Abstract
Breast cancer is the most common cancer among Latinas. This study examined social, cultural, and health care system factors that impact the quality of life and survivorship experiences of Latina immigrant breast cancer survivors. We interviewed Latina breast cancer survivors (n = 19) and, based on the interview findings, conducted two focus groups (n = 9). Research staff translated transcripts from Spanish into English. Two trained raters reviewed the content and identified themes. Thematic content analysis was used to categorize and organize data. Participants were largely monolingual in Spanish, predominantly from Central and South America and most (68%) had lived in the U.S. for ten or more years. All women were diagnosed and treated in the U.S. and were an average of 3.1 years from diagnosis. Women’s survivorship experiences appeared to be shaped by cultural beliefs and experiences as immigrants such as secrecy/shame about a breast cancer diagnosis, feelings of isolation, importance of family support (familism), challenges with developing social relationships in the U.S. (less personalismo), and, for some, their partner’s difficulty with showing emotional support (machismo). Navigating the U.S. medical system and language barriers were additional challenges in the participants’ health care interactions. Latina breast cancer survivors adhere to certain cultural values and face unique issues as immigrants, potentially influencing overall quality of life and doctor–patient communication. Efforts to improve Latina immigrant breast cancer survivors’ quality of life could include increased assessment of psychosocial functioning and referral to social support services, culturally sensitive navigation programs, and consistent use of appropriately trained interpreters.
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References
Huerta EE (2003) Cancer statistics for Hispanics, 2003: good news, bad news, and the need for a health system paradigm change. CA Cancer J Clin 53:205–207
Napoles-Springer AM, Ortiz C, O’Brien H et al (2007) Use of cancer support groups among Latina breast cancer survivors. J Cancer Surviv 1:193–204
Paskett ED, Alfano CM, Davidson MA et al (2008) Breast cancer survivors’ health-related quality of life: racial differences and comparisons with noncancer controls. Cancer 113:3222–3230
Ashing-Giwa KT, Padilla G, Tejero J et al (2004) Understanding the breast cancer experience of women: a qualitative study of African American, Asian American, Latina and Caucasian cancer survivors. Psychooncology 13:408–428
Ashing-Giwa KT, Padilla GV, Bohorquez DE et al (2006) Understanding the breast cancer experience of Latina women. J Psychosoc Oncol 24:19–52
Eversley R, Estrin D, Dibble S et al (2005) Post-treatment symptoms among ethnic minority breast cancer survivors. Oncol Nurs Forum 32:250–256
Lopez-Class M, Gomez-Duarte J, Graves KD et al (2011) A contextual approach to understanding breast cancer survivorship among Latinas. Psychooncology (in press)
Sammarco A, Konecny LM (2008) Quality of life, social support, and uncertainty among Latina breast cancer survivors. Oncol Nurs Forum 35:844–849
Wildes KA, Miller AR, de Majors SS et al (2009) The religiosity/spirituality of Latina breast cancer survivors and influence on health-related quality of life. Psychooncology 18:831–840
Yanez B, Thompson EH, Stanton AL (2011) Quality of life among Latina breast cancer patients: a systematic review of the literature. J Cancer Surviv 5(2):191–207
Angel R, Thoits P (1987) The impact of culture on the cognitive structure of illness. Cult Med Psychiatry 11:465–494
Kagawa-Singer M, Kassim-Lakha S (2003) A strategy to reduce cross-cultural miscommunication and increase the likelihood of improving health outcomes. Acad Med 78:577–587
Surbone A, Kagawa-Singer M, Terret C et al (2007) The illness trajectory of elderly cancer patients across cultures: SIOG position paper. Ann Oncol 18:633–638
Hammond PB (1978) Introduction to cultural and social anthropology, 2nd edn. Macmillan, New York
Betancourt JR, Green AR, Carrillo JE et al (2003) Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep 118:293–302
Kleinman A, Eisenberg L, Good B (1978) Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med 88:251–258
Ashing-Giwa K, Kagawa-Singer M (2006) Infusing culture into oncology research on quality of life. Oncol Nurs Forum 33:31–36
Epstein RM, Street RL Jr (2007) Patient-centered communication in cancer care: promoting healing and reducing suffering. National Cancer Institute, NIH Publication, Bethesda, No. 07–6225
Institute of Medicine, National Research Council of The National Academies (2006) From cancer patient to cancer survivor: lost in transition. The National Academies Press, Washington
Spencer SM, Lehman JM, Wynings C et al (1999) Concerns about breast cancer and relations to psychosocial well-being in a multiethnic sample of early-stage patients. Health Psychol 18:159–168
Rodriguez MA, Bustamante AV, Ang A (2009) Perceived quality of care, receipt of preventive care, and usual source of health care among undocumented and other Latinos. J Gen Intern Med 24:508–513
Perez D, Ang A, Vega WA (2009) Effects of health insurance on perceived quality of care among Latinos in the United States. J Gen Intern Med 24:555–560
Buki LP, Garces DM, Hinestrosa MC et al (2008) Latina breast cancer survivors’ lived experiences: diagnosis, treatment, and beyond. Cultur Divers Ethnic Minor Psychol 14:163–167
Sheppard VB, Figueiredo M, Canar J et al (2008) Latina a Latina: developing a breast cancer decision support intervention. Psychooncology 17:383–391
Campesino M, Schwartz GE (2006) Spirituality among Latinas/os: implications of culture in conceptualization and measurement. ANS Adv Nurs Sci 29:69–81
Sanchez-Burks J, Nisbett RE, Ybarra O (2000) Cultural styles, relational schemas, and prejudice against out-groups. J Pers Soc Psychol 79:174–189
Jackson LM, Esses VM, Burris CT (2001) Contemporary sexism and discrimination: the importance of respect for men and women. Pers Soc Psychol Bull 27:48–61
Schwartz SJ (2007) The applicability of familism to diverse ethnic groups: a preliminary study. J Soc Psychol 147:101–118
Luquis RR, Villanueva CI (2006) Knowledge, attitudes, and perceptions about breast cancer and breast cancer screening among Hispanic women residing in South Central Pennsylvania. J Community Health 31:25–42
Sullivan MC (2001) Lost in translation: how Latinos view end-of-life care. Plast Surg Nurs 21:90–91
Perez-Stable EJ, Sabogal F, Otero-Sabogal R et al (1992) Misconceptions about cancer among Latinos and Anglos. JAMA 268:3219–3223
Abraido-Lanza AE, Viladrich A, Florez KR et al (2007) Commentary: fatalismo reconsidered: a cautionary note for health-related research and practice with Latino populations. Ethn Dis 17:153–158
Hunt LM, de Voogd KB (2005) Clinical myths of the cultural “other”: implications for Latino patient care. Acad Med 80:918–924
Collins D, Villagran MM, Sparks L (2008) Crossing borders, crossing cultures: barriers to communication about cancer prevention and treatment along the U.S./Mexico border. Patient Educ Couns 71:333–339
Cianelli R, Ferrer L, McElmurry BJ (2008) HIV prevention and low-income Chilean women: machismo, marianismo and HIV misconceptions. Cult Health Sex 10:297–306
Sobralske MC (2006) Health care seeking among Mexican American men. J Transcult Nurs 17:129–138
Morse JM, Field PA (1995) Qualitative research methods for health professionals, 2nd edn. Sage, Thousand Oaks
Galanti GA (2003) The Hispanic family and male-female relationships: an overview. J Transcult Nurs 14:180–185
Cavazos-Rehg PA, Zayas LH, Spitznagel EL (2007) Legal status, emotional well-being and subjective health status of Latino immigrants. J Natl Med Assoc 99:1126–1131
Viruell-Fuentes EA (2007) Beyond acculturation: immigration, discrimination, and health research among Mexicans in the United States. Soc Sci Med 65:1524–1535
Yanez BR, Maly RC, Stanton AL (2011) A structural equation model on treatment decision making among Latinas with breast cancer. Ann Behav Med 41(Suppl 1):s74
Powe BD, Weinrich S (1999) An intervention to decrease cancer fatalism among rural elders. Oncol Nurs Forum 26:583–588
Teal CR, Street RL (2009) Critical elements of culturally competent communication in the medical encounter: a review and model. Soc Sci Med 68:533–543
Wells KJ, Battaglia TA, Dudley DJ et al (2008) Patient navigation: state of the art or is it science? Cancer 113:1999–2010
Acknowledgments
We would like to thank Janet Cañar, M.D., MPH. for her assistance with data collection and manuscript preparation and to Melissa Figuerido, Ph.D., for her involvement with the early phases of this project. Thank you also to Claire Selsky, MA, for her time and expertise as a coder and to Susan Marx, who provided additional assistance with manuscript preparation. We are also very appreciative of the support and collaboration provided by Nueva Vida, Inc. We are also indebted to our participants for sharing their stories with us. Finally, we would like to thank members of the Latin American Cancer Research Coalition (LACRC): Jessika Angulo-Duarte, Stacey Banks, Janet Cañar, M.D., MPH; Enrique Cobham, MBA; Michael Dalious, MA; Marguerite Duane, M.D., MHA; Kirsten Edmiston, M.D.; Karol Espejo; Amanda Graham, Ph.D.; Ronald Greger, M.D.; Margarita Gutierrez; Elmer Huerta, M.D., MPH; Anna Maria Izquierdo-Porrera, M.D.; Gheorge Luta, Ph.D.; Barbara Merritt, RN; Lilian Meza; Noel Mueller, MPH; Anne-Michelle Noone, MS; Donetta Padmore; Nancy Pallesen, MSW; Margarita Paredes, M.D., MS; Jyl Pomeroy, RN; Dino Ramzi, M.D., MPH; Christine Reesor, MSN, FNP; Yosselyn Rodriquez; Juan Romagoza, M.D.; Michael Sanchez, MPH, CHES; Claire Selsky, MA; Vanessa Sheppard, Ph.D.; Cherie Spencer, MS; Alicia Wilson; and Bin Yi, MS. These LACRC team members and investigators provided support and assistance in the conduct of this study. We also thank Susan Marx for her assistance with the manuscript preparation.
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Supported by Susan G. Komen for the Cure grant no. POP0601292 and NCI grant no. K07CA131172 (KDG), NCI grant no. U01CA114593 and K05CA96940 (JM) from the National Cancer Institute.
Appendix: Focus Group Discussion Guide
Appendix: Focus Group Discussion Guide
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1.
What does the term “quality of life” mean to you?
Possible probes:
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(a)
Physical functioning
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(b)
Psychological functioning
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(c)
Spiritual functioning/religion
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(d)
Social relationships: deepening of connection with family or friends
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(e)
Functional: ability to work, provide for family
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(a)
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2.
What impacts your current quality of life?
Possible probes:
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(a)
Physical changes since treatment
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(b)
Weight gain/weight loss
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(c)
Relationships: family, friends
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(d)
Intimate relationships: changes in sexual functioning
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(e)
Work stress
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(f)
Attitude
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(a)
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3.
What symptoms (or side effects) do you currently experience because of your cancer treatment?
Possible probes:
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(a)
Loss of functioning in arm
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(b)
Weight gain/weight loss
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(c)
Change in sexual desire, menopause
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(d)
Changes in attitude
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(e)
Cognitive changes (memory, word-finding ability)
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(a)
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4.
How does your family impact your quality of life?
Possible probes:
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(a)
Spouse/partner
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(b)
Children, parents
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(c)
Siblings
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(d)
Extended family—here and back home
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(a)
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5.
How has language ability impacted your quality of life?
Possible probes:
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(a)
Communicating with health care team
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(b)
Communicating about insurance
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(a)
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6.
How have your values impacted your quality of life?
Possible probes:
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(a)
Spiritual beliefs/attitude (optimism)
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(b)
Family orientation
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(c)
Not wanting to burden others
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(d)
Keeping health concerns private
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(a)
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Lopez-Class, M., Perret-Gentil, M., Kreling, B. et al. Quality of Life Among Immigrant Latina Breast Cancer Survivors: Realities of Culture and Enhancing Cancer Care. J Canc Educ 26, 724–733 (2011). https://doi.org/10.1007/s13187-011-0249-4
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DOI: https://doi.org/10.1007/s13187-011-0249-4