Social disparities and cancer-related stress
Socioeconomic disparities in health have been demonstrated over a wide range of health outcomes. A differential capacity to cope with stressful life events has been proposed as one mechanism contributing to disparities. SES differences in coping with cancer-related stressors are the subject of this thesis. Study 1 examined SES differences in psychological distress associated with cancer screening. Lower SES groups had lower psychosocial wellbeing but were not more vulnerable to adverse psychological consequences. Study 2 tested the hypothesis that SES differences in adjustment to a cancer diagnosis are greater when the prognosis is poorer. There was some evidence that lower SES groups were more adversely affected by a more advanced disease stage diagnosis compared to higher SES groups. The qualitative interviews in Study 3 considered the possibility that this was due to differential experience of care, but found little evidence that cancer patients' experiences of medical care differed by SES. Studies 4, 5 and 6 used a large longitudinal sample of cancer patients (breast, prostate and colorectal). Study 4 explored whether SES moderated psychosocial adjustment related to the types of treatment received, presence of co-morbidity or disease stage at diagnosis. The effect of receiving surgery appeared to diminish rather than increase SES differences in adjustment. Study 5 showed that higher SES groups had more psychosocial resources to cope with a cancer diagnosis and that resources were related to psychosocial wellbeing, but despite this, Study 6 found no evidence that lower SES groups experienced poorer adjustment to a cancer diagnosis over time. Overall the studies found little evidence that lower SES gives greater vulnerability to serious stressors, and if anything, suggested that a cancer diagnosis seemed to minimise the expected SES differences in psychological wellbeing.