Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-25T21:02:51.215Z Has data issue: false hasContentIssue false
  • English
  • Français

Challenges of illness in metastatic breast cancer: A low-income African American perspective

Published online by Cambridge University Press:  18 June 2009

Margaret Quinn Rosenzweig ,
Theresa Wiehagen ,
Adam Brufsky  and
Robert Arnold
Margaret Quinn Rosenzweig*
Affiliation:
University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
Theresa Wiehagen
Affiliation:
University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
Adam Brufsky
Affiliation:
University of Pittsburgh Cancer Institute/Magee Women's Hospital, Pittsburgh, Pennsylvania
Robert Arnold
Affiliation:
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
*
Address correspondence and reprint requests to: Margaret Quinn Rosenzweig, University of Pittsburgh School of Nursing, 3600 Victoria Building, Room 329-A, Pittsburgh, PA 15261. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Disparities in breast cancer survival and treatment for African American and low income women are well documented, yet poorly understood. As care for women with metastatic breast cancer (MBC) evolves to a chronic care model, any inequities in optimal treatment and management of symptoms must also be identified and eliminated. The purpose of this study was to explore how race and income status influence women's experiences with MBC, particularly the management of symptoms, by describing the perceived challenges and barriers to achieving optimal symptom management among women with MBC and exploring whether the perceived challenges and barriers differed according to race or income.

Method:

Quantitative techniques were used to assess demographics, clinical characteristics, symptom distress, and quality of life and to classify women into groups according to race and income. Qualitative techniques were used to explore the perceived challenges, barriers, and potential influences of race and income on management of symptoms in a prospective sample of 48 women with MBC.

Results:

Commonalities of themes across all groups were faith, hope, and progressive loss. Low-income African American women uniquely experienced greater physical and social distress and more uncertainty about treatment and treatment goals than the other delineated racial and economic groups.

Significance of results:

There are many commonalities to the challenges of illness presented to women with MBC. There are also interesting, emerging thematic racial and economic differences, most compelling among the low income African American women with resultant practice and research implications.

Keywords

Grounded theoryInformal carersThreats to caring
Type
Original Articles
Information
Palliative & Supportive Care , Volume 7 , Issue 2 , June 2009 , pp. 143 - 152
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Ashing-Giwa, K. (1999). Quality of life and psychosocial outcomes in long-term survivors of breast cancer: A focus on African-American women. Journal of Psychosocial Oncology, 17, 47–62.CrossRefGoogle Scholar
Bach, P.B., Schrag, D., Brawley, O.W., et al. (2002). Survival of Blacks and Whites after a cancer diagnosis. Journal of the American Medical Association, 287, 2106–2113.CrossRefGoogle ScholarPubMed
Berg, J.W., Ross, R. & Latourette, H.B. (1977). Economic status and survival of cancer patients. Cancer, 39, 467–477.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
Bickell, N., Wang, J. & Oluwole, S. (2006). Missed opportunities: Racial disparities in adjuvant breast cancer treatment. Journal of Clinical Oncology, 24, 1357–1361.CrossRefGoogle ScholarPubMed
Born, W., Greiner, A., Sylvia, E., et al. (2004). Knowledge, attitudes, and beliefs about end-of-life care among inner-city African Americans and Latinos. Journal of Palliative Medicine, 7, 247–256.CrossRefGoogle ScholarPubMed
Borum, M., Lynn, J. & Zhong, Z. (2000). The effects of patient race on outcomes in seriously ill patients in SUPPORT: An overview of economic impact, medical intervention, and end-of-life decisions. Journal of the American Geriatric Society, 48, S194–S198.CrossRefGoogle ScholarPubMed
Boyer-Chammard, A., Taylor, T.H. & Anton-Culver, H. (1999). Survival differences in breast cancer among racial/ethnic groups: A population-based study. Cancer Detection and Prevention, 23, 463–473.CrossRefGoogle ScholarPubMed
Bradley, C.J., Given, C.W. & Roberts, C. (2002). Race, socioeconomic status, and breast cancer treatment and survival. Journal of the National Cancer Institute, 94, 490–496.CrossRefGoogle ScholarPubMed
Cella, D., Tulsky, D. & Gray, G. (1993). The functional assessment of cancer therapy scale: Development and validation of the general measure. Journal of the Clinical Oncology, 11, 570–579.CrossRefGoogle ScholarPubMed
Cleeland, C.S., Gonin, R., Baez, L., et al. (1997). Pain and treatment of pain in minority patients with cancer: The Eastern Cooperative Oncology Group Minority Outpatient Pain Study. Annals of Internal Medicine, 127, 813–816.CrossRefGoogle ScholarPubMed
Crawley, L. (2005). Racial, cultural, and ethnic factors influencing end-of-life care. Journal of Palliative Medicine, 8, S58–S69.CrossRefGoogle ScholarPubMed
Crawley, L., Payne, R., Bolden, J., et al. (2000). Palliative and end-of-life care in the African American community. Journal of the American Medical Association, 284, 2518–2521.CrossRefGoogle ScholarPubMed
Dignam, J.J. (2000). Differences in breast cancer prognosis among African-American and Caucasian women. CA: A Cancer Journal for Clinicians, 50, 50–64.Google ScholarPubMed
Dodd, M., Janson, S., Facione, N., et al. (2001). Advancing the science of symptom management. Journal of Advanced Nursing, 33, 668–676.CrossRefGoogle ScholarPubMed
Ebright, P.R. & Lyon, B. (2002). Understanding hope and factors that enhance hope in women with breast cancer. Oncology Nursing Forum, 29, 561–568.CrossRefGoogle ScholarPubMed
Franzini, L., Williams, A.F., Franklin, J., et al. (1997). Effects of race and socioeconomic status on survival of 1,332 Black, Hispanic, and White women with breast cancer. Annals of Surgical Oncology, 4, 111–118.CrossRefGoogle Scholar
Freeman, H. (1991). Race, poverty, and cancer. Journal of the National Cancer Institute, 83, 526–527.CrossRefGoogle ScholarPubMed
Gates, M.F., Lackey, N.R. & Brown, G. (2001). Caring demands and delay in seeking care in African American women newly diagnosed with breast cancer: An ethnographic, photographic study. Oncology Nursing Forum, 28, 529–537.Google ScholarPubMed
Gibson, R. (2001). Palliative care for the poor and disenfranchised: A view from the Robert Wood Johnson Foundation. Royal Society of Medicine Press Limited, 94, 486–489.CrossRefGoogle ScholarPubMed
Gordon, H., Street, R., Sharf, B., et al. (2006). Racial differences in trust and lung cancer patients' perceptions of physician communication. American Journal of Clinical Oncology, 24, 904–909.CrossRefGoogle ScholarPubMed
Gray, R.E., Goel, V., Fitch, M.I., et al. (2002). Supportive care provided by physicians and nurses to women with breast cancer: Results from a population based survey. Supportive Care in Cancer, 10, 647–652.CrossRefGoogle ScholarPubMed
Griggs, J.J., Sorbero, M.E., Stark, A.T., et al. (2003). Racial disparity in the dose and dose intensity of breast cancer adjuvant chemotherapy. Breast Cancer Research and Treatment, 81, 21–31.CrossRefGoogle ScholarPubMed
Hauser, J.M., Kleefield, S.F., Brennan, T.A., et al. (1997). Minority populations and advance directives: Insights from a focus group methodology. Cambridge Quarterly of Healthcare Ethics, 6, 58–71.CrossRefGoogle ScholarPubMed
Henderson, P.D., Gore, S.V., Davis, B.L., et al. (2003). African American women coping with breast cancer: A qualitative analysis. Oncology Nursing Forum, 30, 641–647.CrossRefGoogle ScholarPubMed
Holloway, I. & Wheeler, S. (1996). Qualitative Research for Nurses. Oxford, UK: Blackwell Science.Google Scholar
Jemal, A., Murray, T., Ward, E., et al. (2005). Cancer statistics. CA: A Cancer Journal for Clinicians, 55, 10–30.Google ScholarPubMed
Johnson, K.S., Elbert-Avila, K.I. & Tulsky, J.A. (2005). The influence of spiritual beliefs and practices on the treatment preferences of African Americans: A review of the literature. Journal of the American Geriatrics Society, 53, 711–719.CrossRefGoogle ScholarPubMed
Joslyn, S.A. & West, M.M. (2000). Racial differences in breast carcinoma survival. Cancer, 88, 114–123.3.0.CO;2-J>CrossRefGoogle ScholarPubMed
Krakauer, E.L., Crenner, C. & Fox, K. (2002). Barriers to optimum end-of-life care for minority patients. Journal of the American Geriatrics Society, 50, 182–190.CrossRefGoogle ScholarPubMed
Kwate, N. (2002). Race, socioeconomic status, and breast cancer treatment and survival. Journal of the National Cancer Institute, 94, 1254.CrossRefGoogle ScholarPubMed
Lackey, N.R., Gates, M.F. & Brown, G. (2001). African American women's experiences with the initial discovery, diagnosis, and treatment of breast cancer. Oncology Nursing Forum, 28, 519–527.Google ScholarPubMed
Mandelblatt, J.S., Schechter, C.B., Yabroff, K.R., et al. (2004). Benefits and costs of interventions to improve breast cancer outcomes in African American women. American Journal of Clinical Oncology, 22, 2554–2566.CrossRefGoogle ScholarPubMed
Mandelblatt, J.S., Yabroff, K.R. & Kerner, J.F. (1999). Equitable access to cancer services: A review of barriers to quality care. Cancer, 86, 2378–2390.3.0.CO;2-L>CrossRefGoogle ScholarPubMed
McCorkle, R. & Quint-Benoliel, J. (1983). Symptom distress, current concerns and mood disturbance after diagnosis of life threatening disease. Social Sciences in Medicine, 17, 431–438.CrossRefGoogle ScholarPubMed
McGinnis, L.S., Menck, H.R., Eyre, H.J., et al. (2000). National Cancer Data Base survey of breast cancer management for patients from low income zip codes. Cancer, 88, 933–945.3.0.CO;2-I>CrossRefGoogle ScholarPubMed
McKinley, E.D., Garret, J.M., Evans, A.T., et al. (1996). Differences in end-of-life decision making among Black and White ambulatory cancer patients. Journal of General Internal Medicine, 11, 651–656.CrossRefGoogle ScholarPubMed
Miles, M. & Huberman, A. (1994). An Expanded Sourcebook: Qualitative Data Analysis (2nd Edition) Thousand Oaks, CA: Sage.Google Scholar
Moore, R. (2001). African American women and breast cancer: Notes from a study of narrative. Cancer Nursing, 24, 35–42.CrossRefGoogle ScholarPubMed
Morrison, R.S., Wallenstein, S., Natale, D.K., et al. (2000). “We Don't Carry That”: Failure of pharmacies in predominantly nonwhite neighborhoods to stock opioid analgesics. New England Journal of Medicine, 342, 1023–1026.CrossRefGoogle ScholarPubMed
Payne, R., Medina, E. & Hampton, J. (2002). Quality of life concerns in patients with breast cancer: Evidence for disparity of outcomes and experiences in pain management and palliative care among African American women. Cancer, 97(Suppl.), 311–317.CrossRefGoogle Scholar
Phipps, E., True, G., Harris, D., et al. (2003). Approaching the end of life: Attitudes, preferences, and behaviors of African-American and White patients and their family caregivers. American Journal of Clinical Oncology, 21, 549–554.CrossRefGoogle ScholarPubMed
Polite, B.N. & Olopade, O.I. (2005). Breast cancer and race: A rising tide does not lift all boats equally. Perspectives in Biology and Medicine, 48, S166–S175.CrossRefGoogle Scholar
Portenoy, R., Ugarte, C., Fuller, I., et al. (2004). Population-based survey of pain in the United States: Differences among White, African American, and Hispanic subjects. Journal of Pain, 5, 317–328.CrossRefGoogle ScholarPubMed
Post-White, J., Ceronsky, C., Kreitzer, M.J., et al. (1996). Hope, spirituality, sense of coherence, and quality of life in patients with cancer. Oncology Nursing Forum, 23, 1571–1579.Google Scholar
Rosenzweig, M., Weihagen, T., Brufsky, A., et al. (2009). The unique perspedtive of illness among women with metastatic breast cancer according to race and income. Journal of Hospice and Palliative, 11, 27–39.Google Scholar
Simon, M.S. & Severson, R.K. (1997). Racial differences in breast cancer survival: The interaction of socioeconomic status and tumor biology. American Journal of Obstetrics and Gynecology, 176, S233–S239.CrossRefGoogle ScholarPubMed
Tammemagi, C.M., Neslund-Dudas, C., Simoff, M., et al. (2004). Lung carcinoma symptoms: An independent predictor of survival and an important mediator of African-American disparity in survival. Cancer, 101, 1655–1663.CrossRefGoogle Scholar
Wilmouth, M.C. & Sanders, L.D. (2001). Accept me for myself: African American women's issues after breast cancer. Oncology Nursing Forum, 28, 875–879.Google Scholar
Yood, M.U., Johnson, C.C., Blount, A., et al. (1999). Race and differences in breast cancer survival in a managed care population. Journal of the National Cancer Institute, 91, 1487–1491.CrossRefGoogle Scholar