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Quality of Life Among Immigrant Latina Breast Cancer Survivors: Realities of Culture and Enhancing Cancer Care

Journal of Cancer Education volume 26, pages 724–733 (2011)Cite this article

Abstract

Breast cancer is the most common cancer among Latinas. This study examined social, cultural, and health care system factors that impact the quality of life and survivorship experiences of Latina immigrant breast cancer survivors. We interviewed Latina breast cancer survivors (n = 19) and, based on the interview findings, conducted two focus groups (n = 9). Research staff translated transcripts from Spanish into English. Two trained raters reviewed the content and identified themes. Thematic content analysis was used to categorize and organize data. Participants were largely monolingual in Spanish, predominantly from Central and South America and most (68%) had lived in the U.S. for ten or more years. All women were diagnosed and treated in the U.S. and were an average of 3.1 years from diagnosis. Women’s survivorship experiences appeared to be shaped by cultural beliefs and experiences as immigrants such as secrecy/shame about a breast cancer diagnosis, feelings of isolation, importance of family support (familism), challenges with developing social relationships in the U.S. (less personalismo), and, for some, their partner’s difficulty with showing emotional support (machismo). Navigating the U.S. medical system and language barriers were additional challenges in the participants’ health care interactions. Latina breast cancer survivors adhere to certain cultural values and face unique issues as immigrants, potentially influencing overall quality of life and doctor–patient communication. Efforts to improve Latina immigrant breast cancer survivors’ quality of life could include increased assessment of psychosocial functioning and referral to social support services, culturally sensitive navigation programs, and consistent use of appropriately trained interpreters.

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Acknowledgments

We would like to thank Janet Cañar, M.D., MPH. for her assistance with data collection and manuscript preparation and to Melissa Figuerido, Ph.D., for her involvement with the early phases of this project. Thank you also to Claire Selsky, MA, for her time and expertise as a coder and to Susan Marx, who provided additional assistance with manuscript preparation. We are also very appreciative of the support and collaboration provided by Nueva Vida, Inc. We are also indebted to our participants for sharing their stories with us. Finally, we would like to thank members of the Latin American Cancer Research Coalition (LACRC): Jessika Angulo-Duarte, Stacey Banks, Janet Cañar, M.D., MPH; Enrique Cobham, MBA; Michael Dalious, MA; Marguerite Duane, M.D., MHA; Kirsten Edmiston, M.D.; Karol Espejo; Amanda Graham, Ph.D.; Ronald Greger, M.D.; Margarita Gutierrez; Elmer Huerta, M.D., MPH; Anna Maria Izquierdo-Porrera, M.D.; Gheorge Luta, Ph.D.; Barbara Merritt, RN; Lilian Meza; Noel Mueller, MPH; Anne-Michelle Noone, MS; Donetta Padmore; Nancy Pallesen, MSW; Margarita Paredes, M.D., MS; Jyl Pomeroy, RN; Dino Ramzi, M.D., MPH; Christine Reesor, MSN, FNP; Yosselyn Rodriquez; Juan Romagoza, M.D.; Michael Sanchez, MPH, CHES; Claire Selsky, MA; Vanessa Sheppard, Ph.D.; Cherie Spencer, MS; Alicia Wilson; and Bin Yi, MS. These LACRC team members and investigators provided support and assistance in the conduct of this study. We also thank Susan Marx for her assistance with the manuscript preparation.

Author information

Affiliations

  1. Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA

    Maria Lopez-Class, Monique Perret-Gentil, Barbara Kreling, Jeanne Mandelblatt & Kristi D. Graves

  2. Nueva Vida, Washington, DC, USA

    Larisa Caicedo

  3. Cancer Control Program, Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA

    Kristi D. Graves

Authors
  1. Maria Lopez-Class
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  2. Monique Perret-Gentil
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  3. Barbara Kreling
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  4. Larisa Caicedo
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  5. Jeanne Mandelblatt
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  6. Kristi D. Graves
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Corresponding author

Correspondence to Kristi D. Graves.

Additional information

Supported by Susan G. Komen for the Cure grant no. POP0601292 and NCI grant no. K07CA131172 (KDG), NCI grant no. U01CA114593 and K05CA96940 (JM) from the National Cancer Institute.

Appendix: Focus Group Discussion Guide

Appendix: Focus Group Discussion Guide

  1. 1.

    What does the term “quality of life” mean to you?

    Possible probes:

    1. (a)

      Physical functioning

    2. (b)

      Psychological functioning

    3. (c)

      Spiritual functioning/religion

    4. (d)

      Social relationships: deepening of connection with family or friends

    5. (e)

      Functional: ability to work, provide for family

  2. 2.

    What impacts your current quality of life?

    Possible probes:

    1. (a)

      Physical changes since treatment

    2. (b)

      Weight gain/weight loss

    3. (c)

      Relationships: family, friends

    4. (d)

      Intimate relationships: changes in sexual functioning

    5. (e)

      Work stress

    6. (f)

      Attitude

  3. 3.

    What symptoms (or side effects) do you currently experience because of your cancer treatment?

    Possible probes:

    1. (a)

      Loss of functioning in arm

    2. (b)

      Weight gain/weight loss

    3. (c)

      Change in sexual desire, menopause

    4. (d)

      Changes in attitude

    5. (e)

      Cognitive changes (memory, word-finding ability)

  4. 4.

    How does your family impact your quality of life?

    Possible probes:

    1. (a)

      Spouse/partner

    2. (b)

      Children, parents

    3. (c)

      Siblings

    4. (d)

      Extended family—here and back home

  5. 5.

    How has language ability impacted your quality of life?

    Possible probes:

    1. (a)

      Communicating with health care team

    2. (b)

      Communicating about insurance

  6. 6.

    How have your values impacted your quality of life?

    Possible probes:

    1. (a)

      Spiritual beliefs/attitude (optimism)

    2. (b)

      Family orientation

    3. (c)

      Not wanting to burden others

    4. (d)

      Keeping health concerns private

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Lopez-Class, M., Perret-Gentil, M., Kreling, B. et al. Quality of Life Among Immigrant Latina Breast Cancer Survivors: Realities of Culture and Enhancing Cancer Care. J Canc Educ 26, 724–733 (2011). https://doi.org/10.1007/s13187-011-0249-4

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  • DOI: https://doi.org/10.1007/s13187-011-0249-4

Keywords

  • Breast cancer
  • Survivorship
  • Latinos
  • Quality of life
  • Qualitative