Introduction

Culture could be defined as that complex whole which includes knowledge, belief, art, morals, law, custom, and any other capabilities and habits acquired by man as a member of society. The influence of culture is very pervasive, it is not restricted to religious rituals, and can be detected in several aspects of advanced cancer care.

Traditional issues in advanced cancer care related to culture

Traditionally culture has been associated with some issues considered to be relevant in the setting of advanced cancer:

• Rituals of dying and death.

• Manners of grieving and the grieving process itself.

• Gender roles and family systems.

• Emotional expression and sharing.

• Dietary requirements and use of alternative therapies.

• Beliefs about causation of illness.

New issues in advanced cancer care related to culture

There are several “new” issues emerging in the care of advanced cancer that are related to culture:

• Terminal sedation versus euthanasia.

• Last 48 hours of life versus traditions of Agonía.

• Definition of “terminality.”

• Hospice versus nonhospice traditions.

• External versus internal locus of control and acceptance of death.

• Perceived value of disclosure and cognition.

• Communication – diagnosis disclosure – truth-telling.

Diagnosis disclosure

The last decade has witnessed a transition in health professionals in the UK and USA from “full open disclosure” to “conditional disclosure” of terminal diagnosis and prognosis when confronting dying patients. Simultaneously, research in countries such as Spain, Italy, Japan, Greece, Portugal, Israel, France, Colombia, and the Philippines has prompted the review of the long-held assumption that diagnosis disclosure is always in the best interest of the patient.