Psychosocial Distress: A Case Study of a Male African American Veteran with End-Stage Colon Cancer

The prevalence of psychosocial distress among cancer patients is a significant problem. At least 30% to 45% of all cancer patients experience some form of distress, with much higher rates (70%) of distress found in patients with late-stage illness (Iconomou, Mega, Koutras, Iconomou, & Kalofonos, 2004; Loscalzo & Clark, 2007; Zabora, BrintzenhofeSzoc, Curbow, Hooker, & Piantadosi, 2001). Emotional distress is likely to occur among patients with a poor cancer prognosis, which indicates a need for addressing the psychological impact of having a terminal illness (Mystakidou et al., 2012); and, when endstage cancer is diagnosed unexpectedly, the impact of illness can suddenly change a person's life and trigger past experiences with trauma. This issue is more complex for older Vietnam veterans who have previously experienced trauma and loss, having to adjust to everyday circumstances after military service earlier in their life. Some research suggests that prior experience with death and loss earlier in life can influence a re-experiencing of trauma and can alter attitudes toward death and dying (Song, Ratner, Bartels, Alderton, Hudson, & Ahluwalia, 2007). Additionally, being diagnosed with end-stage cancer can exacerbate past psychological distress that was perceived as under control (Frazier & Caston, 2014). An important area of psychosocial cancer care focuses on poor health outcomes for disadvantaged populations. Due to health disparities such as low socioeconomic status and lack of preventive medical care, African Americans experience late-stage cancer diagnosis and high rates of death (DeSantis, Naishadham, & Jemal, 2013; Ward et al., 2004). In addition, daily stressful life-events as well as chronic stress that extends over time tend to have a substantial impact on health, especially among African Americans (Davis, Myers, Nyamathi, Brecht, Lewis, & Hamilton, 2014; Geronimus, Hicken, Keene, & Bound, 2006). As African Americans age, they also experience various psychosocial issues, along with chronic health problems, that impact life transitions and cause distress. For example, they can encounter food and housing insecurity, lack appropriate resources, and have difficulty accessing social services, complicating these problems and contributing to negative outcomes for African Americans (Lewinson, & Collard, 2012; Wingate-Lewinson, Hopps, & Reeves, 2010). In addition to the complex circumstances that older African Americans face, many who served in the United States military are aging and need additional medical care. Consequences of military service intensifies life circumstances placing older veterans at higher risks for depression, post-traumatic stress disorder, and experience other problems such as divorce and social isolation, which is especially possible for veterans who were exposed to combat, adding to chronic stress (MacLean, & Elder, 2007). Even though aging veterans may be entitled to health care benefits from the Department of Veterans Affairs, many do not use these services (Nelson, Starkebaum, & Reiber, 2007) leaving older African American veterans particularly vulnerable. For older veterans, other factors influence distress, for example, having comorbid medical conditions like hypertension and diabetes along with advanced cancer as well as geriatric symptoms consisting of fatigue, falls, and weight loss, all of which contribute to the complexity of care. Economic issues and financial pressures like inadequate health insurance and the lack of an income to pay for services further complicates the psychological well-being of seriously-ill, older adults, especially among older minority patients (LaVeist, Nickerson, & Bowie, 2000). Patients from racial and ethnic minority populations often experience greater incidence rates of cancer, more severe cancer burden, and worse health outcomes than their nonminority counterparts. In particular, according to a 2013-2014 American Cancer Society report, African American men have higher incidences and death rates for all cancers (American Cancer Society, 2014). …