A qualitative exploration of race-based differences in social support needs of diverse women with breast cancer on adjuvant therapy

Women's experiences with breast cancer during diagnosis and therapy, Wolaita, Ethiopia: a qualitative study

BACKGROUND

Breast cancer is the most common cancer in women and the most frequent cancer worldwide. After being diagnosed with breast cancer, women experience unexpected and stressful events. In Ethiopia, specifically in the study area, the experiences of women with breast cancer, the challenges they face during treatment and follow-up have not been thoroughly investigated.

OBJECTIVE

This qualitative study explores the experiences of women diagnosed with breast cancer and undergoing therapy at a University-based hospital in Ethiopia.

METHODS

A qualitative research design was used, to explore the experiences of women diagnosed with breast cancer and undergoing therapy. A purposively selected sample of ten women who had been diagnosed with breast cancer and were receiving therapy was recruited. Recruitment was conducted from August 1 to September 30, 2022. Semi-structured face-to-face interviews were conducted to collect data on their experiences. The interviews were transcribed verbatim, and a thematic analysis approach was employed utilizing open coding. The coded data were then analysed to reveal important insights and understandings about the participants' experiences with breast cancer during the diagnosis and therapy journey.

RESULT

The thematic analysis of the data revealed four prominent themes: women's mixed emotions, characterized by a sense of high threat and hope upon receiving breast cancer diagnosis results; dealing with the changes, both physical and psychological, that the cancer and its treatment bring about in women's bodies and emotional well-being; dealing with the challenges associated with accessing therapy, including unfavourable hospital conditions and financial hardship; and experiencing care and supports from health care providers, family and friends, and faith-based communities.

CONCLUSION

These findings underscore the importance of providing comprehensive support and care for women with breast cancer. Enhancing the hospital environment, addressing resource shortages, and prioritising patient well-being are crucial steps towards improving the experiences of breast cancer patients in the study area.

Silent suffering: the impact of sexual health challenges on patient-clinician communication and adherence to adjuvant endocrine therapy among Black women with early-stage breast cancer

PURPOSE

Adjuvant endocrine therapy (AET) increases sexual health challenges for women with early-stage breast cancer. Black women are more likely than women of other racial/ethnic groups to report adverse symptoms and least likely to initiate and maintain AET. Little is known about how sexual health challenges influence patient-clinician communication and treatment adherence. This study explores facilitators of and barriers to patient-clinician communication about sexual health and how those factors might affect AET adherence among Black women with early-stage breast cancer.

METHODS

We conducted 32 semi-structured, in-depth interviews among Black women with early-stage breast cancer in the U.S. Mid-South region. Participants completed an online questionnaire prior to interviews. Data were analyzed using thematic analysis.

RESULTS

Participants' median age was 59 (range 40-78 years, SD = 9.0). Adverse sexual symptoms hindered participants' AET adherence. Facilitators of patient-clinician communication about sexual health included female clinicians and peer support. Barriers included perceptions of male oncologists' disinterest in Black women's sexual health, perceptions of male oncologists' biased beliefs about sexual activity among older Black women, cultural norms of sexual silence among Southern Black women, and medical mistrust.

CONCLUSIONS

Adverse sexual symptoms and poor patient-clinician communication about sexual health contribute to lower AET adherence among Black women with early-stage breast cancer. New interventions using peer support models and female clinicians trained to discuss sexual health could ameliorate communication barriers and improve treatment adherence.

IMPLICATIONS FOR CANCER SURVIVORS

Black women with early-stage breast cancer in the U.S. Mid-South may require additional resources to address sociocultural and psychosocial implications of cancer survivorship to enable candid discussions with oncologists.

African American Women Breast Cancer Survivors: Coping with the COVID-19 Pandemic

African American women breast cancer survivors are among those with the greater burden of cancer. Breast cancer is the second leading cause of death among black women, and this death rate is 40% higher than that of white women. The COVID-19 pandemic increased the burden of morbidity and mortality among this population of cancer survivors. In this report, we explore the ways in which the COVID-19 pandemic was a source of stress for African American women breast cancer survivors and their subsequent responses to these stressors. This is a qualitative descriptive study with content analysis of data from the narratives of 18 African American breast cancer survivors. Participants were interviewed via phone and video conferencing platform and asked questions related to their experiences with the COVID-19 pandemic. The findings suggest stressors associated with (1) potential COVID-19 spreaders in their immediate environments; (2) closures and restricted access to social- and faith-based activities; (3) televised news broadcasts of COVID-19; and (4) disruptions to planned cancer prevention and control healthcare. Three categories emerged that captured the ways in which these women responded to stressors during the early phase of this pandemic: (1) seeking control in their social environments; (2) following the rules; and (3) seeking support from God, family, and friends. These findings can be used to better support breast cancer patients during the early phases of a pandemic.

Association between aspects of social support and health-related quality of life domains among African American and White breast cancer survivors

PURPOSE

Social support is associated with breast cancer survivors' health-related quality of life (HRQoL). More nuanced information is needed regarding aspects of social support associated with different HRQoL domains among diverse populations. We assessed the association between emotional/informational and tangible support and five HRQoL domains and evaluated race as an effect modifier.

METHODS

African American and White women (n = 545) diagnosed with hormone-receptor-positive breast cancer completed a survey that assessed sociodemographic, clinical, and psychosocial factors. We assessed bivariate relationships between emotional/informational and tangible support along with overall HRQoL and each HRQoL domain.We tested interactions between race and emotional/informational and tangible social support using linear regression.

RESULTS

The sample included African American (29%) and White (71%) breast cancer survivors. Emotional/informational social support had a statistically significant positive association with emotional well-being (β = .08, p = 0.005), social well-being (β = 0.36, p < 0.001), functional well-being (β = .22, p < .001), breast cancer concerns (β = .16, p = 0.002), and overall HRQoL (β = .83, p < .001). Similarly, tangible social support had a statistically significant positive association with emotional well-being (β = .14, p = 0.004), social well-being (β = .51, p < .001), functional well-being (β = .39, p < .001), and overall HRQoL (β = 1.27, p < .001). The interactions between race and social support were not statistically significant (p > 0.05).

CONCLUSIONS

Results underscore the importance of the different social support types among breast cancer survivors, regardless of survivors' race.

IMPLICATIONS FOR CANCER SURVIVORS

Population-based interventions can be standardized and disseminated to provide guidance on how to increase emotional/information and tangible support for all breast cancer survivors by caregivers, health providers, and communities.

Adherence to Endocrine Therapy and Racial Outcome Disparities in Breast Cancer

The disparity in outcomes of breast cancer for Black compared with White women in the U.S. is well known and persistent over time, with the largest disparities appearing among women with hormone receptor-positive (HR+) cancers. The racial gap in breast cancer survival first emerged in the 1980s, a time of significantmen treatment advances in early-stage breast cancer, including the introduction of adjuvant endocrine therapy. Since that time, the gap has continued to widen despite steady advances in treatment and survival of breast cancer overall. Although advanced stage at presentation and unfavorable biology undoubtedly contribute to racial differences in survival of HR+ breast, treatment disparities are increasingly acknowledged to play a key role as well. The recent recognition of racial differences in endocrine therapy use may be a key explanatory factor in the persistent racial gap in mortality of HR+ disease, and may be a key focus of intervention to improve breast cancer outcomes for Black women. IMPLICATIONS FOR PRACTICE: Black women with hormone receptor-positive breast cancer experience the greatest racial disparity in survival among all breast cancer subtypes. This survival gap appears consistently across studies and is not entirely explained by differences in presenting stage, tumor biology as assessed by genomic risk scores, or receipt of chemotherapy. Recent research highlights lower adherence to endocrine therapy (ET) for Black women. Health systems and individual providers should focus on improving communication about the importance of ET use, sharing decisions around ET, providing appropriate support for side effects and other ET-related concerns, and equitably delivering survivorship care, including ET adherence assessment.

Psychometric validation of the Chinese version of the PROMIS Social Relationships Short Forms

AIM

This study aimed to culturally adapt and psychometrically validate the PROMIS Social Relationships Short Forms (PROMIS-SR) among Chinese patients with breast cancer.

DESIGN

A cross-sectional study.

METHOD

The PROMIS-SR was translated into simplified Chinese by strictly adhering to the Functional Assessment of Chronic Illness Therapy translation method and was subsequently tested among patients with breast cancer (N = 965). Eligible patients filled out the demographic information questionnaire, the PROMIS-SR, and the Functional Assessment of Cancer Therapy-Breast.

RESULTS

Confirmatory factor analysis (CFA) provided support for the original structure of the PROMIS-SR. All instruments reported strong known-group, cross-cultural and convergent validity, as hypothesized. Correlation coefficients ranged from 0.67 to 0.85, and Cronbach's α of all items were high (0.90-0.94).

Emotional, informational and instrumental support needs in patients with breast cancer who have undergone surgery: a cross-sectional study

OBJECTIVES

This study evaluated emotional, informational and instrumental support needs in patients with breast cancer who had undergone surgery, then identified the variables associated with those needs.

DESIGN

This was a cross-sectional survey study.

SETTING

Questionnaires were distributed in tertiary hospitals in China between January 2018 and July 2020.

PARTICIPANTS

We recruited 477 eligible patients with breast cancer via convenience sampling. Due to exclusions for response errors, the final analysed sample included 461 participants (mean age of 50.9 years). Each completed a questionnaire consisting of a sociodemographic information component and three short forms from the Patient-Reported Outcome Measurement Information System (social relationships short forms, anxiety short form and depression short form). Subsequent analyses included the χ² test, Pearson correlation and multivariate regression.

RESULTS

The T scores for informational support were lower than those for the reference group (general population), while those for emotional and informational support were average. Marital status, childbearing history, lifestyle, employment status, anxiety and depression levels were related to the scores for emotional, informational and instrumental support in this population. The regression analysis revealed that emotional support levels, instrumental support levels, marital status, employment status, anxiety and depression outcomes were predictors for informational support levels.

CONCLUSIONS

Informational support should be specifically assessed and promoted among patients with breast cancer in general, while marital status, childbearing history, lifestyle, employment status, anxiety and depression levels should be evaluated when conducting interventions to promote emotional, informational and instrumental support for those who have undergone surgery. Early and regular screenings for high-risk patients will help nurses identify those who are likely to benefit from targeted preventive interventions aimed at emotional, informational and instrumental support issues.

TRIAL REGISTRATION NUMBER

ChiCTR2000035439; ClinicalTrials.gov registry.

THRIVE intervention development: using participatory action research principles to guide a mHealth app-based intervention to improve oncology care

Background:

Women with hormone receptor-positive, early-stage breast cancer who adhere to adjuvant endocrine therapy (AET) reduce the risk of cancer recurrence and mortality. AET, however, is associated with adverse symptoms that often result in poor adherence. We applied participatory action research (PAR) principles to conduct focus groups and interviews to refine and enhance a web-enabled app intervention that facilitates patient-provider communication about AET-related symptoms and other barriers to adherence.

Methods:

We conducted four focus groups with women with early-stage breast cancer on AET (N=28), stratified by race (Black and White) and length of time on AET (<6 months and >6 months), to determine preferences and refine the app-based intervention. A fifth mixed-race focus group was convened (N=6) to refine THRIVE app content using high-fidelity mock-ups and to develop new, tailored feedback messages. We also conducted interviews with oncology nurses (N=5) who participated in the THRIVE randomized controlled trial.

Results:

Participants reported preferences for weekly reminder messages to use the THRIVE app, a free-text option to write in AET-related symptoms, and app aesthetics. Other requested app features included: a body map for identifying pain, sleep and dental problems on the symptom list, a dashboard, tailored feedback messages, and information about social support resources. Participants also developed new intervention messages, decided which messages to keep, and edited language for appropriateness and sensitivity. They also discussed the type of electronic pill monitor and incentive plan to be used in the intervention. Nurses reported THRIVE alerts integrated seamlessly into their clinical workflow and increased patient-provider communication, facilitating quicker response to patients’ reported symptoms. Nurses reported no negative feedback or usability concerns with the app.

Conclusions:

THRIVE app content reflects researchers’ partnership with a racially diverse sample of breast cancer survivors and healthcare providers and adherence to participatory design by incorporating patient-requested app features, app aesthetics, and message content. The app has the potential to improve AET adherence and quality of life among breast cancer survivors and reduce disparities in mortality rates for Black women by facilitating communication with healthcare providers.

The Association of Sources of Support, Types of Support and Satisfaction with Support Received on Perceived Stress and Quality of Life of Cancer Patients

INTRODUCTION

The aim of the present study is to carry out a multidimensional analysis of the relationship of social support with quality of life and the stress perceived by cancer patients.

METHODS

The participants were 200 patients with cancer. Data was gathered on sociodemographic characteristics, health, quality of life, social support and perceived stress.

RESULTS

Frequency of and satisfaction with different sources and types of support are related positively with improvement of quality of life and negatively with perceived stress. The emotional support from the partner and the emotional and informational support from the family are significant predictors of quality of life. Emotional support from the family reduces patients' perceived stress. Satisfaction with emotional support from the partner and with the informational support from friends and family increases quality of life. Satisfaction with emotional support from the family and with informational support from friends decreases patients' perceived stress. Instrumental support and support provided by health professionals are not good predictors of quality of life and perceived stress. Satisfaction with the support received is more significantly related with quality of life and stress than the frequency with which the sources provide support.

CONCLUSIONS

These results have important practical implications to improve cancer patients' quality of life and reduce their perceived stress through social support. Designing intervention strategies to improve satisfaction with the support provided to patients by their closest networks results in a global benefit for the patient's quality of life.

Visual cues of the built environment and perceived stress among a cohort of black breast cancer survivors

We investigated relationships between independently observed, visual cues of residential environments and subsequent participant-reported stress within a population-based cohort of Black breast cancer survivors (n = 476). Greater visual cues of engagement - presence of team sports, yard decorations, outdoor seating - (compared to less engagement) was marginally associated with lower perceived stress in univariate models, but attenuated towards null with adjustment for socio-demographic, behavioral, and health-related covariates. Similarly, physical disorder and perceived stress were not associated in adjusted models. Relationships between observed built environment characteristics and perceived stress might be influenced by socioeconomic and health behavior factors, which longitudinal studies should investigate.

THRIVE study protocol: a randomized controlled trial evaluating a web-based app and tailored messages to improve adherence to adjuvant endocrine therapy among women with breast cancer

Background

Long-term use of adjuvant endocrine therapy (AET) among women with early-stage, hormone receptor-positive breast cancer significantly reduces the risk of hospitalizations, cancer recurrence, and mortality. AET is associated with adverse symptoms that often result in poor adherence. A web-enabled app offers a novel way to communicate and manage symptoms for women on AET. In a region with significant racial disparities in breast cancer outcomes, our study tests the impact of a web-enabled app that collects and transmits patient-reported symptoms to healthcare teams to facilitate timely and responsive symptom management on medication adherence.

Methods

In this randomized controlled trial, we randomize 300 patients initiating AET to one of three arms: 1) an “App” group (n = 100) that receives weekly reminders to use the THRIVE study app; 2) an “App+Feedback” group (n = 100) that receives weekly reminders and tailored feedback based on their use of the app; or 3) a “Usual Care” group (n = 100) that receives usual care only. Participants are stratified by race: 50% White and 50% Black. The duration of the intervention is six months following enrollment, and outcomes are assessed at 12-months. The primary outcome is adherence, which is captured using an electronic monitoring pillbox. Secondary outcomes include symptom burden, quality of life, self-efficacy for managing symptoms, and healthcare costs. We also evaluate the impact of the intervention on racial disparities in adherence. Data are derived from three sources: electronic health record data to capture treatment changes, healthcare utilization, and health outcomes; self-report survey data related to adherence, symptom burden, and quality of life; and an electronic medication monitoring device that captures adherence.

Discussion

A successful web-enabled intervention could be disseminated across systems, conditions, and populations. By evaluating the impact of this intervention on a comprehensive set of measures, including AET adherence, patient outcomes, and costs, our study will provide valuable and actionable results for providers, policy makers, and insurers who strive to achieve the “Triple Aim” – reduce costs while improving health outcomes and the patient care experience.

Trial registration

NCT03592771. Prospectively registered on July 19, 2018.