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