Psychosocial Predictors of Delay in Seeking Cancer Treatment in Viet Nam

Vanderbilt University, Nashville TN

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Abstract

PROJECT SUMMARY Successful treatment of cancer in LMIC faces many resource limitations (e.g., lack of trained personnel), but also is impacted by psychosocial factors such as fatalism and lack of symptom knowledge that can increase treatment seeking delay, resulting in presentation for treatment at later cancer stages. This occurs in high income countries (HIC) as well, but may be of particular importance in LMIC due to their resource limitations. In addition, whereas 70% of cancer deaths occur in LMIC, the large majority of research in this area has been conducted in HIC. Our U.S. and Vietnamese team has been funded by U.S. NIH and the Vietnamese government for 15 years to develop mental health research, training, and clinical capacity in Vietnam, and our behavioral health and mental health-related infrastructure here is well developed. We recently extended this work to include the mental health of cancer patients, in Danang, Vietnam (Yen, Weiss & Trung, 2016), developing collaborative relationships with the Danang Oncology Hospital (DOH). During discussions there, our colleagues shared their concern that a large proportion of their patients appeared to significantly delay seeking medical support after becoming aware of their symptoms. They also noted that addressing such behavioral issues (e.g., why people delay treatment seeking) was beyond their oncology-focused expertise. This led to this R21 collaboration, which has four primary activities: (1) Conduct a needs assessment in Vietnam in regards to research and policy related to cancer treatment seeking delay. (2) Conduct a pilot study of predictors of delay in treatment seeking among DOH patients. Predictors will include fatalism, avoidant coping style, knowledge of cancer symptoms, and others, providing data of substantive value and for planning future, more full-scaled research. A central research goal is to identify cultural moderators of these variables' effects on delay. In addition, the pilot study will provide direct information regarding capacity and needs in this research area; this goal is derived from our experience over the past 15 years that the way to most deeply understand research strengths and needs is, in conjunction a needs assessment, to conduct pilot research in the area. (3) Provide training seminars in this area. The seminar content will be based in part on results of the above activities but likely will include areas such as statistical analysis of behavioral health data (provided by the mental health side of the team), and cancer symptoms and symptom progression (provided by the cancer side of the team). (4) Develop a plan for more in-depth research, and for a public health campaign to address identified issues. This will include, as suggested by the data, additional research (e.g., at other oncology hospitals in Vietnam) as well as future development and evaluation of public health campaigns to increase public understanding of cancer treatment seeking delay. A long-term goal is to use our knowledge of cancer treatment seeking delay in Vietnam and investigate how to apply it to other NCD here such as heart disease.