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Torralba-Martínez E, Quintana MJ, Carbonell MC, de Las Sias E, Carrillo CPS, Codern-Bové N. Coping experiences of women in the different phases of breast cancer. Support Care Cancer 2021; 30:197-206. [PMID: 34247298 DOI: 10.1007/s00520-021-06400-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/27/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE To understand the evolution of coping among women diagnosed with breast cancer over time, and the effect of age and family income on coping. METHOD Using a phenomenological qualitative study, data was collected through semi-structured interviews with sixteen women in a hospital in Barcelona (Spain) between January 2018 and June 2019. An analysis of thematic content and discursive profile was carried out, assisted by the Nvivo v.12 program. RESULTS Coping strategies change according to the meaning of breast cancer in each phase and the age and family income. In the acute phase, multiple coping strategies are identified, and this variety was more frequent among the young women in the study. In the extended phase, planning, distancing, and seeking social support become important. The latter used during treatment by older women in the study, regardless of family income. In the follow-up phase, distancing stands out, but also the search for social support among young women with fewer resources. CONCLUSIONS Coping with breast cancer evolves according to the meaning that the disease receives in each phase. In addition, the analysis by discursive profile shows how the social support context is also related to the coping strategies in each phase.
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Affiliation(s)
- Elena Torralba-Martínez
- Department of Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Av. de Can Domènech 737, Cerdanyola del Vallès, 08193, Barcelona, Spain
| | - María Jesús Quintana
- Department of Clinical Epidemiology and Public Health-Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Carrer Sant Antoni Ma Claret 167, 08025, Barcelona, Catalonia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Universitat Autònoma de Barcelona, 08041, Barcelona, Catalonia, Spain
| | - Magda Ciendones Carbonell
- Unidad de Patología Mamaria, Hospital de La Santa Creu I Sant Pau, Carrer Sant Quintí 89, 08041, Barcelona, Catalonia, Spain
| | - Elena de Las Sias
- Independent Clinical Psycho-Oncology, Universidad Complutense de Madrid, Av. Séneca, 2, 28040, Madrid, Spain
| | | | - Núria Codern-Bové
- Escola Universitària d'Infermeria i Teràpia Ocupacional de Terrassa (EUIT), Universitat Autònoma de Barcelona, c/ de la Riba 90, 08221, Terrassa, Catalonia, Spain.
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Shift Work and Breast Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249544. [PMID: 33419321 PMCID: PMC7767214 DOI: 10.3390/ijerph17249544] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/16/2020] [Indexed: 01/11/2023]
Abstract
The rates of shift work outside of daylight hours have increased in recent years, and nighttime shift work is now considered a potential carcinogenic occupational exposure. Light at night exposure, lower melatonin production, and the production of stress-related mediators disrupt normal sleep–wake cycles. Women who work lower-wage jobs and part-time workers whose shifts are determined entirely by their supervisors (rotating shifts) may be subject to stress related to efforts to align childcare and other needs with the unpredictable nature of rotating shift work. The causal link between breast cancer and the sleep cycle or circadian disruption are yet to be established; however, disruption of the circadian cycles by light at night exposure or chronic exposure to stress-related mediators have all been linked to the increased risk of breast cancer. We review the existing literature on shift work and breast cancer, identify knowledge gaps, and suggest future directions for research.
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Tracy JK, Adetunji F, Al Kibria GM, Swanberg JE. Cancer-work management: Hourly and salaried wage women's experiences managing the cancer-work interface following new breast cancer diagnosis. PLoS One 2020; 15:e0241795. [PMID: 33152051 PMCID: PMC7643956 DOI: 10.1371/journal.pone.0241795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 10/20/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The purpose of this paper is to report the baseline characteristics of EMPOWER participants-a group of newly diagnosed breast cancer survivors-and describe differences in hourly and salaried wage women's experiences regarding cancer and work management in the three months following breast cancer diagnosis. DESIGN AND SETTING The EMployment and Potential Outcomes of Working through canceER (EMPOWER) project is a prospective longitudinal, mixed methods pilot study designed to evaluate how employment influences treatment decisions among women diagnosed with breast cancer. Participants were women diagnosed with new breast cancer and treated at one of two clinical sites of the University of Maryland Medical System. Women were enrolled in the study within three months of first breast cancer diagnosis. Study visits occurred every three months for one year. This paper reports data from for the baseline and three-month visit which had been completed by all enrollees. METHODS Trained research personnel collected demographic information, medical history and health status, social history, employment data, cancer-related data, psychosocial adjustment, and financial wellbeing at the baseline enrollment visit. A semi-structured qualitative interview was administered at the three-month study visit to assess employment decisions and the impact of job demands, cancer care, and cancer-work fit during the three months following diagnosis. RESULT Fifty women with new, primary diagnosis of breast cancer were enrolled in the study. Mean age of participants was 51 years, and 46% identified their race as Black or other. The majority of women disclosed their diagnosis to their employer and nearly all maintained some level of employment during the first three to six months of treatment. Women with hourly wage jobs were similar to those with salaried wage jobs with respect to demographic and social characteristics. Women with hourly wage jobs were more likely to report working in physically demanding jobs and taking unpaid leave. They were also more likely to experience side effects that required physical restrictions at work, to leave their jobs due to demands of treatment, and to report managing cancer and work concurrently as very difficult. Women in salaried wage jobs were more likely to report falling behind or missing work and working remotely as a cancer-management strategy. Women in hourly jobs more often reported difficulty managing the competing demands of cancer and work. CONCLUSION While further study is needed, these results suggest that women in hourly and salaried workers reported similar experiences managing cancer and work, with a few key exceptions. These exceptions pertain to the nature of hourly-wage work. Cancer survivors employed in hourly jobs may be more vulnerable to poor employment outcomes due to limited access to paid time off and workplace flexibility, and challenges related to managing physical aspects of cancer and employment.
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Affiliation(s)
- J. Kathleen Tracy
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Fiyinfolu Adetunji
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Gulam M. Al Kibria
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Jennifer E. Swanberg
- Department of Occupational Therapy, College of Health and Wellness, Johnson & Wales University, Providence, Rhode Island, United States of America
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Spencer JC, Rotter JS, Eberth JM, Zahnd WE, Vanderpool RC, Ko LK, Davis MM, Troester MA, Olshan AF, Wheeler SB. Employment Changes Following Breast Cancer Diagnosis: The Effects of Race and Place. J Natl Cancer Inst 2020; 112:647-650. [PMID: 31599949 PMCID: PMC7301070 DOI: 10.1093/jnci/djz197] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/18/2019] [Accepted: 09/23/2019] [Indexed: 11/13/2022] Open
Abstract
The financial implications of breast cancer diagnosis may be greater among rural and black women. Women with incident breast cancer were recruited as part of the Carolina Breast Cancer Study. We compared unadjusted and adjusted prevalence of cancer-related job or income loss, and a composite measure of either outcome, by rural residence and stratified by race. We included 2435 women: 11.7% were rural; 48.5% were black; and 38.0% reported employment changes after diagnosis. Rural women more often reported employment effects, including reduced household income (43.6% vs 35.4%, two-sided χ2 test P = .04). Rural white, rural black, and urban black women each more often reported income reduction (statistically significant vs. urban white women), although these groups did not meaningfully differ from each other. In multivariable regression, rural differences were mediated by socioeconomic factors, but racial differences remained. Programs and policies to reduce financial toxicity in vulnerable patients should address indirect costs of cancer, including lost wages and employment.
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Affiliation(s)
- Jennifer C Spencer
- Department of Health Policy and Management
- Lineberger Comprehensive Cancer Center
| | | | - Jan M Eberth
- University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Epidemiology and Biostatistics
- Cancer Prevention and Control Program
- Rural and Minority Health Research Center
| | - Whitney E Zahnd
- Department of Health Services Policy and Management
- Rural and Minority Health Research Center
| | - Robin C Vanderpool
- Oregon Health & Science University, Portland, OR; Department of Health, Behavior & Society, University of Kentucky, Lexington, KY
| | - Linda K Ko
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Health Services, University of Washington, Seattle, WA
| | - Melinda M Davis
- Arnold School of Public Health, University of South Carolina, Columbia, SC; Department of Family Medicine (MMD) and Oregon Rural Practice-based Research Network
| | | | | | - Stephanie B Wheeler
- Department of Epidemiology
- Center for Health Promotion and Disease Prevention
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Swanberg JE, Vanderpool RC, Tracy JK. Cancer-work management during active treatment: towards a conceptual framework. Cancer Causes Control 2020; 31:463-472. [PMID: 32125547 DOI: 10.1007/s10552-020-01285-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 02/19/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Forward progress in cancer treatment has resulted in fewer adverse consequences of cancer during and after treatment, offering employed cancer patients the possibility of continuing to work during treatment, returning to work after treatment, or implementing a combination of strategies to manage the cancer-work interface. Yet, much of the research on cancer and employment examines return to work as the primary outcome, neglecting to consider the circumstances of survivors who maintain employment while engaged in active treatment. We introduce the Cancer-Work Management Framework (CWMF), a conceptual framework for understanding the cancer and job demands survivors who continue to work during active treatment experience and how cancer and job resources and strategies could promote cancer-work fit and ultimately optimize employment and health outcomes. METHODS We provide an overview of the research describing the cancer-work management experiences of survivors who maintain employment during active treatment and summarize the theories that informed the CWMF including ecological systems, boundary-spanning, and job demands and resources theories. RESULTS The paper presents a description of the components of the CWMF which include cancer demands, cancer care resources and strategies, work demands, and workplace resources. We also describe a process-cancer-work fit-that reflects the interplay between demands and resources influence employment and health outcomes. CONCLUSIONS Future research directions for developing knowledge about the cancer-work management process are proposed with suggestions for study of how cancer and job demands influence cancer treatment and employment decisions.
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Affiliation(s)
- Jennifer E Swanberg
- Department of Health Policy and Management, School of Professional Studies, Providence College, 1 Cunningham Square, Providence, RI, 02918, USA.
- University of Maryland School of Social Work, Baltimore, MD, USA.
| | - Robin C Vanderpool
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - J Kathleen Tracy
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Kumar A, Bhagabaty SM, Tripathy JP, Selvaraj K, Purkayastha J, Singh R. Delays in Diagnosis and Treatment of Breast Cancer and the Pathways of Care: A Mixed Methods Study from a Tertiary Cancer Centre in North East India. Asian Pac J Cancer Prev 2019; 20:3711-3721. [PMID: 31870113 PMCID: PMC7173377 DOI: 10.31557/apjcp.2019.20.12.3711] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION In India, mortality rate in breast cancer is high because more than half are diagnosed late at locally advanced or metastatic stages. This might be due to presentation delay (recognition of symptoms to first provider consultation) and treatment delay (first provider consultation to initiation of treatment), together known as overall delay. We aimed to estimate the overall delay in diagnosis and treatment in breast cancer and the associated factors, describe pathway of care and explore the reasons for delay from a patients' and providers' perspective. METHODS Explanatory sequential mixed-methods study with a quantitative component (retrospective cohort study including breast cancer patients registered at Dr. Borooah Cancer Institute (BBCI), Guwahati during February-June 2019) followed by descriptive qualitative component (in-depth interviews with 15 patients and 10 care providers). RESULTS Of 269 breast cancer patients, median (Inter Quartile Range) overall delay was 203 (110-401) days, presentation delay was 35 (10-112) days and treatment delay was 130 (75-258) days. Majority of patients approached private sector (190, 70.6%) as the first care provider. Nearly half of all patients (136, 50.6%) visited one health care provider before reaching the BBCI and another one-third (90, 33.5%) visited two providers. Reasons for presentation delay were misconception about the disease, perceived stigma, fear and denial of cancer, attribution of symptoms to trivial conditions, family responsibilities and embarrassment of breast examination by a male doctor. Treatment delay was due to initial visit to, misclassification of disease severity, dissatisfaction with care at public facilities, poor accessibility and affordability, fear of treatment and its side effects. CONCLUSION Treatment delay was the major contributor to overall delay. Private providers need to be sensitized and trained in screening of breast cancer and referral of suspected cases of cancer. More awareness is needed about warning symptoms of breast cancer and misconceptions regarding the disease.<br />.
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Affiliation(s)
- Arvind Kumar
- Public Health, Cluster Coordinator, Doctors For You, Guwahati, India
| | | | - Jaya Prasad Tripathy
- Department of Community Medicine, Assistant Professor, All India Institute of Medical Sciences, Nagpur, India
| | - Kalaiselvi Selvaraj
- Department of Community Medicine, Assistant Professor, All India Institute of Medical Sciences, Nagpur, India
| | - Joydeep Purkayastha
- Department of Preventive Oncology, Dr. B. Borooah Cancer Institute, Guwahati, India
| | - Ravikant Singh
- Public Health, Cluster Coordinator, Doctors For You, Guwahati, India
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Nichols HM, Swanberg JE, Vanderpool RC. Patient-Provider Communication: Experiences of Low-Wage-Earning Breast Cancer Survivors in Managing Cancer and Work. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:542-549. [PMID: 29480506 DOI: 10.1007/s13187-018-1338-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In 2017, there will be more than 250,000 new diagnoses of invasive breast cancer; most cases will occur in working-age women. The goal of this qualitative study was to explore low-wage-earning breast cancer survivors' experiences communicating with their oncology team about cancer and employment issues. Twenty-four low-wage-earning breast cancer survivors in the USA were interviewed in 2012 using a structured interview protocol. Sociodemographic data, cancer history, and patient-provider communication experiences regarding the management of cancer and work were collected. Interviews were analyzed using grounded theory strategy of constant comparative analysis. Low-wage-earning breast cancer survivors' experiences communicating with their oncology team about employment and cancer focused on three dimensions of patient-provider communication: extent, quality, and content. Over 70% of respondents reported no communication or only routine communication with their providers regarding work; three quarters of women reported poor or standard communication quality, and content of work-related communication covered scheduling issues, work absences, continuing to work during treatment, and financial concerns. Communication between oncology care teams and low-wage-earning cancer patients is critical to the successful management of treatment and work responsibilities given the vulnerable employment situation of these women. There is a need for education of oncology team members about how cancer and its treatment can impact employment for all workers, but especially for low-wage workers, thereby allowing the care team to address these issues proactively and help patients successfully manage both cancer treatment and work responsibilities.
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Affiliation(s)
- Helen M Nichols
- School of Social Work, University of Maryland, Baltimore, MD, USA
| | - Jennifer E Swanberg
- School of Social Work and Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Robin C Vanderpool
- Department of Health, Behavior & Society, University of Kentucky College of Public Health, 2365 Harrodsburg Road, Suite A230, Lexington, KY, 40504, USA.
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Bonsu AB, Ncama BP. Recognizing and appraising symptoms of breast cancer as a reason for delayed presentation in Ghanaian women: A qualitative study. PLoS One 2019; 14:e0208773. [PMID: 30625156 PMCID: PMC6326484 DOI: 10.1371/journal.pone.0208773] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/21/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The burden of late presentation is well established in women presenting with advanced breast cancer in Africa. This paper aims to explore the reasons for delayed presentation in Ghanaian women with breast cancer. METHOD Eleven (11) women diagnosed with advanced breast cancer were purposively sampled within three years of diagnosis at the palliative care clinic of the Komfo Anokye Teaching Hospital, Ghana. Participation was voluntary. Data was collected through in-depth interviews using a self-devised semi-structured interview guide. The interviews were conducted in "Twi" (local language), audio-tape recorded and covered the women's journey from symptom discovery to their intention to seek help. All audio-taped interviews were transcribed based on the meaning of the respondents' comments. The data was managed using Nvivo version 11 qualitative software. Data was analyzed concurrently with data collection applying the principles of thematic analysis. KEY FINDINGS All the women delayed presentation due to overlapping reasons. Symptom appraisal among the women occurred in two main stages: individual understanding of breast symptom and interactive understanding of the breast symptom. These stages were based on cognitive, psycho-cultural and social factors. The five main themes generated from the data were: symptom experience, knowledge of breast cancer, role of social life and network, coping with a breast symptom and lastly intent to seeking health care. A conceptual model was developed to illustrate the relationships among the key factors and concepts emanated from this study. CONCLUSION Recognition and appraisal of breast cancer symptom in the eleven (11) Ghanaian women interviewed in this study was poor. For instance, a painless breast lump was considered not serious until a sensory symptom appears. This led women to experience appraisal and time point intervals. To minimize the incidence of late presentation of breast cancer cases in Ghana, adequate educational intervention should be provided for Ghanaian women and their social network, and other stakeholders.
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Affiliation(s)
- Adwoa Bemah Bonsu
- Discipline of Nursing, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Busisiwe Purity Ncama
- Discipline of Nursing, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Swanberg JE, Nichols HM, Vanderpool RC, Rosenblatt P, Tracy JK. Working poor and working nonpoor cancer survivors: Work-related and employment disparities. Cancer Rep (Hoboken) 2018; 1:e1134. [PMID: 32729229 DOI: 10.1002/cnr2.1134] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/06/2018] [Accepted: 08/10/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Many cancer survivors face challenges remaining at work during treatment or returning to work posttreatment. Workplace supports can ease the strain associated with managing the cancer-work interface. Limited research has examined the employment experiences of low-wage earning survivors, who are less likely to have access to workplace supports, overlooking a factor that may influence survivors' employment outcomes. AIMS This study assessed differences in employment experiences between working poor (WP) and working nonpoor (WNP) cancer survivors in the United States. METHODS AND RESULTS Data from the 2011 Medical Expenditure Panel Survey (MEPS) and the 2011 MEPS Experiences with Cancer Survivorship Supplement were analyzed to evaluate differences in workplace supports, cancer-related psychological job distress, productivity, and employment outcomes between WP and WNP cancer survivors. The sample included adults diagnosed with cancer within 5 years prior to survey completion and engaged in paid employment since diagnosis. Working poor respondents had income below 200% of the poverty level. Chi-square tests assessed differences between WP (n = 57) and WNP (n = 164) cancer survivors' demographic, cancer, and employment characteristics; cancer-related psychological job distress; employee productivity; and employment outcome measures. Multiple logistic regression analyses determined the independent association between WP status and these same variables controlling for sociodemographic confounders. Working poor survivors were more likely to take unpaid time off, change from full-time to part-time, to report cancer-related psychological job distress, negative influences on job productivity and employment outcomes, and less likely to have health insurance. In logistic regression analyses, those who took unpaid time off were more likely to be WP; being WP was also associated with poorer employment outcomes, after controlling for sociodemographics differences between WP and WNP. CONCLUSION Working poor survivors had fewer workplace supports and poorer employment outcomes than WNP survivors, highlighting important occupational disparities for cancer survivors. Areas for future research are discussed.
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Affiliation(s)
- Jennifer E Swanberg
- Department of Health Policy and Management, School of Professional Studies, Providence College, Providence, Rhode Island.,University of Maryland School of Social Work, Baltimore, Maryland.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.,University of Maryland Greenebaum Comprehensive Cancer Center
| | - Helen M Nichols
- University of Maryland School of Social Work, Baltimore, Maryland
| | - Robin C Vanderpool
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Paula Rosenblatt
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.,University of Maryland Greenebaum Comprehensive Cancer Center
| | - J Kathleen Tracy
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.,University of Maryland Greenebaum Comprehensive Cancer Center
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Swanberg JE, Nichols HM, Ko J, Tracy JK, Vanderpool RC. Managing cancer and employment: Decisions and strategies used by breast cancer survivors employed in low-wage jobs. J Psychosoc Oncol 2017; 35:180-201. [PMID: 28045595 DOI: 10.1080/07347332.2016.1276503] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Advances in breast cancer screening and treatment have led to an overall 5-year survival rate of 90%. Many of these cancer cases are diagnosed in working women. Few studies have explicitly examined the cancer-work interface, as experienced by low-wage earning women with breast cancer. This study uses in-depth, semistructured interviews with 24 low-wage breast cancer survivors to identify employment decisions and factors that influenced or enabled these decisions, and examine the individual strategies and workplace supports used to manage the cancer-work interface among a subset of women (n = 13) who continued to work. Future research areas and clinical implications are discussed.
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Affiliation(s)
| | - Helen M Nichols
- a School of Social Work , University of Maryland , Baltimore , MD , USA
| | - Jungyai Ko
- b Department of Social Work , Hallym University , Chuncheon, Gangwon-do , South Korea
| | - J Kathleen Tracy
- c Department of Epidemiology and Public Health , University of Maryland , Baltimore , MD , USA
| | - Robin C Vanderpool
- d Department of Health , Behavior and Society, University of Kentucky , Lexington , KY , USA
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Moodley J, Cairncross L, Naiker T, Momberg M. Understanding pathways to breast cancer diagnosis among women in the Western Cape Province, South Africa: a qualitative study. BMJ Open 2016; 6:e009905. [PMID: 26729392 PMCID: PMC4716174 DOI: 10.1136/bmjopen-2015-009905] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The aim of this study was to explore and understand women's pathways to breast cancer diagnosis and factors influencing this journey. DESIGN AND SETTING Indepth interviews were conducted with clients at a tertiary level breast cancer clinic in Cape Town, South Africa. A thematic analysis was performed underpinned by the theoretical concepts of the Model of Pathways to Treatment framework. PARTICIPANTS 20 women were interviewed within 1 week of being diagnosed with breast cancer. RESULTS The average time between discovery of bodily changes to breast cancer diagnosis was 8.5 months. Deficits in breast self-awareness and knowledge of breast cancer symptoms delayed women's interpretation of bodily changes as being abnormal. All women first noticed breast lumps; however, many did not perceive it as abnormal until additional symptoms were present. General good health, attribution of symptoms to ageing, and past benign breast disease resulted in women being complacent about bodily changes. Disclosure to family members served as a trigger to seek healthcare. The initial type of primary level care services women accessed was influenced by perceptions of care each service provided, finances, structural factors, and personal safety related to the physical location of services. CONCLUSIONS Symptom appraisal and interpretation contributed significantly to delayed presentation. To improve timely diagnosis of breast cancer, interventions that increase women's confidence in detecting breast changes, improve knowledge of breast cancer symptoms, address myths, and encourage prompt help-seeking behaviour are required.
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Affiliation(s)
- Jennifer Moodley
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Women's Health Research Unit, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Lydia Cairncross
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Thurandrie Naiker
- Department of Radiation Oncology, University of Cape Town, Cape Town, South Africa
| | - Mariette Momberg
- Women's Health Research Unit, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Abstract
For more than 20 years, the US National Institutes of Health (NIH) Office of Research on Women's Health (ORWH) has promoted the NIH's research agenda on women's health and sex and gender issues. Important biological and behavioral differences between women and men influence health and well-being, affecting normal function as well as the manifestations, epidemiology, and response to treatment of many illnesses. This special issue is dedicated to reaching across the globe to increase awareness of the importance of women's health research and to stimulate consideration of sex and gender differences in research at institutions around the world.
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Affiliation(s)
- Stacie Geller
- University of Illinois College of Medicine at Chicago, United States
| | - Claire Pomeroy
- Albert and Mary Lasker Foundation, New York, United States
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