Supportive Care in Cancer

, Volume 27, Issue 2, pp 697–704 | Cite as

Hispanic breast cancer patients’ symptom experience and patient-physician communication during chemotherapy

  • Jessica L. Krok-SchoenEmail author
  • Katia Fernandez
  • Gary W. Unzeitig
  • Griselda Rubio
  • Electra D. Paskett
  • Douglas M. Post
Original Article



Patient-clinician communication difficulties are a major barrier to effective symptom management during chemotherapy especially among non-English-speaking and minority patients. This study sought to examine how information is exchanged between patients and clinicians during chemotherapy treatment regarding pain, depression, fatigue, and nausea experienced among the most prevalent non-English-speaking group in the USA, Hispanic breast cancer survivors.


Hispanic breast cancer patients and clinicians participated in focus groups to examine Hispanic breast cancer survivors’ experience and patient-physician communication of symptoms during chemotherapy. Three separate focus groups (English language with patients, Spanish language with patients, and English language with clinicians) were conducted. All participants completed a demographic questionnaire.


Six breast cancer survivors participated in the English-language focus group, ten breast cancer survivors participated in the Spanish-language focus group, and five clinicians participated. Presence and communication of depressive symptoms between the English- and Spanish-language groups differed, with the majority of the English-language group sharing their experiences of depressive symptoms while those in the Spanish-language group did not report depressive symptoms. Results also indicated that most patients were unhappy with the response of clinicians regarding their reported symptoms. Several barriers to effective patient-clinician communication, including limited physician time, lack of patient knowledge, timidity, and language, were identified.


The findings of this study underscore the need to improve patient-physician communication during chemotherapy to reduce the symptom burden among Hispanic breast cancer patients.


Hispanic Breast cancer Patient-physician communication Symptoms Chemotherapy 



We would also like to acknowledge the breast cancer survivors and clinicians who were part of our focus groups.

Compliance with ethical standards

Informed consent procedures and study protocols were approved by the Institutional Review Boards of the participating clinics and universities.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    American Cancer Society (2015) Cancer facts & figures for Hispanic/Latinos 2015–2017. American Cancer Society, AtlantaGoogle Scholar
  2. 2.
    Freedman RA, He Y, Winer EP, Keating NL (2013) Racial/ethnic differences in receipt of timely adjuvant therapy for older women with breast cancer: are delays influenced by the hospitals where patients obtain surgical care? Health Serv Res 48(5):1669–1683PubMedPubMedCentralGoogle Scholar
  3. 3.
    Fedewa SA, Ward EM, Stewart AK, Edge SB (2010) Delays in adjuvant chemotherapy treatment among patients with breast cancer are more likely in African American and Hispanic populations: a national cohort study 2004-2006. J Clin Oncol 28(27):4135–4141PubMedCrossRefGoogle Scholar
  4. 4.
    Golan-Vered Y, Pud D (2013) Chemotherapy-induced neuropathic pain and its relation to cluster symptoms in breast cancer patients treated with paclitaxel. Pain Pract 13(1):46–52PubMedCrossRefGoogle Scholar
  5. 5.
    Lawrence DP, Kupelnick B, Miller K, Devine D, Lau J (2004) Evidence report on the occurrence, assessment, and treatment of fatigue in cancer patients. J Natl Cancer Inst Monogr 32:40–50CrossRefGoogle Scholar
  6. 6.
    Laird BJ, Scott AC, Colvin LA, McKeon AL, Murray GD, Fearon KC et al (2011) Pain, depression, and fatigue as a symptom cluster in advanced cancer. J Pain Symptom Manag 42(1):1–11CrossRefGoogle Scholar
  7. 7.
    So WK, Marsh G, Ling WM, Leung FY, Lo JC, Yeung M et al (2009) The symptom cluster of fatigue, pain, anxiety, and depression and the effect on the quality of life of women receiving treatment for breast cancer: a multicenter study. Oncol Nurs Forum 36(4):E205–E214PubMedCrossRefGoogle Scholar
  8. 8.
    Fernandez-Ortega P, Caloto MT, Chirveches E, Marquilles R, Francisco JS, Quesada A et al (2012) Chemotherapy-induced nausea and vomiting in clinical practice: impact on patients’ quality of life. Support Care Cancer 20(12):3141–3148PubMedCrossRefGoogle Scholar
  9. 9.
    Reich M, Lesur A, Perdrizet-Chevallier C (2008) Depression, quality of life and breast cancer: a review of the literature. Breast Cancer Res Treat 110(1):9–17PubMedCrossRefGoogle Scholar
  10. 10.
    Cheng KKF, Wong WH, Koh C (2016) Unmet needs mediate the relationship between symptoms and quality of life in breast cancer survivors. Support Care Cancer 24(5):2025–2033PubMedCrossRefGoogle Scholar
  11. 11.
    Graves KD, Jensen RE, Canar J, Perret-Gentil M, Leventhal KG, Gonzalez F et al (2012) Through the lens of culture: quality of life among Latina breast cancer survivors. Breast Cancer Res Treat 136(2):603–613PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Yoon J, Malin JL, Tisnado DM, Tao ML, Adams JL, Timmer MJ, Ganz PA, Kahn KL (2008) Symptom management after breast cancer treatment: is it influenced by patient characteristics? Breast Cancer Res Treat 108(1):69–77PubMedCrossRefGoogle Scholar
  13. 13.
    Fu OS, Crew KD, Jacobson JS, Greenlee H, Yu G, Campbell J, Ortiz Y, Hershman DL (2009) Ethnicity and persistent symptom burden in breast cancer survivors. J Cancer Surviv 3(4):241–250PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Booth CM, Clemons M, Dranitsaris G, Joy A, Young S, Callaghan W, Trudeau M, Petrella T (2007) Chemotherapy-induced nausea and vomiting in breast cancer patients: a prospective observational study. J Support Oncol 5(8):374–380PubMedGoogle Scholar
  15. 15.
    Kreling B, Figueiredo MI, Sheppard VL, Mandelblatt JS (2006) A qualitative study of factors affecting chemotherapy use in older women with breast cancer: barriers, promoters, and implications for intervention. Psycho-Oncology 15(12):1065–1076PubMedCrossRefGoogle Scholar
  16. 16.
    Brown LF, Kroenke K (2009) Cancer-related fatigue and its associations with depression and anxiety: a systematic review. Psychosomatics 50(5):440–447PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Cordero ED, Dimsdale JE, Navarro AM (2015) Feeling “pooped” and “run down?”: fatigue experiences in Latino cancer patients. J Appl Biobehav Res 20(1):1–24CrossRefGoogle Scholar
  18. 18.
    Maly RC, Liu Y, Leake B, Thind A, Diamant AL (2010) Treatment-related symptoms among underserved women with breast cancer: the impact of physician-patient communication. Breast Cancer Res Treat 119(3):707–716PubMedCrossRefGoogle Scholar
  19. 19.
    Ashing-Giwa KT, Tejero JS, Kim J, Padilla GV, Hellemann G (2007) Examining predictive models of HRQOL in a population-based, multiethnic sample of women with breast carcinoma. Qual Life Res 16(3):413–428PubMedCrossRefGoogle Scholar
  20. 20.
    Clauser SB, Arora NK, Bellizzi KM, Haffer SC, Topor M, Hays RD (2008) Disparities in HRQOL of cancer survivors and non-cancer managed care enrollees. Health Care Financ Rev 29(4):23–40PubMedPubMedCentralGoogle Scholar
  21. 21.
    Eversley R, Estrin D, Dibble S, Wardlaw L, Pedrosa M, Favila-Penney W (2005) Post-treatment symptoms among ethnic minority breast cancer survivors. Oncol Nurs Forum 32(2):250–256PubMedCrossRefGoogle Scholar
  22. 22.
    Napoles AM, Ortiz C, Santoyo-Olsson J, Stewart AL, Lee HE, Duron Y, Dixit N, Luce J, Flores D (2017) Post-treatment survivorship care needs of Spanish-speaking Latinas with breast cancer. J Community Support Oncol 15(1):20–27PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Ashing-Giwa KT, Padilla G, Tejero J, Kraemer J, Wright K, Coscarelli A, Clayton S, Williams I, Hills D (2004) Understanding the breast cancer experience of women: a qualitative study of African American, Asian American, Latina and Caucasian cancer survivors. Psycho-Oncology 13(6):408–428PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Kaplan CP, Napoles A, Davis S, Lopez M, Pasick RJ, Livaudais-Toman J et al (2016) Latinos and cancer information: perspectives of patients, health professionals and telephone cancer information specialists. J Health Dispar Res Pract 9(2):154–167PubMedPubMedCentralGoogle Scholar
  25. 25.
    Alegria M, Shrout PE, Woo M, Guarnaccia P, Sribney W, Vila D et al (2007) Understanding differences in past year psychiatric disorders for Latinos living in the US. Soc Sci Med 65(2):214–230PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Tami-Maury I, Aigner CJ, Rush S, Hong JH, Strom SS, Prokhorov AV et al (2017) The association of smoking with English and Spanish language use as a proxy of acculturation among Mexican-Americans. J Immigr Minor Health 19(5):1156–1162PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Yanez B, Maggard Gibbons M, Moreno PI, Jorge A, Stanton AL (2016) Predictors of psychological outcomes in a longitudinal study of Latina breast cancer survivors. Psychol Health 31(11):1359–1374PubMedCrossRefGoogle Scholar
  28. 28.
    Interian A, Ang A, Gara MA, Link BG, Rodriguez MA, Vega WA (2010) Stigma and depression treatment utilization among Latinos: utility of four stigma measures. Psychiatr Serv 61(4):373–379PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Ashing-Giwa K, Rosales M, Lai L, Weitzel J (2013) Depressive symptomatology among Latina breast cancer survivors. Psycho-Oncology 22(4):845–853PubMedCrossRefGoogle Scholar
  30. 30.
    Livaudais JC, Thompson B, Godina R, Islas I, Ibarra G, Coronado GD (2010) A qualitative investigation of cancer survivorship experiences among rural Hispanics. J Psychosoc Oncol 28(4):361–380PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Ashing-Giwa KT, Padilla GV, Bohorquez DE, Tejero JS, Garcia M (2006) Understanding the breast cancer experience of Latina women. J Psychosoc Oncol 24(3):19–52PubMedCrossRefGoogle Scholar
  32. 32.
    Katz SJ, Wallner LP, Abrahamse PH, Janz NK, Martinez KA, Shumway DA, Hamilton AS, Ward KC, Resnicow KA, Hawley ST (2017) Treatment experiences of Latinas after diagnosis of breast cancer. Cancer 123(16):3022–3030PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Epstein RM, Duberstein PR, Fenton JJ, Fiscella K, Hoerger M, Tancredi DJ, Xing G, Gramling R, Mohile S, Franks P, Kaesberg P, Plumb S, Cipri CS, Street RL Jr, Shields CG, Back AL, Butow P, Walczak A, Tattersall M, Venuti A, Sullivan P, Robinson M, Hoh B, Lewis L, Kravitz RL (2017) Effect of a patient-centered communication intervention on oncologist-patient communication, quality of life, and health care utilization in advanced cancer: the VOICE randomized clinical trial. JAMA Oncology 3(1):92–100PubMedPubMedCentralGoogle Scholar
  34. 34.
    Epstein RM, Street RL Jr (2007) Patient-centered communication in cancer care: promoting healing and reducing suffering. National Cancer Institute, Bethesda, pp 07–6225Google Scholar
  35. 35.
    Mandelblatt JS, Sheppard VB, Hurria A, Kimmick G, Isaacs C, Taylor KL, Kornblith AB, Noone AM, Luta G, Tallarico M, Barry WT, Hunegs L, Zon R, Naughton M, Winer E, Hudis C, Edge SB, Cohen HJ, Muss H, Cancer Leukemia Group B (2010) Breast cancer adjuvant chemotherapy decisions in older women: the role of patient preference and interactions with physicians. J Clin Oncol 28(19):3146–3153PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Maly RC, Stein JA, Umezawa Y, Leake B, Anglin MD (2008) Racial/ethnic differences in breast cancer outcomes among older patients: effects of physician communication and patient empowerment. Health Psychol 27(6):728–736PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Jerant A, Franks P, Kravitz RL (2011) Associations between pain control self-efficacy, self-efficacy for communicating with physicians, and subsequent pain severity among cancer patients. Patient Educ Couns 85(2):275–280PubMedCrossRefGoogle Scholar
  38. 38.
    Street RL Jr, Makoul G, Arora NK, Epstein RM (2009) How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns 74(3):295–301PubMedCrossRefGoogle Scholar
  39. 39.
    Post DM, Shapiro CL, Cegala DJ, David P, Katz ML, Krok JL, Phillips GS, McAlearney AS, Lehman JS, Hicks W, Paskett ED (2013) Improving symptom communication through personal digital assistants: the CHAT (Communicating Health Assisted by Technology) project. J Natl Cancer Inst Monogr 2013(47):153–161PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Basch E, Deal AM, Kris MG, Scher HI, Hudis CA, Sabbatini P, Rogak L, Bennett AV, Dueck AC, Atkinson TM, Chou JF, Dulko D, Sit L, Barz A, Novotny P, Fruscione M, Sloan JA, Schrag D (2016) Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial. J Clin Oncol 34(6):557–565PubMedCrossRefGoogle Scholar
  41. 41.
    Agboola SO, Ju W, Elfiky A, Kvedar JC, Jethwani K (2015) The effect of technology-based interventions on pain, depression, and quality of life in patients with cancer: a systematic review of randomized controlled trials. J Med Internet Res 17(3):e65PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Moradian S, Voelker N, Brown C, Liu G, Howell D (2018) Effectiveness of Internet-based interventions in managing chemotherapy-related symptoms in patients with cancer: a systematic literature review. Support Care Cancer 26(2):361–374Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, College of MedicineThe Ohio State UniversityColumbusUSA
  2. 2.Comprehensive Cancer CenterThe Ohio State UniversityColumbusUSA
  3. 3.College of MedicineThe Ohio State UniversityColumbusUSA
  4. 4.Doctors Hospital of LaredoLaredoUSA
  5. 5.Division of Cancer Prevention and Control, Department of Internal Medicine, College of MedicineThe Ohio State UniversityColumbusUSA
  6. 6.Division of Epidemiology, College of Public HealthThe Ohio State UniversityColumbusUSA

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