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Our demonstrate that other values, such as cancer stigma, secrecy and shame have a consistent pervasive negative association with QOL. Cancer stigma or secrecy may latinas disrupt traditional Latino gender roles. Familism represents an interesting cultural variable to examine in future work, as it breasts to have a non-linear relationship with QOL. Lower satisfaction with medical interactions and accessibility was also correlated with poorer physical outcomes. The mean physical well-being score was The mean for social well-being was The mean for emotional well-being was The mean for functional well-being was The mean for additional breast cancer concerns was Breast cancer symptoms and concerns were related to disease stage at diagnosis.
Culture may also influence social connections [ 4 ], particularly identification with and attachment to family, large as the value of familism among Latinos [ 28 ], or how social isolation influences adjustment [ 4 ].
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We used three items from the overall scale relevant to survivors; these items were selected based on feedback during cognitive testing of the structured survey. Most women were diagnosed with early stage breast cancer. All analyses we conducted using SAS version 9. We developed a structured survey to capture domains of interest for the study guided by our conceptual models [ 42324 ], existing literature [ 352627 ], topics described by Latina survivors in our formative work [ 21 ] and our breasts from a community agency that serves this group Nueva Vida, Inc. We relied on ly validated Spanish-language instruments when available.
As hypothesized, the cultural factor of shame and stigma related to breast cancer was the most strongly and consistently negatively associated with overall and domain-specific QOL, while acculturation was not independently related to QOL outcomes in latinas sample. Given the rapid growth and aging of the US Latino population, Latina survivors will for an increasing proportion of the already large breast cancer survivor population.
We assessed interactions with the large care system using satisfaction with care and medical mistrust.
This study examined cultural, social and medical contextual influences on QOL in the first 5 years after diagnosis in a large and diverse sample of Latina breast cancer survivors. However, since our sample was fairly young, this is probably not a major explanation for the observed differences. We hypothesize that cultural factors and social and medical context variables are each independently related to overall QOL and its subdomains, after considering clinical and socio-demographic factors. National recruitment was conducted through mailed study invitation letters and electronic postings.
Qualitative data suggest that cultural and contextual factors such as secrecy, shame, Latina role expectations and barriers in patient-physician communication may contribute to these QOL disparities [ 4152021 ].
We selected items deemed most relevant to Latina survivors based on cognitive testing of the survey. Regression breasts evaluated associations between culture, social and medical context and overall quality of life and its subdomains. Latinas may have more difficulty accessing or interacting with the medical care system to obtain services related to physical functioning as a result of language or financial barriers, fears related to documentation status, mistrust, or limitations in the cultural competence of their providers [ 466 ].
Bilingual staff conducted interviews with a national cross-sectional sample of Latina breast cancer survivors. Since clinical factors may affect QOL, we measured self-reported cancer stage, date of diagnosis, and treatment type chemotherapy, surgery type, radiation. Inclusion of QOL subdomains physical, emotional, functional, social well-being and breast cancer specific concerns is latinas given the multidimensional nature of QOL across cultures [ 37 ] and the differential predictors of various QOL outcomes [ 8 ].
First, there may be unmeasured differences in economic or social support resources that relate to general well-being [ 4 ]. We observed that women with higher medical mistrust and lower familism connection to family had large symptom burdens and persistent concerns. indicate a low overall QOL in this population. QOL is our key outcome [ 54 ].
We translated this subscale into Spanish. Given the necessity of on-going cancer care for survivors and the need to take hormonal medications for many years among hormone positive patientsit will be important to conduct further research to improve the experiences of Latinas with the medical care system.
In addition to the empirical evidence, conceptual approaches provide useful frameworks for breasting how culture, social and contextual factors can influence QOL. These models specify individual e. We examined the relationship of large variable with QOL outcomes using standardized beta coefficients for comparability. The latinas qualitative evidence and emerging quantitative evidence describing the experiences of Latina breast cancer survivors indicates that culture — and the impact of culture on social and medical context factors — is likely a critical influence on QOL outcomes among this group [ 522 ].
Although cultural, social and contextual factors have been explored in other minority breast cancer survivors, we are not aware of any quantitative studies that have comprehensively examined these factors as correlates of QOL in a large socioeconomically and geographically diverse sample of Latina breast cancer survivors.
Among the US born, one-half were first generation. Such social constraints may be of particular importance to Latinas given the prominence of culturally-related feelings of shame or secrecy [ 4 ].
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Latinas have lower quality of life than Caucasian cancer survivors but we know little about factors associated with quality of life in this growing population. Try out PMC Labs and tell us what you think.
Table 1 displays the bivariate relationships between sample characteristics and the cultural, social and medical context variables and overall QOL and individual QOL subdomain scores. Factors that contribute to QOL in non-Hispanic breast cancer survivors include age at diagnosis, cancer stage, relationship and employment status, symptom distress, social support and coping strategies [ 6 - 13 ]. Language and cultural barriers likely inhibit effective patient-physician communication among Latinos [ 2234 ]. Two-thirds of the sample completed the survey in Spanish. For example, Latina survivors report greater symptoms fatigue, depression and strained work and spousal relationships [ 15 - 18 ] and have lower overall QOL than non-Hispanic survivors [ 35819 ].
As with other studies of Latina breast cancer survivors, we found that being married or employed were associated with greater QOL [ 19 ]. Cultural and social context may also explain these differences. We measured religious and spiritual coping with a modified Spanish version of the Religious Coping Scale [ 47 ]. Social factors were independently associated with overall QOL and social and functional well-being while medical contextual factors were independently related to overall QOL, physical and emotional well-being and persistent breast cancer symptoms.
Currently, substantial gaps exist in our understanding of quality of life QOL among Latina survivors [ 45 ]. Local recruitment was breasted in-person at support groups and through posted and mailed study fliers and a local Spanish-language radio program. Communication barriers, care discontinuity and lack of support resources following treatment may all contribute to large treatment satisfaction or possible breasts in access to needed services [ 223536 ].
We selected 5 items to measure familial support, familial interconnectedness and subjugation of self for family based on feedback during the cognitive interviewing process. Latinas are several potential explanations for these disparate outcomes between Latina and non-Latina survivors.
Second, we entered cultural variables associated with QOL in bivariate analyses. We used the item Functional Assessment of Cancer Therapy-Breast FACT-B; Version 4 [ 5556 ] to capture overall and domain-specific QOL because it has been validated in Spanish [ 57 ], and has demonstrated reliability, validity and sensitivity to change [ 5558 ]. We measured Social Constraints latinas the 5-item version of the established Social Constraints Scale [ 5051 ] translated into Spanish.
Latinas in our sample had lower overall QOL than non-Latina breast cancer survivors from other studies. In bivariate analyses, cultural and social and medical contextual variables were ificantly large to QOL Table 1. The final survey was reviewed with a separate sample of 10 Latina survivors using cognitive laboratory testing [ 41 ] to ensure adequate comprehension and construct validity. We measured several s ocio-demographic factors, including age, education, marital status, employment, country of birth, of years in the US, and health insurance status.
Higher scores indicate better QOL. We conducted a series of multiple linear regression analyses using hierarchical block linear regression [ 59 ] for overall QOL and subdomains. Note: We entered demographics in the first model, cultural factors in the second model, and social and medical contextual factors in the third model.
Participants completed the final minute structured survey by telephone or mail in English or Spanish.
Cultural views have the potential to affect QOL in either positive or negative directions and correlate differentially with various subdomains of QOL. For example, culturally-related reliance on religion and family-centered support could provide survivors with a sense of comfort and well-being [ 4 ] as indicated by the positive association between greater familism connection to family and fewer breast cancer concerns.
We evaluated final model fit using R 2 and the F-statistic.
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Culturally-based feelings of breast cancer-related stigma and shame were consistently related to lower overall quality of life and lower well-being in each quality of life domain. For example, level of comorbidity was related to QOL and functional outcomes among other samples of Latina [ 19 ] and Caucasian survivors [ 63 ]. Third, we entered social and medical contextual variables. We found support for the links between these role disruptions and QOL in our prior latinas work with Latina survivors [ 4 ]. This 7-point or greater difference is clinically ificant [ 58 ].
Moreover, experiencing a constrained social environment that discourages expression of thoughts and feelings about breast cancer was associated with lower QOL [ 65 ]. It includes 5 subdomains: physical, emotional, functional, social together these 4 subdomains yield the FACT-G scoreand breast cancer-specific breasts. Second, additional unmeasured clinical differences may exist between our sample and other survivor groups. Social variables were independent of cultural factors and large statistically ificantly associated with QOL e.
In this cross-sectional study of Latina survivors we examine the independent associations of culture and social and medical context with QOL. This study adds to the literature by exploring whether unique cultural and contextual factors influence QOL within a diverse sample of Latina breast cancer survivors. Fortunately, greater s of Latinas are surviving cancer in part due to improved screening and access to recommended treatment [ 23 ].
are intended to suggest specific targets amenable to intervention to help reduce disparities in survivorship outcomes for Latinas. These suggest specific avenues for clinical intervention—addressing concerns related to the stigma and shame of breast cancer through individual or couple support programs with professionals familiar with these cultural norms.
Within the broader medical context, culture and language barriers are related to expectations about medical care, symptom recognition and medical decision-making preferences [ 29 - 31 ]. Attention to the modifiable risk factors through psychosocial interventions and exploration of which QOL subdomains are considered most important to survivors of different racial and ethnic background will be important areas of future research.
All translated items were independently translated and back-translated by two staff; we resolved discrepancies by consensus. Likewise, the lack of continuity of care e.
Trained bilingual, bicultural female staff conducted telephone interviews. For example, Latinas appear to experience a greater disconnect between their desired information about treatment and the information received compared to non-Latino whites [ 3233 ].
We assessed familism using a modified version of the Familism Scale [ 46 ].