The development of supportive care for cancer patients has been shown to have a positive impact on both mortality rates and many aspects of life after cancer, particularly in young women. Meanwhile, there are still numerous inequalities in terms of cancer mortalities and quality of life among cancer survivors in France. The processes leading to unequal access to supportive care services, and the impact this has on the post-treatment period, have been poorly documented, however. The goal of this study was to understand the barriers to using supportive care services among young women breast cancer survivors under the age of 50 and to find out how this can contribute to inequalities. Thirty-six young breast cancer survivors, one third of which deemed socially deprived, were interviewed using a qualitative, inductive approach at two comprehensive care centres in France. Our findings primarily show that there are still a number of barriers to accessing supportive care for a large number of patients. The way information about supportive services is delivered is a major cause of inequalities in the use of these services. The guidance provided does not take into account either the patients’ needs or their capacity to integrate the information and anticipate problems. Certain specific post-treatment issues have yet to be addressed. Some systemic barriers could be lifted by changing the way information on supportive care services is currently organised and thereby prevent the survivorship plans now being implemented in cancer care settings from reinforcing health inequalities.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
http://lesdonnees.e-cancer.fr/les-fiches-de-synthese/29-incidence-mortalite/84-cancer-sein/7-incidence-france-cancer-sein.html#ind4 Accessed 18 Dec 2015
Le Corroller-Soriano AG, Bouhnik AD, Preau M, Malavolti L, Julian-Reynier C, Auquier P, Moatti JP (2011) Does cancer survivors’ health-related quality of life depend on cancer type? Findings from a large French national sample 2 years after cancer diagnosis. Eur J Cancer Care 20:132–140
Avis NE, Crawford S, Manuel J (2005) Quality of life among younger women with breast cancer. J Clin Oncol 23:3322–3330
Ganz PA, Greendale GA, Petersen L, Kahn B, Bower JE (2003) Breast cancer in younger women: reproductive and late health effects of treatment. J Clin Oncol 21:4184–4193
Kornblith AB, Powell M, Regan MM, Bennett S, Krasner C, Moy B, Younger J, Goodman A, Berkowitz R, Winer E (2007) Long-term psychosocial adjustment of older vs younger survivors of breast and endometrial cancer. Psychooncology 16:895–903
Dunn J, Steginga SK (2000) Young women’s experience of breast cancer: defining young and identifying concerns. Psychooncology 9:137–146
Champion VL, Wagner LI, Monahan PO et al (2014) Comparison of younger and older breast cancer survivors and age-matched controls on specific and overall QoL domains. Cancer 120(15):2237–2246
Fiszer C, Dolbeault S, Sultan S, Brédart A (2014) Prevalence, intensity, and predictors of the supportive care needs of women diagnosed with breast cancer: a systematic review. Psychooncology 23(4):361–374
Harrison JD, Young JM, Price MA, Butow PN, Solomon MJ (2009) What are the unmet supportive care needs of people with cancer? A systematic review. Support Care Cancer 17:1117–1128
Lubberding S, van Uden-Kraan CF, Te Velde EA, Cuijpers P, Leemans CR, Verdonck-de Leeuw IM (2015) Improving access to supportive cancer care through an eHealth application: a qualitative needs assessment among cancer survivors. J Clin Nurs 24:1367–1379
Holm LV, Hansen DG, Larsen PV, Johansen C, Vedsted P, Bergholdt SH, Kragstrup J, Søndergaard J (2013) Social inequality in cancer rehabilitation: a population-based cohort study. Acta Oncol 52(2):410–422
Kowalski C, Lee SY, Ansmann L, Wesselmann S, Pfaff H (2014) Meeting patients’ health information needs in breast cancer center hospitals—a multilevel analysis. BMC Health Serv Res 25:14–601
Bouhnik AD, Bendiane MK, Cortaredona S et al (2015) The labour market, psychosocial outcomes and health conditions in cancer survivors: protocol for a nationwide longitudinal survey 2 and 5 years after cancer diagnosis (the VICAN survey). BMJ Open 5(3):e005971
French National Cancer Institute (2014) « La vie deux ans après un diagnostic de cancer - De l’annonce à l’après cancer » Collection Études et enquêtes INCa. http://www.ecancer.fr/publications/99-recherche/774-la-vie-deux-ans-apres-un-diagnostic-de-cancer-de-lannonce-a-lapres-cancer Accessed 18 Sept 2015
Eccles SA, Aboagye EO, Ali S et al (2013) Critical research gaps and translational priorities for the successful prevention and treatment of breast cancer. Breast Cancer Res 15(5):R92
Andersen BL, Yang HC, Farrar WB, Golden-Kreutz DM, Emery CF, Thornton LM, Young DC, Carson WE (2008) Psychologic intervention improves survival for breast cancer patients: a randomized clinical trial. Cancer 113(12):3450–3458
Moumjid N, Charles C, Morelle M, Gafni A, Brémond A, Farsi F, Whelan T, Carrère MO (2009) The statutory duty of physicians to inform patients versus unmet patients’ information needs: the case of breast cancer in France. Health Policy 91(2):162–173. doi:10.1016/j.healthpol.2008.11.010
Brédart A, Kop JL, Griesser AC, Fiszer C, Zaman K, Panes-Ruedin B, Jeanneret W, Delaloye JF, Zimmers S, Berthet V, Dolbeault S (2013) Assessment of needs, health-related quality of life, and satisfaction with care in breast cancer patients to better target supportive care. Ann Oncol 24(8):2151–2158
Sanson-Fisher R, Girgis A, Boyes A, Bonevski B, Burton L, Cook P (2000) The unmet supportive care needs of patients with cancer. Supportive care review group. Cancer 88:226–237
Molassiotis A, Brunton L, Hodgetts J, Green AC, Beesley VL, Mulatero C, Newton-Bishop JA, Lorigan P (2014) Prevalence and correlates of unmet supportive care needs in patients with resected invasive cutaneous melanoma. Ann Oncol 25(10):2052–2058
Gould J, Sinding C, Mitchell TL, Gustafson DL, Peng I, Mcgillicuddy P, Fitch MI, Aronson J, Burhansstipanov L (2009) “Below their notice”: exploring women’s subjective experiences of cancer system exclusion. J Cancer Educ 24(4):308–314
French National Cancer Institute—French Cancer Plan 2014–2019 http://www.e-cancer.fr/Expertises-et-publications/Catalogue-des-publications/Summary-Plan-cancer-2014-2019. Accessed Sept 18 2015
Ronson A, Body JJ (2002) Psychosocial rehabilitation of cancer patients after curative therapy. Support Care Cancer 10(4):281–291
John DA, Kawachi I, Lathan CS, Ayanian JZ (2014) Disparities in perceived unmet need for supportive services among patients with lung cancer in the Cancer Care Outcomes Research and Surveillance Consortium. Cancer 120:3178–3191
Shaw I (2003) Qualitative research and outcomes in health, social work and education. Qual Res 3(1):57–77
Labbe E, Blanquet M, Gerbaud L, Poirier G, Sass C, Vendittelli F, Moulin JJ (2015) A new reliable index to measure individual deprivation: the EPICES score. Eur J Public Health 25(4):604–609
Longhofer JL, Floersch J, Hoy J (2013) Qualitative methods for practice research. Oxford University Press, New York
Hovick SR, Liang MC, Kahlor L (2014) Predicting cancer risk knowledge and information seeking: the role of social and cognitive factors. Health Commun 29(7):656–668
Lombrail P (2007) Health care and secondary access to care inequalities. Rev Epidemiol Sante Publique 55(1):23–30
Hewitt ME, Bamundo A, Day R et al (2007) Perspectives on post-treatment cancer care: qualitative research with survivors, nurses, and physicians. J Clin Oncol 25:2270–2273
Protière C, Moumjid N, Bouhnik AD, Le Corroller Soriano AG, Moatti JP (2012) Heterogeneity of cancer patient information-seeking behaviors. Med Decis Mak 32(2):362–375
Haynes-Maslow L, Allicock M, Johnson S (2015) Cancer support needs for African American breast cancer survivors and caregivers. J Cancer Educ
Skrutkowski M, Saucier A, Meterissian S (2011) The breast cancer patient navigation kit: development and user feedback. J Cancer Educ 26(4):782–792
Liao MN, Chen SC, Chen SC, Lin YC, Hsu YH, Hung HC, Wang CH, Chen MF, Jane SW (2012) Changes and predictors of unmet supportive care needs in Taiwanese women with newly diagnosed breast cancer. Oncol Nurs Forum 39(5):E380–E389
Veloso AG, Sperling C, Vilstrup Holm L, Nicolaisen A, Rottmann N, Thayssen S, Depont Christensen R, Lehmann Knudsen J, Hansen DG (2013) Unmet needs in cancer rehabilitation during the early cancer trajectory—a nationwide patient survey. Acta Oncol 52:372–381
Miedema B, Easley J (2012) Barriers to rehabilitative care for young breast cancer survivors: a qualitative understanding. Support Care Cancer 20:1193–1201
This research is supported by the French League against Cancer and Canceropôle Lyon Rhône-Alpes Auvergne.
All study procedures were approved by the local Ethics Committee (Sud Est 1).
Conflict of Interest
The authors do not have any financial ties with the organization sponsoring the research (e.g. French League against Cancer; Canceropôle Lyon Rhone-Alpes Auvergne). The authors have full control of all primary data and grant the journal the right to review their data upon request.
Rights and permissions
About this article
Cite this article
Regnier Denois, V., Querre, M., Chen, L. et al. Inequalities and Barriers to the Use of Supportive Care Among Young Breast Cancer Survivors: a Qualitative Understanding. J Canc Educ 32, 790–798 (2017). https://doi.org/10.1007/s13187-016-1087-1
- Breast cancer
- Young women
- Supportive care