Cancer patients psychological adjustment and perception of illness: cultural differences between Belgium and Turkey

Little is known about cultural differences in psychological adjustment and perception of illness (PI) during medical procedures in general and radiotherapy in particular. This study compares a Turkish (TP) and a French speaking Belgian (BP) population. A group of 296 consecutive patients attending the radiotherapy clinic of Institut Jules Bordet, Brussels, (n = 172) and Oncology Institute, Capa-Istanbul, (n = 124) were interviewed and assessed by a symptom checklist, the SCL-90-R, at the beginning and at the end of the radiotherapy. PI, derived from a semi-structured interview, was assessed at the beginning of radiotherapy by a five-point observer-rating scale derived from the Omega Vulnerability Rating Scale. Differences in SCL-90-R scores, taking into account country, age, gender, level of education and PI as potential explanatory variables, have been tested by a multivariate analysis of variance with a design of repeated measures using the SCL-90-R scores as dependent variables. Mainly a time effect and a country effect have been found. Some interactions between both effects have also been found. Globally, all the SCL-90-R scores decrease between the beginning and the end of the radiotherapy. The effect of country is noticeable for most of the SCL-90-R components, with higher scores in the BP, except for the positive symptom total score where the TP showed higher scores. The interaction between country and time is not significant, the scores of both the BP and TP decreasing over time, except for somatization scores (P < 0.001) where the scores of the BP were stable over time while the scores of the TP decreased considerably, and for paranoid ideation scores (P = 0.001) where the scores of the BP decreased while the scores of the TP increased. Results showed a higher rate of correct perception in the BP compared to the TP (P = 0.0001). A PI effect has been found for somatization (P = 0.02), anxiety (P = 0.01) and Global Severity Index scores (P = 0.05), with higher mean scores for the "correct perception" category. No interaction with time was found. A significant interaction effect between country and PI has been found for anxiety scores with higher scores in the correct perception category in the BP and in the "denial of implications" category in the TP (P < 0.001). Results highlight cultural differences in psychological adjustment and/or in the responses to self-report questionnaires: greater weight was given to items by the BP, more numerous items were scored by the TP, and greater weight was given to the somatization subscale compared to the psychological subscales by the TP. This study suggests that psychosocial distress is expressed differently in Belgium and Turkey, where patients express mostly somatic complaints. Finally PI, a culture-dependent factor, appears to influence psychological adjustment very differently, a correct perception of illness leading to more anxiety in the BP compared to the TP.