Abstract
Cancer fatalism-the belief that death is inevitable when cancer is present-has been identified as a barrier to participation in cancer screening, detection, and treatment. Yet this literature has not been reviewed in a comprehensive and systematic manner. Therefore, this literature review addressed (1) philosophical and theoretical underpinnings of cancer fatalism; (2) relationships among demographic factors, cancer fatalism, and cancer screening; (3) the role of cancer fatalism for patients diagnosed with cancer; and (4) intervention strategies. Most of the reviewed studies were descriptive or correlational, did not have an explicit theoretical framework, had varied definitions of fatalism, and reported screening as "intent to screen" or as "past screening behaviors." Review of the studies suggests that cancer fatalism develops over time and is most frequently reported among medically underserved persons and those with limited knowledge of cancer. Cancer fatalism may be modified through culturally relevant interventions that incorporate spirituality. Emphasis must be placed on recognizing the role of cancer fatalism when planning health promotion activities. Future studies should focus on the consistent measurement of cancer fatalism and testing intervention strategies.
Cancer fatalism-the belief that death is inevitable when cancer is present-has been identified as a barrier to participation in cancer screening, detection, and treatment. In the recent past, discussions of cancer fatalism were often limited to anecdotal findings or as implications for future research. These perceptions of cancer fatalism have frequently been identified through the analysis of data from focus groups and interviews. 1-4 But empirical and theoretical research that sought to measure cancer fatalism as an independent or dependent variable was sparse. In 1980, the landmark study sponsored by the American Cancer Society and conducted by an African-American-owned evaluation group called EVAXX, Inc 5 was critical in documenting the view of "cancer as a death sentence" among the 750 African Americans who took part in the study. This study further highlighted many of the glaring disparities between African Americans and Caucasians with regard to cancer knowledge and health behaviors. For example, the report found that African Americans underestimated the prevalence of cancer, were pessimistic about its cure, and were less knowledgeable about cancer, compared to Caucasians. Sadly, many of these same factors continue to highlight the disparities in cancer care for some African Americans.
Then the introduction of Freeman's Poverty-Cancer spiral perhaps signaled a new paradigm in which fatalism was viewed as an interrelationship between race, poverty, and cancer. 6 Further, Freeman 6 identified fatalism as a significant barrier to cancer care that should be acknowledged and appropriately addressed. 6 In 1995, one of a few theory-based studies to evaluate perceptions of cancer fatalism was introduced, 7 and in 1996, a review of the literature of cancer fatalism was published. 8 This report focused on the philosophical origins of cancer fatalism, differing theoretical and operational definitions of cancer fatalism, research findings, and implications for nursing. 8 The brevity of that review (6 studies) highlighted the lack of empirical research on the phenomenon at that time.
Since the review of studies on cancer fatalism published in 1996, 8 research that specifically addresses cancer fatalism as an independent or a dependent variable has significantly increased. While there continues to be a lack of consistency regarding theoretical and operational definitions of the phenomenon as identified in the 1996 review, the current research on cancer fatalism has expanded to encompass its influence at multiple points along the cancer continuum (prevention and early detection, treatment, multiple cancer types, and intervention strategies to modify fatalistic perceptions). But this literature has not been reviewed in a comprehensive and systematic matter. Such a review is imperative in order to understand how the state of the science about cancer fatalism has evolved since the 1996 review. 8 Therefore, this literature review seeks to answer 4 questions: (1) What are the philosophical and theoretical principles that shape an understanding of cancer fatalism? (2) What are the relationships among demographic factors, cancer fatalism, and cancer screening (breast, cervical, skin, colorectal)? (3) What role does cancer fatalism play for patients diagnosed with cancer? and (4) What interventions are used to modify perceptions of cancer fatalism? Implications for future research will also be explored.