Enhancing life after cancer in diverse communities

Improving Cancer Survivorship Care for Latino Adolescent, Young Adult Survivors through Community-Partnered Participatory Research

Background

Minority adolescent and young adult (AYA) cancer survivors experience disparities in receipt of survivorship care.

Objective

This study describes the infrastructure of a community-partnered participatory research (CPPR) project between a community-based organization and a National Cancer Institute (NCI)-designated cancer center to develop culturally-tailored interventions to improve Latino AYA cancer survivor knowledge regarding their need for survivorship care.

Methods

Research team participants included the community organization and NCI cancer center directors, a research coordinator, a community liaison, and cross-training program interns. Through use of Jones's theoretical framework, additional stakeholders from academic and community settings were identified and invited to participate in the research team. A process evaluation and qualitative interviews were conducted to assess equal partnership between community and academic stakeholders and determine if the infrastructure followed the five core principles of CPPR. A grounded theory approach was used to analyze qualitative data.

Conclusions

CPPR between an NCI-designated cancer center and a community-based organization is a new research model for conducting minority AYA cancer survivor outreach. Open communication was critical in engaging the Latino community to discuss their survivorship needs. Community stakeholders were key to infrastructure success through fostering a cohesive partnership with and acting as the voice of the Latino community. Implementing a cross-training program promoted continued engagement of community members with academic partners. Proper infrastructure development is critical to building successful research partnerships in order to develop culturally-tailored interventions to improve survivorship care knowledge.

The experience of treatment barriers and their influence on quality of life in American Indian/Alaska Native breast cancer survivors

BACKGROUND

American Indian and Alaska Native (AI/AN) breast cancer survivors experience disparities in breast cancer incidence and age-adjusted mortality compared with non-Hispanic white (NHW) breast cancer survivors. In addition, mortality-to-incidence rates indicate that AI/ANs continue to have the poorest survival from breast cancer compared with other racial groups. "Native American Cancer Education for Survivors" (NACES) is a cultural education and support intervention for AI/AN patients with cancer that collects data from voluntary participants through the NACES quality-of-life (QOL) survey regarding their cancer experience and survivor journey.

METHODS

Data from the NACES QOL survey were analyzed to determine whether barriers accessing and during initial cancer treatment impacted QOL domains for AI/AN cancer survivors. Exploratory analyses of selected variables were conducted and were followed by Kruskal-Wallis tests to determine whether these barriers influenced survivorship QOL for AI/AN breast cancer survivors.

RESULTS

AI/AN breast cancer survivors' social QOL was significantly affected by barriers to accessing cancer treatment. Many respondents experienced barriers, including a lack of cancer care at local clinics and the distance traveled to receive cancer care. During treatment, too much paperwork and having to wait too long in the clinic for cancer care were the most frequently reported barriers.

CONCLUSIONS

Treatment barriers influence AI/AN breast cancer survivors' social QOL. Mediating these barriers is crucial to ameliorating AI/AN survivors' disparities when accessing and completing cancer treatment and improving survivorship QOL. Cancer 2017;123:861-68. © 2016 American Cancer Society.

Health disparities across the breast cancer continuum

OBJECTIVES

To provide a brief overview of disparities across the spectrum of breast cancer incidence, treatment, and long-term care during the survivorship period.

DATA SOURCES

Review of the literature including research reports, review articles, and clinically based articles available through PubMed and CINAHL.

CONCLUSION

Minority women generally experience worse breast cancer outcomes despite a lower incidence of breast cancer than whites. A variety of factors contribute to this disparity, including advanced stage at diagnosis, higher rates of aggressive breast cancer subtypes, and lower receipt of appropriate therapies including surgery, chemotherapy, and radiation. Disparities in breast cancer care also extend into the survivorship trajectory, including lower rates of endocrine therapy use among some minority groups, as well as differences in follow-up and survivorship care.

IMPLICATIONS FOR NURSING PRACTICE

Breast cancer research should include improved minority representation and analyses by race, ethnicity, and socioeconomic status. While we cannot yet change the biology of this disease, we can encourage adherence to screening and treatment and help address the many physical, psychological, spiritual, and social issues minority women face in a culturally sensitive manner.

The National Cancer Institute's Community Networks Program Initiative to Reduce Cancer Health Disparities: Outcomes and Lessons Learned

BACKGROUND

We describe reach, partnerships, products, benefits, and lessons learned of the 25 Community Network Programs (CNPs) that applied community-based participatory research (CBPR) to reduce cancer health disparities.

METHODS

Quantitative and qualitative data were abstracted from CNP final reports. Qualitative data were grouped by theme.

RESULTS

Together, the 25 CNPs worked with more than 2,000 academic, clinical, community, government, faith-based, and other partners. They completed 211 needs assessments, leveraged funds for 328 research and service projects, trained 719 new investigators, educated almost 55,000 community members, and published 991 articles. Qualitative data illustrated how use of CBPR improved research methods and participation; improved knowledge, interventions, and outcomes; and built community capacity. Lessons learned related to the need for time to nurture partnerships and the need to attend to community demand for sustained improvements in cancer services.

IMPLICATIONS

Findings demonstrate the value of government-supported, community-academic, CBPR partnerships in cancer prevention and control research.

Collaboration between a US Academic Institution and International Ministry of Health to develop a culturally appropriate palliative care navigation curriculum

Implementation lessons: (1) The development and testing of a culturally appropriate palliative care navigation curriculum for countries facing high cancer and non-communicable diseases burden requires collaboration with the local Ministry of Health. (2) Lay volunteers from non-governmental and faith-based organizations are potential candidates to provide patient navigation services.

Quality of life and disparities among long-term cervical cancer survivors

PURPOSE

Little population-based research has been done on social, economic, and environmental factors affecting quality of life (QOL) among long-term cancer survivors. This research assesses the impact of disease and nondisease factors on QOL among long-term survivors of cervical cancer.

METHODS

In a collaborative, observational study, data were obtained from cancer registries, interviews, and self-administered questionnaires. Comparisons of QOL were made between women with cervical cancer histories and women from the general population. A total of 715 women 4-28 years postdiagnosis were identified from cancer registries in Connecticut (N = 208), Detroit Metropolitan Area (N = 211), New Mexico (N = 197), and Hawaii (N = 99). QOL was measured according to four SF-36 dimensions-physical functioning, social functioning, bodily pain, and general health status.

RESULTS

Means on SF-36 measures among women with cervical cancer histories were close to or higher than women in the general population. In a multiple regression analysis, economic disadvantage negatively predicted physical functioning (B = -13.4, SE = 2.1), social functioning (B = -13.2, SE = 2.4), bodily pain (B = -12.6, SE = 2.5), and general health (B = -12.8, SE = 2.1). Residence in New Mexico negatively predicted several QOL dimensions. No impact of race was detected when income was controlled. Disease stage did not predict QOL.

CONCLUSIONS

Cervical cancer does not generally reduce QOL among long-term survivors. Economic disadvantage and residential location affect QOL through mechanisms yet to be determined.

IMPLICATIONS FOR CANCER SURVIVORS

Women diagnosed with cervical cancer have good prospects for high quality of life; socioeconomic status strongly affects quality of life over the long term.

Building family capacity for Native Hawaiian women with breast cancer

Native Hawaiian women have the highest breast cancer incidence and mortality rates when compared with other large ethnic groups in Hawai'i. Like other women, they rely on the support of their families as co-survivors. This project explored the feasibility and effects of a culturally tailored educational intervention designed to build family capacity by improving the knowledge and skills of the woman and her family in dealing with breast cancer, particularly in the latter stage of recovery care. Twenty-nine Native Hawaiian women with breast cancer, along with a close family member, were randomly assigned to the intervention (n = 15) or a wait-list control group (n = 14). The authors assessed the knowledge, self-efficacy, and coping skills of women and their family members and the recovery care behaviors of the women at baseline and at four months (after the intervention or control period). The intervention group made significant improvements in self-efficacy and coping; the wait-list control group did not. Evaluation of the intervention suggests that it was well received by participants. This work has relevance for social workers wanting to design and test culturally appropriate interventions for minority groups.