Breast Cancer Research and Treatment

, Volume 153, Issue 2, pp 253–261 | Cite as

Advancing breast cancer survivorship among African-American women

  • Steven S. Coughlin
  • Wonsuk Yoo
  • Mary S. Whitehead
  • Selina A. Smith


Advances have occurred in breast cancer survivorship but, for many African-American women, challenges and gaps in relevant information remain. This article identifies opportunities to address disparities in breast cancer survival and quality of life, and thereby to increase breast cancer survivorship among African-American women. For breast cancer survivors, common side effects, lasting for long periods after cancer treatment, include fatigue, loss of strength, difficulty sleeping, and sexual dysfunction. For addressing physical and mental health concerns, a variety of interventions have been evaluated, including exercise and weight training, dietary interventions, yoga and mindfulness-based stress reduction, and support groups or group therapy. Obesity has been associated with breast cancer recurrence and poorer survival. Relative to white survivors, African-American breast cancer survivors are more likely to be obese and less likely to engage in physical activity, although exercise improves overall quality of life and cancer-related fatigue. Considerable information exists about the effectiveness of such interventions for alleviating distress and improving quality of life among breast cancer survivors, but few studies have focused specifically on African-American women with a breast cancer diagnosis. Studies have identified a number of personal factors that are associated with resilience, increased quality of life, and positive adaptation to a breast cancer diagnosis. There is a need for a better understanding of breast cancer survivorship among African-American women. Additional evaluations of interventions for improving the quality of life and survival of African-American breast cancer survivors are desirable.


African Americans Breast cancer Cancer survivorship Health status disparities Quality of life Survival 


Funding source

This work is funded by the National Cancer Institute (1R01CA166785-01).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest to report.


  1. 1.
    American Cancer Society (2014) Cancer facts and figures 2015. ACS, AtlantaGoogle Scholar
  2. 2.
    Thompson HS, Littles M, Jacob S, Coker C (2006) Post-treatment breast cancer surveillance and follow-up care experiences of breast cancer survivors of African descent: an exploratory qualitative study. Cancer Nurs 29:478–487CrossRefPubMedGoogle Scholar
  3. 3.
    Torres E, Dixon C, Richman AR (2015) Understanding the breast cancer experience of survivors: a qualitative study of African American women in rural Eastern North Carolina. J Cancer Educ 14:1–9Google Scholar
  4. 4.
    Haynes-Maslow L, Allicock M, Johnson S (2015) Cancer support needs for African American breast cancer survivors and caregivers. J Cancer Educ 16:1–6Google Scholar
  5. 5.
    Khatcheressian JL, Hurley P, Bantug E et al (2013) Breast cancer follow-up and management after primary treatment: american Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 31:961–965CrossRefPubMedGoogle Scholar
  6. 6.
    Glanz PA (2009) Survivorship: adult cancer survivors. Prim Care 36:721–741CrossRefGoogle Scholar
  7. 7.
    Hewitt M, Greenfield S, Stovall E (eds) (2005) Committee on cancer survivorship: improving care and quality of life, institute of medicine. From cancer patient to cancer survivor: lost in transition. National Academies Press, Washington, DCGoogle Scholar
  8. 8.
    Rowland JH (2008) Cancer survivorship: rethinking the cancer control continuum. Semin Oncol Nurs 24:145–152CrossRefPubMedGoogle Scholar
  9. 9.
    Miller R (2008) Implementing a survivorship care plan for patients with breast cancer. Clin J Oncol Nurs 12:479–487CrossRefPubMedGoogle Scholar
  10. 10.
    Howlader N, Noone AM, Krapcho M, et al (eds). SEER cancer statistics review, 1975–2011, National Cancer Institute. Bethesda,
  11. 11.
    Albain KS, Unger JM, Crowley JJ et al (2009) Racial disparities in cancer survival among randomized clinical trials patients of the Southwest Oncology Group. J Natl Cancer Inst 101:984–992CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Albano JD, Ward E, Jemal A et al (2007) Cancer mortality in the United States by education level and race. J Natl Cancer Inst 99:1384–1394CrossRefPubMedGoogle Scholar
  13. 13.
    Royak-Schaler R, Passmore SR, Gadalla S et al (2008) Exploring patient-physician communication in breast cancer care for African American women following primary treatment. Oncol Nurs Forum 35:836–843CrossRefPubMedGoogle Scholar
  14. 14.
    Palmer NR, Weaver KE, Hauser SP et al (2015) Disparities in barriers to follow-up care between African American and white breast cancer survivors. Support Care Cancer 36:1–9Google Scholar
  15. 15.
    Gerend MA, Pai M (2008) Social determinants of black-white disparities in breast cancer mortality: a review. Cancer Epidemiol Biomarkers Prev 17:2913–2923CrossRefPubMedGoogle Scholar
  16. 16.
    Coughlin SS (2009) Surviving cancer or other serious illness: a review of individual and community resources. CA Cancer J Clin 58:60–64CrossRefGoogle Scholar
  17. 17.
    Baker F, Denniston M, Smith T, West MM (2005) Adult cancer survivors: how are they faring? Cancer 104(suppl):2565–2576CrossRefPubMedGoogle Scholar
  18. 18.
    Jim HS, Phillips KM, Chait S et al (2012) Meta-analysis of cognitive functioning in breast cancer survivors previously treated with standard-dose chemotherapy. J Clin Oncol 30:3578–3587CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Budhrani PH, Lengacher CA, Kip KE et al (2014) Minority breast cancer survivors: the association between race/ethnicity, objective sleep disturbances, and physical and psychological symptoms. Nurs Res Pract 2014:858403PubMedCentralPubMedGoogle Scholar
  20. 20.
    Pollack LA, Greer GE, Rowland JH et al (2005) Cancer survivorship: a new challenge in comprehensive cancer control. Cancer Causes Control 16(suppl):51–59CrossRefPubMedGoogle Scholar
  21. 21.
    Chen Z, Maricic M, Bassford TL et al (2005) Fracture risk among breast cancer survivors: results from the Women’s Health Initiative Observational Study. Arch Intern Med 165:552–558CrossRefPubMedGoogle Scholar
  22. 22.
    Haque R, Prout M, Geiger AM et al (2014) Comorbidities and cardiovascular disease risk in older breast cancer survivors. Am J Manag Care 20:86–92PubMedCentralPubMedGoogle Scholar
  23. 23.
    Sheean P, Liang H, Schiffer L et al (2015) Assessing the prevalence of compromised bone health among overweight and obese African American breast cancer survivors: a case-control study. J Cancer Surviv 42:1–10Google Scholar
  24. 24.
    Vagenas D, Di Sipio T, Battistutta D et al (2015) Weight and weight change following breast cancer: evidence from a prospective, population-based, breast cancer cohort study. BMC Cancer 15:28CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    Carver JR, Shapiro CL, Ng A et al (2007) American Society of Clinical Oncology clinical evidence review on the ongoing care of adult cancer survivors: cardiac and pulmonary late effects. J Clin Oncol 25:3991–4008CrossRefPubMedGoogle Scholar
  26. 26.
    Kirkham AA, Virani SA, Campbell KL (2015) The utility of cardiac stress testing for detection of cardiovascular disease in breast cancer survivors: a systematic review. Int J Womens Health 7:127–149CrossRefPubMedCentralPubMedGoogle Scholar
  27. 27.
    Houlihan NG (2009) Transitioning to cancer survivorship: plans of care. Oncology 23(8 Suppl):42–48PubMedGoogle Scholar
  28. 28.
    Stricker CT, Jacobs LA, Risendal B et al (2011) Survivorship care planning after the institute of medicine recommendations: how are we faring? Cancer Surv 5:358–370CrossRefGoogle Scholar
  29. 29.
    Saltz T, McCabe MS, Onstad EE et al (2014) Survivorship care plans: is there buy-in from community oncology providers? Cancer 120:722–730CrossRefGoogle Scholar
  30. 30.
    Salz T, Oeffinger KC, McCabe MS et al (2012) Survivorship care plans in research and practice. CA Cancer J Clin 62:101–117CrossRefPubMedCentralPubMedGoogle Scholar
  31. 31.
    Birken SA, Deal AM, Mayer DK, Weiner BJ (2014) Determinants of survivorship care plan use in US cancer programs. J Cancer Educ 29:720–727CrossRefPubMedGoogle Scholar
  32. 32.
    Blanch-Hartigan D, Forsythe LP, Alfano CM et al (2014) Provision and discussion of survivorship care plans among cancer survivors: results of a nationally representative survey of oncologists and primary care physicians. J Clin Oncol 32:1578–1585CrossRefPubMedCentralPubMedGoogle Scholar
  33. 33.
    Forsythe LP, Parry C, Alfano CM et al (2013) Use of survivorship care plans in the United States: associations with survivorship care. J Natl Cancer Inst 105:1579–1587CrossRefPubMedCentralPubMedGoogle Scholar
  34. 34.
    Dulko D, Pace CM, Dittus KL et al (2013) Barriers and facilitators to implementing cancer survivorship plans. Oncol Nurs Forum 40:575–580CrossRefPubMedCentralPubMedGoogle Scholar
  35. 35.
    Palmer SC, Stricker CT, Panzer SL et al (2015) Outcomes and satisfaction after delivery of a breast cancer survivorship care plan: results of a multicenter trial. J Oncol Pract 11:e222–e229CrossRefPubMedGoogle Scholar
  36. 36.
    Smith SL, Singh-Carlson S, Downie L et al (2011) Survivors of breast cancer: patient perspectives on survivorship care planning. J Cancer Surv 5:337–344CrossRefGoogle Scholar
  37. 37.
    Cho J, Jung SY, Lee JE et al (2014) A review of breast cancer survivorship issues from survivors’ perspectives. J Breast Cancer 17:189–199CrossRefPubMedCentralPubMedGoogle Scholar
  38. 38.
    Howard-Anderson J, Ganz PA, Bower JE, Stanton AL (2012) Quality of life, fertility concerns, and behavioral health outcomes in younger breast cancer survivors: a systematic review. J Natl Cancer Inst 104:386–405CrossRefPubMedGoogle Scholar
  39. 39.
    Matthews AK, Tejeda S, Johnson TP et al (2012) Correlates of quality of life among African American and white cancer survivors. Cancer Nurs 35:355–364CrossRefPubMedCentralPubMedGoogle Scholar
  40. 40.
    Ashing-Giwa KT, Lim JW (2009) Examining the impact of socioeconomic status and socioecologic stress on physical and mental health quality of life among breast cancer survivors. Oncol Nurs Forum 36:79–88CrossRefPubMedGoogle Scholar
  41. 41.
    Henderson PD, Gore SV, Davis BL, Condon EH (2003) African American women coping with breast cancer: a qualitative analysis. Oncol Nurs Forum 30:641–647CrossRefPubMedGoogle Scholar
  42. 42.
    Leak A, Hu J, King CR (2008) Symptom distress, spirituality, and quality of life in African American breast cancer survivors. Cancer Nurs 31:E15–E21CrossRefPubMedGoogle Scholar
  43. 43.
    Tate JD (2011) The role of spirituality in the breast cancer experiences of African American women. J Holist Nurs 29:149–155CrossRefGoogle Scholar
  44. 44.
    Gibson LM, Hendricks CS (2006) Integrative review of spirituality in African American breast cancer survivors. ABNF J 17:67–72PubMedGoogle Scholar
  45. 45.
    Powe BD, Hamilton J, Hancock N et al (2007) Quality of life of African American cancer survivors: a review of the literature. Cancer 109(2 Suppl):435–445CrossRefPubMedGoogle Scholar
  46. 46.
    Russell KM, Von Ah DM, Giesler RB et al (2008) Quality of life of African American breast cancer survivors: how much do we know? Cancer Nurs 31:E36–E45CrossRefPubMedGoogle Scholar
  47. 47.
    Meneses-Echavez JF, Gonzalez-Jimenez E, Ramirez-Velez R (2015) Effects of supervised exercise on cancer-related fatigue in breast cancer survivors: a systematic review and meta-analysis. BMC Cancer 15:77CrossRefPubMedCentralPubMedGoogle Scholar
  48. 48.
    Jones JM, Olson K, Catton P et al (2015) Cancer-related fatigue and associated disability in post-treatment cancer survivors. J Cancer Surv 6:1–11CrossRefGoogle Scholar
  49. 49.
    Mishra SI, Scherer RW, Geigle PM, et al (2012) Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database Syst Rev 8: CD007566Google Scholar
  50. 50.
    Lahart IM, Metsios GS, Nevill AM, Carmichael AR (2015) Physical activity, risk of death and recurrence in breast cancer survivors: a systematic review and meta-analysis of epidemiological studies. Acta Oncol 54(5):635–654CrossRefPubMedGoogle Scholar
  51. 51.
    Morey MC, Snyder DC, Sloane R et al (2009) Effects of home-based diet and exercise on functional outcomes among older, overweight long-term cancer survivors: RENEW: a randomized controlled trial. JAMA 301:1883–1891CrossRefPubMedCentralPubMedGoogle Scholar
  52. 52.
    Demark-Wahnefried W, Morey MC, Sloane R et al (2012) Reach out to enhance wellness home-based diet-exercise intervention promotes reproducible and sustainable long-term improvements in health behaviors, body weight, and physical functioning in older, overweight/obese cancer survivors. J Clin Oncol 30:2354–2361CrossRefPubMedCentralPubMedGoogle Scholar
  53. 53.
    Kenzik KM, Morey MC, Cohen HJ et al (2015) Symptoms, weight loss and physical function in a lifestyle intervention study of older cancer survivors. Cancer Epidemiol Biomarkers Prev 24:763–764CrossRefGoogle Scholar
  54. 54.
    Izano MA, Fung TT, Chiuve SS et al (2013) Are diet quality scores after breast cancer diagnosis associated with improved breast cancer survival? Nutr Cancer 65:820–826CrossRefPubMedCentralPubMedGoogle Scholar
  55. 55.
    George SM, Alfano CM, Neuhouser ML et al (2014) Better postdiagnosis diet quality is associated with less cancer-related fatigue in breast cancer survivors. J Cancer Surviv 8:680–687CrossRefPubMedGoogle Scholar
  56. 56.
    Spark LC, Reeves MM, Fieldsoe BS, Eakin EG (2013) Physical activity and/or dietary interventions in breast cancer survivors: a systematic review of the maintenance of outcomes. J Cancer Surviv 7:74–82CrossRefPubMedGoogle Scholar
  57. 57.
    Short CE, James EL, Stacey F, Plotnikoff RC (2013) A qualitative synthesis of trials promoting physical activity behavior change among post-treatment breast cancer survivors. J Cancer Surviv 7:570–581CrossRefPubMedCentralPubMedGoogle Scholar
  58. 58.
    Rogers LQ, McAuley E, Anton PM et al (2012) Better exercise adherence after treatment for cancer (BEAT Cancer) study: rationale, design, and methods. Contemp Clin Trials 33:124–137CrossRefPubMedCentralPubMedGoogle Scholar
  59. 59.
    Short CE, James EL, Plotnikoff RC (2013) Theory- and evidence-based development and process evaluation of the move more for Life program: a tailored-print intervention designed to promote physical activity among post-treatment breast cancer survivors. Int J Behav Nutr Phys Act 10:124CrossRefPubMedCentralPubMedGoogle Scholar
  60. 60.
    Thompson HJ, Sedlacek SM, Paul D et al (2012) Effect of dietary patterns differing in carbohydrate and fat content on blood lipid and glucose profiles based on weight-loss success of breast cancer survivors. Breast Cancer Res 14:R1CrossRefPubMedCentralPubMedGoogle Scholar
  61. 61.
    Protani M, Coory M, Martin JH (2010) Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat 123:627–635CrossRefPubMedGoogle Scholar
  62. 62.
    Helver LK, Varnic M, Le LW et al (2010) Obesity is a risk factor for developing postoperative lymphedema in breast cancer patients. Breast J 16:48–54CrossRefGoogle Scholar
  63. 63.
    Dominick SA, Madlensky L, Natarajan L, Pierce JP (2013) Risk factors associated with breast cancer-related lymphedema in the WHEL study. J Cancer Surviv 7:115–123CrossRefPubMedCentralPubMedGoogle Scholar
  64. 64.
    Kuijpers W, Groen WG, Aaronson NK, van Harten WH (2013) A systematic review of web-based interventions for patient empowerment and physical activity in chronic diseases: relevance for cancer survivors. J Med Internet Res 15:e37CrossRefPubMedCentralPubMedGoogle Scholar
  65. 65.
    Goode AD, Lawler SP, Brakenridge CL, et al (2015) Telephone, print, and web-based interventions for physical activity, diet, and weight control among cancer survivors: a systematic review. J Cancer Surviv. doi: 10.1007/s11764-015-0442-2
  66. 66.
    Spector D, Deal AM, Amos KD et al (2014) A pilot study of a home-based motivational exercise program for African American breast cancers: clinical and quality-of-life outcomes. Integr Cancer Ther 13:121–132CrossRefPubMedGoogle Scholar
  67. 67.
    Calhoun C, Helzlsouer KJ, Gallicchio L (2015) Racial differences in depressive symptoms and self-rated health among breast cancer survivors on aromatase inhibitor therapy. J Psychosoc Oncol 33(3):263–277CrossRefPubMedGoogle Scholar
  68. 68.
    White A, Pollack LA, Smith JL et al (2013) Racial and ethnic differences in health status and health behavior among breast cancer survivors—behavioral risk factor surveillance system, 2009. J Cancer Surviv 7:93–103CrossRefPubMedCentralPubMedGoogle Scholar
  69. 69.
    Schmitz KH, Ahmed RL, Troxel AB et al (2010) Weight lifting for women at risk for breast cancer-related lymphedema: a randomized trial. JAMA 304:2699–2705CrossRefPubMedGoogle Scholar
  70. 70.
    Buffart LM, van Uffelen JG, Riphagen II et al (2012) Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials. BMC Cancer 12:559CrossRefPubMedCentralPubMedGoogle Scholar
  71. 71.
    Cramer H, Lauche R, Paul A, Dobos G (2012) Mindfulness-based stress reduction for breast cancer—a systematic review and meta-analysis. Curr Oncol 19:e343–e352CrossRefPubMedCentralPubMedGoogle Scholar
  72. 72.
    Huang HP, He M, Wang HY, Zhou M (2015) A meta-analysis of the benefits of mindfulness-based stress reduction (MBSR) on psychological function among breast cancer (BC) survivors. Breast Cancer 17(1):1–9CrossRefGoogle Scholar
  73. 73.
    Harder H, Parlour L, Jenkins V (2012) Randomized controlled trials of yoga interventions for women with breast cancer: a systematic literature review. Support Care Cancer 20:3055–3064CrossRefPubMedGoogle Scholar
  74. 74.
    Zainal NZ, Booth S, Huppert FA (2013) The efficacy of mindfulness-based stress reduction on mental health of breast cancer patients: a meta-analysis. Psychooncology 22:1457–1465CrossRefPubMedGoogle Scholar
  75. 75.
    Chatman MC, Green RD (2011) Addressing the unique psychosocial barriers to breast cancer treatment experienced by African American women through integrative navigation. J Natl Black Nurs Assoc 22:20–28Google Scholar
  76. 76.
    Kurita GP, Sjogren P (2015) Pain management in cancer survivorship. Acta Oncol 54(5):629–634CrossRefPubMedGoogle Scholar
  77. 77.
    Yazdani S, Abdi S (2014) Brief review. Pain management for cancer survivors: challenges and opportunities. Can J Anaesth 61:745–753CrossRefPubMedGoogle Scholar
  78. 78.
    Payne R, Medina E, Hampton JW (2003) 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(1 Suppl):311–317CrossRefPubMedGoogle Scholar
  79. 79.
    Sun V, Borneman T, Piper B et al (2008) Barriers to pain assessment and management in cancer survivorship. J Cancer Surviv 2:65–71CrossRefPubMedCentralPubMedGoogle Scholar
  80. 80.
    Von Ah D, Tallman EF (2015) Perceived cognitive function in breast cancer survivors: evaluating relationships with objective cognitive performance and other symptoms using the functional assessment of cancer therapy-cognitive function instrument. J Pain Symptom Manag 49:697–706CrossRefGoogle Scholar
  81. 81.
    Myers JS, Wick JA, Klemp J (2015) Potential factors associated with perceived cognitive impairment in breast cancer survivors. Support Care Cancer 16:1–10Google Scholar
  82. 82.
    Stagl JM, Antoni MH, Lechner SC et al (2015) Randomized controlled trial of cognitive behavioral stress management in breast cancer: a brief report of effects on 5-year depressive symptoms. Health Psychol 34:176–180CrossRefPubMedGoogle Scholar
  83. 83.
    Stagl JM, Bouchard LC, Lechner SC et al (2015) Long-term psychological benefits of cognitive-behavioral stress management for women with breast cancer: 11-year follow-up of a randomized controlled trial. Cancer 121(11):1873–1881CrossRefPubMedGoogle Scholar
  84. 84.
    Lechner SC, Whitehead NE, Vargas S et al (2014) Does a community-based stress management intervention affect psychological adaptation among underserved black breast cancer survivors? J Natl Cancer Inst Monogr 2014:315–322CrossRefPubMedGoogle Scholar
  85. 85.
    Dunkel-Schetter C, Feinstein LG, Taylor SE, Falke RL (1992) Patterns of coping with cancer. Health Psychol 11:79–87CrossRefPubMedGoogle Scholar
  86. 86.
    Folkman S, Moskowitz JT (2004) Coping: pitfalls and promise. Annu Rev Psychol 55:745–774CrossRefPubMedGoogle Scholar
  87. 87.
    Canada AL, Parker PA, de Moor JS et al (2006) Active coping mediates the association between religion/spirituality and quality of life in ovarian cancer. Gynecol Oncol 101:102–107CrossRefPubMedGoogle Scholar
  88. 88.
    Carver CS (2005) Enhancing adaptation during treatment and the role of individual differences. Cancer 104(suppl):2602–2607CrossRefPubMedGoogle Scholar
  89. 89.
    Danhauer SC, Case LD, Tedeschi R et al (2013) Predictors of posttraumatic growth in women with breast cancer. Psychooncology 22:2676–2683CrossRefPubMedGoogle Scholar
  90. 90.
    McDonough MH, Sabiston CM, Wrosch C (2014) Predicting changes in posttraumatic growth and subjective well-being among breast cancer survivors: the role of social support and stress. Psychooncology 23:114–120CrossRefPubMedGoogle Scholar
  91. 91.
    Trunzo JJ, Pinto BM (2003) Social support as a mediator of optimism and distress in breast cancer survivors. J Consult Clin Psychol 71:805–811CrossRefPubMedGoogle Scholar
  92. 92.
    Garner MJ, McGregor BA, Murphy KM et al (2015) Optimism and depression: a new look at social support as a mediator among women at risk for breast cancer. Psychooncology. doi: 10.1002/pon.3782 PubMedGoogle Scholar
  93. 93.
    Goodwin PJ (2005) Support groups in advanced breast cancer. Cancer 104(suppl):2596–2601CrossRefPubMedGoogle Scholar
  94. 94.
    Wells AA, Gulbas L, Sanders-Thompson V et al (2014) African American breast cancer survivors participating in a breast cancer support group: translating research into practice. J Cancer Educ 29:619–625CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Steven S. Coughlin
    • 1
    • 4
  • Wonsuk Yoo
    • 2
  • Mary S. Whitehead
    • 3
  • Selina A. Smith
    • 2
  1. 1.Department of Community Health and Sustainability, Division of Public HealthUniversity of MassachusettsLowellUSA
  2. 2.Institute of Public and Preventive Health, and Department of Family Medicine, Medical College of GeorgiaGeorgia Regents UniversityAugustaUSA
  3. 3.Florida Resources for Empowering Sustainable Health and SISTAAH Talk Breast Cancer Support GroupMiamiUSA
  4. 4.LowellUSA

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