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A qualitative study identifying challenges resulting from complex evidence on lifestyle factors and cancer: perspectives from Black and Latina cancer survivors and healthcare providers

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Abstract

Purpose

Most breast cancer survivors have challenges with adopting healthy lifestyle behaviors. This may be due to contextual challenges that result from the complex nature of the evidence. To address this gap, we explored the experiences of breast cancer survivors of color and oncology healthcare providers.

Methods

Content analysis with inductive and deductive approaches was used for semi-structured interviews with 26 female breast cancer survivors and 10 oncology healthcare providers from Greater New Haven, Connecticut.

Results

Survivors identified substantial confusion on the evidence regarding lifestyle behaviors and breast cancer, stemming from inadequate healthcare provider counseling and an overreliance on informal sources of information. Providers identified lack of evidence-based knowledge as a barrier to counseling on these topics. There was a mixed perspective regarding the consistency of evidence, stemming from a combination of gaps in the available evidence and accessing evidence-based knowledge from a wide range of professional resources. Some providers perceived the guidelines as consistent; others felt guidelines were constantly changing, impacting how and on what they counseled. Therefore, many healthcare providers in oncology care relied on generic messaging on lifestyle behaviors after a cancer diagnosis.

Conclusions

Inconsistent information sources, the rapidly changing evidence, and gaps in the current evidence contribute to generic messaging about lifestyle behaviors and may inhibit a survivor’s ability to engage in behavior change. Consistent and uniform healthy lifestyle guidelines for cancer outcomes may address both provider and patient level barriers to knowledge.

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Acknowledgements

Many thanks to each participant that shared their time and story with our research team and made this research possible.

Funding

Margaret S. Pichardo was funded for this study by the National Institutes of Health—National Cancer Institute, Award (# R01CA207753), and the Yale Center for the Study of Race, Indigeneity and Transnational Migration (RITM) Research Award. Denise Esserman was partially funded by the Yale Clinical and Translational Science Award (UL1 TR001863).

Author information

Authors and Affiliations

  1. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA

    Margaret S. Pichardo, Melinda L. Irwin, Leah M. Ferrucci, Abigail Ginader, Thai Hien Nguyen & Brenda Cartmel

  2. Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Maloney 4, PA, 19104, Philadelphia, USA

    Margaret S. Pichardo

  3. Yale Cancer Center, New Haven, CT, USA

    Melinda L. Irwin, Tara Sanft, Leah M. Ferrucci & Brenda Cartmel

  4. Department of Medical Oncology, Yale School of Medicine, New Haven, CT, USA

    Tara Sanft

  5. Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA

    Denise Esserman

  6. Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, IL, Chicago, USA

    Yamile Molina

  7. University of Illinois Cancer Center, Chicago, IL, USA

    Yamile Molina

  8. Mile Square Health Center, Chicago, IL, USA

    Yamile Molina

Authors
  1. Margaret S. Pichardo
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  2. Melinda L. Irwin
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  4. Leah M. Ferrucci
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  7. Denise Esserman
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  8. Brenda Cartmel
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  9. Yamile Molina
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Contributions

Margaret S. Pichardo, Melinda L. Irwin, and Yamile Molina contributed to the study conception and design. Material preparation and data collection were performed by Margaret S. Pichardo. Data analysis was performed by Margaret S. Pichardo, Abigail Ginader, and Thai Hien Nguyen. The first draft of the manuscript was written by Margaret S. Pichardo, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Funding support and resources acquisition for this study were provided by Melinda L. Irwin and Tara Sanft.

Corresponding author

Correspondence to Margaret S. Pichardo.

Ethics declarations

Ethics approval

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Yale Human Investigation Committee (HIC # 2000025065).

Consent to participate

Verbal informed consent was obtained from all individual participants included in the study.

Competing interests

The authors declare no competing interests.

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Appendix. Sample questions from semi-structure interview guide for survivors and healthcare providers

Appendix. Sample questions from semi-structure interview guide for survivors and healthcare providers

Survivors

  1. 1.

    What support with nutrition and exercise did you receive from your community? Friends? Family?

  2. 2.

    How could your community have supported you with nutrition and exercise?

  3. 3.

    Thinking back to when you were receiving cancer treatment, what has changed about your eating habits since you were diagnosed?

    1. a.

      Specific foods? Drinking? Exercise? Smoking?

    2. b.

      Why did you change your habits?

    3. c.

      What changes were easy or difficult to implement?

    4. d.

      What made them easy or difficult?

    5. e.

      Did you feel supported to make these changes? By who?

  4. 4.

    Thinking back to when you were receiving cancer treatment, what information did you receive about nutrition and exercise during treatment?

    1. a.

      What resources did you have to support you to eat healthier and exercise while you were receiving treatment?

    2. b.

      How did your doctors support you to eat healthier and be active?

  5. 5.

    Thinking back to the time after you had completed your cancer treatment, did you receive a survivorship care plan after completing treatment?

    1. a.

      What did you like or dislike about your care plan?

    2. b.

      Did your care plan include counseling on nutrition and exercise?

    3. c.

      What resources did you have to support you to eat healthier and exercise?

    4. d.

      How did your doctors support you to eat healthier and be active?

  6. 6.

    Thinking about the present, how do you make decisions about what foods to eat and what to avoid?

    1. a.

      What are things that you believe to cause cancer?

    2. b.

      What are your beliefs regarding unhealthy foods and breast cancer?

    3. c.

      What makes food healthy or unhealthy?

  7. 7.

    Thinking about the present, how do you make decisions about whether to engage in exercise or not?

  8. 8.

    How could your care team have supported you with nutrition and exercise after you completed your treatment?

Healthcare providers

  1. 1.

    What do you think is your role in providing lifestyle counseling to survivors?

  2. 2.

    Tell me about a time when you offered counseling on diet and exercise to a patient of color?

    1. a.

      What difficulties, if any, did you experience?

  3. 3.

    In your daily work, what makes it difficult to counsel patients on lifestyle?

    1. a.

      What resources are available to support your ability to counsel patients on lifestyle behaviors?

    2. b.

      What would make it easier for you to regularly counsel patients on lifestyle?

  4. 4.

    How do you confirm that patients have received information about lifestyle behaviors?

  5. 5.

    What resources do you have to offer breast cancer survivors regarding lifestyle behaviors?

  6. 6.

    Where do you get information about the current evidence regarding diet/exercise and cancer?

  7. 7.

    What barriers do you think women of color face to adopt healthy lifestyles?

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Pichardo, M.S., Irwin, M.L., Sanft, T. et al. A qualitative study identifying challenges resulting from complex evidence on lifestyle factors and cancer: perspectives from Black and Latina cancer survivors and healthcare providers. Support Care Cancer 31, 111 (2023). https://doi.org/10.1007/s00520-022-07539-9

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