tom Baker Cancer Centre in Calgary.

“Our findings show that someone who looks different and speaks English as a second language is at greater risk of being distressed during their cancer treatment,” says Thomas. “They have significantly higher symptom burdens. Everyone in Canada has access to the same resources and the same programs, but not all patients are taking advantage of those. People don’t perceive some of the services we provide as relevant to them, even though we know they need it.”

The Research
Thomas and his colleagues tracked the progress of 2,400 patients at the Tom Baker Cancer Centre. Each patient filled out an extensive survey when they entered the facility and their progress was monitored after three, six and 12 months. Visible minorities entering the system showed higher levels of distress, yet often didn’t take advantage of programs designed to alleviate those conditions.

Despite that disparity, Thomas does not finger racism or discrimination as the cause of the results. Rather, he suggests that the health-care system has simply failed to package services in a way that reaches out to people of different cultures. “Health-care providers need to revisit the way we care for our patients,” he says. “We have created some exceptional programs, but we do not adjust or adapt them to different populations. It’s not the patient’s fault. We expect people to adapt to the system. It’s about communication. It’s about taking five extra minutes up front and finding a middle ground with the patient, connecting with people from different cultures.”

Just asking the ethnicity question is a rarity in Canada. With universal access, it has been broadly assumed that people of all races, ages and gender receive and access services in the same way. Statistics related to cancer and ethnicity were not even available in Canada until Thomas published his findings in a paper entitled “Cancer Patient Ethnicity and Associations with Emotional Distress – the 6th Vital Sign: A New Look at Defining Patient Ethnicity in a Multicultural Context.” “In theory, we should have equality because we have a flat system, which creates a supposedly level playing field,” Thomas says. “There has been much more research along these lines in the United States, where they talk about African American men having a 25 per cent higher mortality rate and 40 per cent higher morbidity rate in cancer, compared to white American men.

“We do not have those statistics in Canada because we have not asked the ethnicity questions to begin with. We assume there is a level playing field. Not asking the question doesn’t mean something does not exist.”

An International Lens
Thomas brings a uniquely international perspective on health care and cancer treatment to his research. He was born and raised in Dubai, but his parents were originally from India. He moved back to India to attend high school and university and earned a master’s degree in psychology and a PhD in Applied Sciences. During the course of those studies, he had an opportunity to see the impact of cancer in a variety of different cultures and countries. “No one escapes the distress of cancer. It’s not like getting the flu,” he says. “Patients across the world, no matter what language or culture, they all have the same questions. Am I going to die? Am I going to live? Can I eat the same food? Can I have sex? We are all human and we all have the same concerns.”

Thomas brought that experience with him when he accepted a position at the Tom Baker Cancer Centre in 2005 and he was thrilled with the opportunity to work at a facility so committed to treating the mental and emotional distress associated with cancer. Since arriving, he has continued his post-doctoral studies and has focussed his efforts on research and discovering ways to make the health-care system more responsive to the needs of all people.

“We have the largest psychosocial oncology department in the country. This is where things are happening  – where I wanted to be. We are changing practices in cancer care across the country and the work I am doing is just a small part of what is taking place here,” he says. “I want to make this a better health-care system. My focus is to figure out if we are helping patients make the right choices. Why are we missing pockets of people and thereby creating disparity in outcomes? Can we facilitate better processes?”


CULTURE OF STRESS: University of Calgary researcher Dr. Bejoy Thomas found that people who had English as a second language had significantly higher levels of stress during cancer treatments.

Adapting the System
Thomas suggests that a good way to start addressing those disparities is by adopting a more consumer-driven health- care model. That doesn’t imply privatization, but rather a shift in attitude where patients come first. Take the example of banks. All Canadian banks may have the same basic services across the country, but the way they market and deliver those services changes in places like Chinatown, or on Bay Street, or in any other distinctive market.

“We obviously can’t deliver services in 15 different languages, but we have to be mindful of the patient and try to understand what will work for them,” Thomas says. “You do the same thing, but you just adapt it to different populations. That’s the key to the whole thing. You need to think about marketing these programs and services. We have a great ship, but to make it a luxury cruise liner we need to add these extra things.”

Thomas hopes to continue this line of research in the future and help create a truly universal health-care system that is accessible to everyone. This will ultimately drive down costs and make the system more efficient as well. “With the expansion of minority and immigrant populations across Canada, there should be a strong incentive to address their needs because patients with higher symptom burdens overutilize the system. They have more visits to physicians and specialists, more visits to emergency and more tests. We are spending money on these patients when we could be putting those resources to better use in other areas of health care.”