Elsevier

Cancer Epidemiology

Volume 35, Issue 2, April 2011, Pages 194-201
Cancer Epidemiology

Workshop Report
Health-related quality of life outcomes among cervical cancer survivors: Examining ethnic and linguistic differences

https://doi.org/10.1016/j.canep.2010.06.006Get rights and content

Abstract

Background: This study aims to investigate the utility of an explanatory health-related quality of life (HRQOL) model for cervical cancer survivors. Specifically, this study focuses on the different patterns in the structural model of HRQOL by ethnic and language groups. Methods: Secondary data derived from 560 European- and Latina-American cervical cancer survivors was used. The study methodology was guided by the Contextual Model of health-related quality of life. Results: Structural equation modeling demonstrated significant differences in the overall structural models for HRQOL by ethnicity. For example, European-Americans showed significant association between radiation therapy and HRQOL, while life burden was related to sexual impact for Latina-Americans only. The results showed the significant mediating effects of general health status and psychological well-being between patient–doctor relationship and HRQOL, and between life burden and HRQOL, respectively, for all ethnic and language groups. While language group differences (limited English vs. English proficient) among Latina-Americans emerged in bivariate analyses; these distinctions were not upheld in the overall structural models. Conclusion: The unique contribution of the individual- and systemic-level components in predicting overall HRQOL outcome seems to vary by ethnic group membership. Our findings advance our understanding of the predictors and the association among the predictors of HRQOL. This study may contribute to the evolution of culturally and linguistically responsive HRQOL conceptual frameworks and instrumentation for vulnerable populations.

Introduction

Cervical cancer survivors (CCS) may experience medical, physical, psychological, social, functional and sexual disruptions after diagnosis and treatment of cervical cancer resulting in tremendous burden in daily life [1], [2], [3], [4]. The physical effects of the cervical cancer and its treatment are numerous and can include fatigue, pain, bladder dysfunction, and vaginal and bowel problems [5], [6], [7], [8]. Additionally, survivors of cervical cancer have reported psychological distress such as anxiety, anger, and mood disturbance [2], [9], [10], [11]. Further, the sexual and reproductive side effects resulting from the treatments for cervical cancer include reduced sexual desire, premature menopause, loss of fertility, and reduction in vaginal elasticity often resulting in pain and impaired sexual functioning [11], [12], [13].

The U.S.-based studies on CCS’ health-related quality of life (HRQOL) have primarily focused on European-American women; thus limited research exist addressing Latina-American CCS [14], [15]. Latina-Americans are over-represented among cervical cancer cases, and experience poorer HRQOL [3], [16]. Earlier findings using linear models suggest that socio-ecological (e.g., income, work status, neighborhood contexts and life-stress) and cultural factors may contribute to HRQOL outcomes in cancer survivors [17].

Therefore, this study employed the Contextual Model of HRQOL [18] that incorporates socio-ecological and cultural dimensions as the theoretical and analytical foundation to explain HRQOL of CCS. This Model proposes that HRQOL is shaped by two components: individual-level and systemic-level factors (Fig. 1). Individual-level factors are comprised of variables that are expected to have a stronger influence and directly predict HRQOL, while systemic-level factors assert a broad yet weaker impact on HRQOL [19]. As a result, this model assumes the mediating effects of individual-level factors between systemic-level factors and HRQOL.

This study examines the different patterns in the structural model of HRQOL by ethnicity (European- vs. Latina-Americans). Structural differences by language (Spanish, only vs. English proficient) are also investigated for the Latina-American survivors. Thus, the main research question is “Will pathways among predictors influencing HRQOL vary according to ethnicity and language?”

Section snippets

Methods

This study used secondary data derived from 560 European- (n = 273) and Latina-Americans (n = 287) who participated in a HRQOL study for CCS [20], [21]. The study employed a cross-sectional design with a population-based sample drawn from the California Cancer Surveillance Program and hospital registries. Participants were within 1–5 years of a cervical cancer diagnosis (stages I–III) and currently cancer free. Additionally, they were not diagnosed with another type of cancer and 18 years or older.

Sample characteristics

The final sample consists of 273 European- and 287 Latina-American CCS. About 30% of Latinas (n = 88) preferred to participate in English, and about 70% of Latinas (n = 199) preferred Spanish. The mean age of all participants was 49 years (SD = 12.1). The mean years since cancer diagnosis were about 3 years (Mean = 3.29; SD = 1.6). Spanish-speaking Latinas were more likely to report lower income level, compared to European- and English-speaking Latina-Americans (Table 1). Table 2 illustrates that the

Discussion

This study intended to investigate differences in the pathways among predictors influencing HRQOL between European- and Latina-American CCS based on the Contextual Model of HRQOL. Moreover, language group categories were included to understand the impact of language among Latina-Americans. The SEM results demonstrated that there are significant differences in the overall structural models by ethnicity, but the language group differences were not upheld for Latin-American CCS. The Contextual

Funding source

Research supported by a grant from the California Cancer Research Program (#2110008).

Conflict of interest statement

There is no conflict of interest.

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