The use of denial in an ethnically diverse British cancer population: a cross-sectional study

A total of 82 Asian and 117 randomly selected white Caucasian patients at the Leicestershire Cancer Centre were assessed using measures of coping and adaption to cancer. On the Mental Adjustment to Cancer (MAC) scale, Asian patients were more fatalistic (P<0.0001) and had more significant hopeless/helpless scores (P=0.007). The two ethnic groups answered the three questions thought to assess denial differently. Caucasians were more likely not to dwell on their illness (73 vs 55.5%, P<0.0001) and agree with the statement ‘I have difficulty believing this is happening to me’ (73 vs 60.5%, P<0.0001). However, Asian patients were more likely to agree with the statement ‘I don't really believe I have cancer’ (48.2 vs 31.3%, P=0.019). Within both groups there was an association with denial and anxious preoccupation (P<0.001). On the Hospital Anxiety and Depression (HAD) scale, there was no difference in anxiety scores between either sexes or between the Asian and Caucasian groups. However, Asian patients were more depressed (P=0.001). Although denial was significantly related to the presence of both depression (P<0.0001) and anxiety (P=0.001) in the entire patient population, there were different predictors of denial in each subgroup. On multiple regression analysis depression was linked with denial in Caucasians, whereas Fighting Spirit (minus helplessness/hopelessness) was linked with denial in Asian patients. There are definite differences in coping styles in British cancer patients according to ethnicity. While significant numbers in both groups employ denial in some form, Caucasian patients appear to adapt to the psychological pressures of cancer more successfully than Asian patients at a particular point in time. Further work is required to elucidate longitudinal relationships between denial and adaption to cancer.