Supportive Care in Cancer

, Volume 24, Issue 12, pp 4979–4986 | Cite as

Post-treatment problems of African American breast cancer survivors

  • Andrea M. BarsevickEmail author
  • Amy Leader
  • Patricia K. Bradley
  • Tiffany Avery
  • Lorraine T. Dean
  • Melissa DiCarlo
  • Sarah E. Hegarty
Original Article



African American breast cancer survivors (AABCS) have a lower survival rate across all disease stages (79 %) compared with White survivors (92 %) and often have more aggressive forms of breast cancer requiring multimodality treatment, so they could experience a larger burden of post-treatment quality of life (QOL) problems. This paper reports a comprehensive assessment of the number, severity, and domains of problems faced by AABCS within 5 years after treatment completion and identifies subgroups at risk for these problems.


A population-based random sample was obtained from the Pennsylvania Cancer Registry of African American females over 18 years of age who completed primary treatment for breast cancer in the past 5 years. A mailed survey was used to document survivorship problems.


Two hundred ninety-seven AABCS completed the survey. The median number of survivor problems reported was 15. Exploratory factor analysis of the problem scale revealed four domains: emotional problems, physical problems, lack of resources, and sexuality problems. Across problem domains, younger age, more comorbid conditions, and greater medical mistrust were risk factors for more severe problems.


The results demonstrated that AABCS experienced significant problem burden in the early years after diagnosis and treatment. In addition to emotional and physical problem domains that were documented in previous research, two problem domains unique to AABCS included lack of resources and sexuality concerns. At risk groups should be targeted for intervention. The study results reported in this manuscript will inform future research to address problems of AABCS as they make the transition from cancer patient to cancer survivor.


Cancer survivor Disparities Breast cancer African American Quality of life Medical mistrust 



Community Academic Advisory Board

Tiffany Avery, MD

Wake Forest University

Donna M. Duncan, MBA

Linda Creed Breast

Catharine Crème Henry, MA

Living Beyond Breast Cancer

April Reilly, MSW

American Cancer Society

Novella Lyons

Women of Faith and Hope

Dianne L. Hyman, BSN, RN, OCN

MD Cancer Center - Cooper

Joanne Buzaglo, PhD

Cancer Support Community

Linda G. Fleisher, PhD, MPH

Children’s Hospital of Philadelphia

Gwendolyn A. Smith, RN, CCRN, MBA

Crozer-Keystone Health System

Jeanne Chavious, MSW

Retired, Temple Cancer Center

Loraine T. Dean, ScD

Johns Hopkins University

Evelyn Robles-Rodriguez, MSN, RN

MD Anderson Cancer Center - Cooper

Compliance with ethical standards

Funding source

This study was funded by the American Cancer Society Research Scholar Grant, RSGT #10-243-01 (Barsevick) and National Cancer Institute, K01 CA184288 (Dean).

Conflicts of interest

The authors declare that they have no conflict of interest.

Supplementary material

520_2016_3359_MOESM1_ESM.doc (87 kb)
ESM 1 (DOC 87 kb)


  1. 1.
    American Cancer Society (2014) Cancer treatment and survivorship facts & figures 2014–2015. American Cancer Society, Atlanta GAGoogle Scholar
  2. 2.
    American Cancer Society (2013) Cancer facts and figures for African Americans 2013–2014. American Cancer Society, Atlanta GAGoogle Scholar
  3. 3.
    Mollica M, Newman SD (2014) Breast cancer in African Americans: from patient to survivor. J Transcult Nurs 25(4):334–340PubMedCrossRefGoogle Scholar
  4. 4.
    Russell KM et al. (2008) Quality of life of African American breast cancer survivors: how much do we know? Cancer Nurs 31(6):E36–E45PubMedCrossRefGoogle Scholar
  5. 5.
    Von Ah DM et al. (2012) Health-related quality of life of African American breast cancer survivors compared with healthy African American women. Cancer Nurs 35(5):337–346PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Paskett ED et al. (2008) Breast cancer survivors’ health-related quality of life: racial differences and comparisons with noncancer controls. Cancer 113(11):3222–3230PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Mollica M, Nemeth L (2015) Transition from patient to survivor in African American breast cancer survivors. Cancer Nurs 38(1):16–22PubMedCrossRefGoogle Scholar
  8. 8.
    Gallicchio L, Calhoun C, Helzlsouer KJ (2014) Association between race and physical functioning limitations among breast cancer survivors. Support Care Cancer 22(4):1081–1088PubMedCrossRefGoogle Scholar
  9. 9.
    Dean LT et al. (2015) Black breast cancer survivors experience greater upper extremity disability. Breast Cancer Res Treat 154(1):117–125PubMedCrossRefGoogle Scholar
  10. 10.
    Schmitz KH et al. (2013) Impact of obesity on cancer survivorship and the potential relevance of race and ethnicity. J Natl Cancer Inst 105(18):1344–1354PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Heiney SP (2014) Social disconnection in African American women with breast cancer. Oncol Nurs Forum 41(1):E28–E34PubMedCrossRefGoogle Scholar
  12. 12.
    Palmer NR et al. (2015) Disparities in barriers to follow-up care between African American and White breast cancer survivors. Support Care Cancer 23(11):3201–3209PubMedCrossRefGoogle Scholar
  13. 13.
    Mollica M et al. (2015) Quality of life in African American breast cancer survivors: an integrative literature review. Cancer Nurs 38(3):194–204PubMedCrossRefGoogle Scholar
  14. 14.
    Baker F et al. (2005) Adult cancer survivors: how are they faring? Cancer 104(11 Suppl):2565–2576PubMedCrossRefGoogle Scholar
  15. 15.
    Zhao, L., et al. (2007) Exploratory factor analysis of the Cancer Problems in Living Scale. p 27Google Scholar
  16. 16.
    Howard-Anderson J et al. (2012) Quality of life, fertility concerns, and behavioral health outcomes in younger breast cancer survivors: a systematic review. J Natl Cancer Inst 104(5):386–405PubMedCrossRefGoogle Scholar
  17. 17.
    Lewis PE et al. (2012) Psychosocial concerns of young African American breast cancer survivors. J Psychosoc Oncol 30(2):168–184PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Sheppard VB et al. (2014) The importance of contextual factors and age in association with anxiety and depression in Black breast cancer patients. Psychooncology 23(2):143–150PubMedCrossRefGoogle Scholar
  19. 19.
    Smith AW et al. (2008) Cancer, comorbidities, and health-related quality of life of older adults. Health Care Financ Rev 29(4):41–56PubMedPubMedCentralGoogle Scholar
  20. 20.
    Kumar S, Hurria A (2010) Impact of age, sex, and comorbidity on cancer therapy and disease prgression. J Clin Oncol 28(26):4086–4093CrossRefGoogle Scholar
  21. 21.
    Hershey DS et al. (2012) Perceived impact of cancer treatment on diabetes self-management. Diabetes Educ 38(6):779–790PubMedCrossRefGoogle Scholar
  22. 22.
    Patterson RE et al. (2010) Medical comorbidities predict mortality in women with a history of early stage breast cancer. Breast Cancer Res Treat 122(3):859–865PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Patterson RE et al. (2011) Improvement in self-reported physical health predicts longer survival among women with a history of breast cancer. Breast Cancer Res Treat 127(2):541–547PubMedCrossRefGoogle Scholar
  24. 24.
    Thompson HS et al. (2004) The Group-Based Medical Mistrust Scale: psychometric properties and association with breast cancer screening. Prev Med 38(2):209–218PubMedCrossRefGoogle Scholar
  25. 25.
    Armstrong K et al. (2013) Prior experiences of racial discrimination and racial differences in health care system distrust. Med Care 51(2):144–150PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Armstrong K et al. (2008) Differences in the patterns of health care system distrust between blacks and whites. J Gen Intern Med 23(6):827–833PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    LaVeist TA, Isaac LA, Williams KP (2009) Mistrust of health care organizations is associated with underutilization of health services. Health Serv Res 44(6):2093–2105PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Ashing-Giwa KT et al. (2004) Breast cancer survivorship in a multiethnic sample: challenges in recruitment and measurement. Cancer 101(3):450–465PubMedCrossRefGoogle Scholar
  29. 29.
    Napoles-Springer AM, Santoyo J, Stewart AL (2005) Recruiting ethnically diverse general internal medicine patients for a telephone survey on physician-patient communication. J Gen Intern Med 20(5):438–443PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Dillman DA (2007) Mail and internet surveys: the tailored design method 2nd ed. 2007 Update with internet, visual, and media mode. John Wiley & Sons, Inc, HobokenGoogle Scholar
  31. 31.
    Napoles-Springer AM et al. (2005) Patients’ perceptions of cultural factors affecting the quality of their medical encounters. Health Expect 8(1):4–17PubMedCrossRefGoogle Scholar
  32. 32.
    Kreuter MW et al. (2003) Achieving cultural appropriateness in health promotion programs: targeted and tailored approaches. Health Educ Behav 30(2):133–146PubMedCrossRefGoogle Scholar
  33. 33.
    Resnicow K et al. (1999) Cultural sensitivity in public health: defined and demystified. Ethn Dis 9(1):10–21PubMedGoogle Scholar
  34. 34.
    Germino BB et al. (2011) Engaging African American breast cancer survivors in an intervention trial: culture, responsiveness and community. J Cancer Surviv 5(1):82–91PubMedCrossRefGoogle Scholar
  35. 35.
    Ashing-Giwa KT et al. (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
  36. 36.
    Matthews AK et al. (2012) Correlates of quality of life among African American and White cancer survivors. Cancer Nurs:355–364Google Scholar
  37. 37.
    Von Friederich-Fitzwater MM, Denyse T (2012) The unmet needs of African American women with breast cancer. Advances in Breast Cancer Research (1):1–6Google Scholar
  38. 38.
    Davey MP et al. (2010) “They paid no mind to my state of mind”: African American breast cancer patients’ experiences of cancer care delivery. J Psychosoc Oncol 28(6):683–698PubMedCrossRefGoogle Scholar
  39. 39.
    Ashing-Giwa K et al. (2013) Are survivorship care plans responsive to African-American breast cancer survivors?: voices of survivors and advocates. J Cancer Surviv 7(3):283–291PubMedCrossRefGoogle Scholar
  40. 40.
    Janz NK et al. (2008) Racial/ethnic differences in adequacy of information and support for women with breast cancer. Cancer 113(5):1058–1067PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Cubbin C (2015) Survey methodology of the geographic research on wellbeing (GROW) study. BMC Res Notes 8:402PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Robinson-White S et al. (2010) Patient navigation in breast cancer: a systematic review. Cancer Nurs 33(2):127–140PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Andrea M. Barsevick
    • 1
    Email author
  • Amy Leader
    • 1
  • Patricia K. Bradley
    • 2
  • Tiffany Avery
    • 3
  • Lorraine T. Dean
    • 4
  • Melissa DiCarlo
    • 1
  • Sarah E. Hegarty
    • 1
  1. 1.Thomas Jefferson UniversityPhiladelphiaUSA
  2. 2.Villanova UniversityVillanovaUSA
  3. 3.Wake Forest UniversityWinston-SalemUSA
  4. 4.Johns Hopkins UniversityBaltimoreUSA

Personalised recommendations