Psychological outcomes in ethnically minoritised adolescents and young adults with cancer: A systematic review

Background
Ethnic disparities in cancer prevalence and health outcomes have been widely documented in adults. However, less is known about the impact of ethnic differences in young cancer patients who present with complex needs along their developmental trajectories. The present review aimed to examine psychological outcomes amongst ethnically minoritised adolescents and young adults (AYAs) with cancer.

Method
A systematic search was conducted on four databases using terms related to AYAs, cancer, ethnic minority and psychological outcomes. Quantitative studies of any design were included and screened against the eligibility criteria. Studies were rated for methodological quality and synthesised narratively.

Results
Twelve studies conducted in the United States were identified with mostly moderate to low quality and the evidence was mixed. Six studies found ethnic disparities in psychological outcomes: the majority demonstrated that ethnically minoritised AYAs experienced significantly more distress compared to White peers with cancer. Hispanic youths were highlighted as a vulnerable group that fared worse in their mental health compared to other minoritised youths. Longitudinal data showed that minoritised AYAs experienced more marked improvement in their psychological health over time compared to Caucasians.

Conclusion
There is emerging evidence regarding inter-ethnic differences in psychological outcomes amongst AYAs with cancer. However, the findings are inconsistent, reflecting methodological weaknesses and the complexities of intersectionality impacting on mental health. Further cross-cultural research is necessary to substantiate these findings and elucidate mechanisms behind these inequalities to promote more equitable healthcare.

Plain language summary
People’s risks of getting cancer, how they manage and their likelihood to survive can vary across different ethnic backgrounds. However, we do not know whether these differences we see in adults also exist in younger cancer patients. To understand more about this younger group who may have additional needs as they grow up to become adults, we wanted to find out from existing research whether the mental health of young cancer patients from minoritised backgrounds differ compared to White young patients. We conducted an in-depth search on four databases and compared the results from the relevant research studies.

After comparing 12 studies, our results were:
• Half of the studies showed that minoritised young people struggle more with their mental health compared to White young people.
• Hispanic youths in particular had worse mental health amongst all groups.
• The studies measured different things and their results were mixed, so it is hard to compare or draw any firm conclusions about whether young cancer patients’ mental health differed between ethnic groups.

We need to do more research to confirm these results and to understand more about why some ethnic groups with cancer might have poorer mental health.

Publications router.