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Case history

image A 44-year-old man of Irish-Chinese descent with a diagnosis of metastatic epidermal growth factor receptor (EGFR)-positive adenocarcinoma of the lung was admitted to the acute oncology ward with severe vomiting during his initial cycle of first line palliative treatment with the tyrosine kinase inhibitor (TKI) gefitinib. It transpired that he had been taking traditional Chinese medicine alongside his treatment.

Following discussion with the oncology pharmacist he was given advice about potential interactions between traditional Chinese medicine and anticancer therapy. The medications were adapted and the patient continued his treatment without further incident.

How does improving cultural competence in cancer services enhance the patient experience and care received?

What communication issues may arise during a consultation with a patient from a black and minority ethnic group?

What impact can complementary and alternative medicine (CAM) have on oncological treatment?

What role could the multidisciplinary team (MDT) play in his cancer care?

How does improving cultural competence in cancer services enhance the patient experience and care received?

Cultural competence in the context of healthcare encompasses the behaviours, attitudes and actions of the individual healthcare professional and organizations that can help to manage potential conflict that may arise through differences in culture.1 The definition of culture is far ranging and consists of the beliefs, behaviours, objectives and other characteristics common to members of a particular group or society. This case focuses on the role of ethnic background and language. It is important, however, for healthcare professionals to consider other factors that patients may use to define themselves, including sexuality, religion, geography, income and education.

We live in an increasingly diverse and multiethnic society. According to the 2011 census in England and Wales, over two decades the proportion of the population describing themselves as belonging to a black and minority ethnic group increased from 5.9% in 1991 to 14% in 2011.2 As a result, coupled with a rising incidence of cancer,3,4 more black and minority ethnic patients are engaging with cancer services across the UK. There is increasing concern about health inequalities in these groups, specifically access to cancer services, from screening to referral for specialist treatment to palliative and end-of-life care.5,6 Promoting interactions and understanding between cancer care practitioners and black and minority ethnic patients may therefore significantly improve engagement with treatment and cancer outcomes.

The main impact of culture on healthcare arises from systematic health beliefs, rather than linguistic differences. Health beliefs relate to an internalized construct that informs an individual's understanding of health and illness. They may directly influence the patient's willingness to seek help when unwell, impact on the patient's description of symptoms and also affect adherence to treatment or follow-up. In Western societies, most healthcare professionals subscribe to the biomedical model. This explains disease in the context of biological processes; for example, lung cancer is known to be ...

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