From survivorship to thrivership: native peoples weaving a healthy life from cancer

The Resilience of Indigenous Women of the U.S. Who Experience Cancer: Transcending Adversity

Almost no research specifically explores resilience among Indigenous women of the U.S. who experience cancer. A qualitative descriptive study included a sample of 43 Indigenous women from the Northern Plains region of the U.S. Almost 90% (88%, n=37) of participants indicated personal growth in response to having cancer, indicating they valued relationships (n=3), had a stronger faith (n=5), were grateful and living in moment (n=21), were healthier (n=5), and helped others (n=6) in response to their cancer experience. Results indicate that factors that promote and facilitate resilience are critical for culturally responsive practice with Indigenous women.

A pilot randomised controlled trial of a multimodal supportive care (ThriverCare) intervention for managing unmet supportive care needs in men with metastatic prostate cancer on hormonal treatment and their partner/caregivers

PURPOSE

Men with metastatic prostate cancer experience high levels of unmet supportive care needs in current healthcare delivery. We set out to determine the effectiveness of a multimodality supportive care (ThriverCare) intervention on the prevalence of unmet supportive care needs for men and their partner/caregivers.

METHODS

A prospective parallel group, pilot randomised controlled pilot trial in 4 hospitals in Scotland. 38 participants with radiologically proven metastatic prostate cancer disease and 10 partners/caregivers were recruited into the study. A two arm 1:1 study design compared the usual standard of care (SC) approach to SC plus ThriverCare intervention. The primary outcome was the Supportive Care Needs Survey at 3 months of intervention.

RESULTS

There was no statistical significant difference in the prevalence of unmet supportive care needs between the intervention group and the usual SC group at baseline p = 0.112, however a statistically significant difference was observed at 3 months, indicating that the prevalence of unmet supportive care needs were less in the intervention group (1.13, SD 2.5) compared to the usual SC (6.17, SD 7.05), p = 0.002.

CONCLUSION

ThriverCare appears to improve the supportive care experience of men with metastatic prostate cancer on hormonal treatment and their partner/caregivers. Our results accentuate that no longer one size of care delivery fits all, care must be responsive and adaptable to meet the individual needs of people affected by cancer to thrive.

The Experience of Cancer in American Indians Living in Oklahoma

Many cancers in American Indians (AIs) are not diagnosed early leading to effects on physical, social, and emotional well-being or quality of life (QOL). Little research has been done on QOL of AIs in Oklahoma. This study examined the experience of living with cancer of AIs in Oklahoma to gain greater understanding of QOL issues and provide a basis for interventions to improve QOL. Twenty AIs diagnosed with cancer and receiving care in Oklahoma participated in this pilot study through semistructured interviews. Data were analyzed using thematic analysis. Themes identified included circles of support, finding meaning in the experience, and facing personal challenges such as health care-related issues, including mental health needs and fragmented care. The findings from this pilot study provide insights into the cancer experience of AIs in Oklahoma and demonstrate that care navigation and social support are important aspects to address in intervention development.

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.

Guideline-concordant cancer care and survival among American Indian/Alaskan Native patients

BACKGROUND

American Indians/Alaskan Natives (AI/ANs) have the worst 5-year cancer survival of all racial/ethnic groups in the United States. Causes for this disparity are unknown. The authors of this report examined the receipt of cancer treatment among AI/AN patients compared with white patients.

METHODS

This was a retrospective cohort study of 338,204 patients who were diagnosed at age ≥65 years with breast, colon, lung, or prostate cancer between 1996 and 2005 in the Surveillance, Epidemiology, and End Results-Medicare database. Nationally accepted guidelines for surgical and adjuvant therapy and surveillance were selected as metrics of optimal, guideline-concordant care. Treatment analyses compared AI/ANs with matched whites.

RESULTS

Across cancer types, AI/ANs were less likely to receive optimal cancer treatment and were less likely to undergo surgery (P ≤ .025 for all cancers). Adjuvant therapy rates were significantly lower for AI/AN patients with breast cancer (P < .001) and colon cancer (P = .001). Rates of post-treatment surveillance also were lower among AI/ANs and were statistically significantly lower for AI/AN patients with breast cancer (P = .002) and prostate cancer (P < .001). Nonreceipt of optimal cancer treatment was associated with significantly worse survival across cancer types. Disease-specific survival for those who did not undergo surgery was significantly lower for patients with breast cancer (hazard ratio [HR], 0.62), colon cancer (HR, 0.74), prostate cancer (HR, 0.52), and lung cancer (HR, 0.36). Survival rates also were significantly lower for those patients who did not receive adjuvant therapy for breast cancer (HR, 0.56), colon cancer (HR, 0.59), or prostate cancer (HR, 0.81; all 95% confidence intervals were <1.0).

CONCLUSIONS

Fewer AI/AN patients than white patients received guideline-concordant cancer treatment across the 4 most common cancers. Efforts to explain these differences are critical to improving cancer care and survival for AI/AN patients.

Factors that influence mammography use among older American Indian and Alaska Native women

INTRODUCTION

American Indian and Alaska Native (AIAN) women have relatively high breast cancer mortality rates despite the availability of free or low-cost screening.

PURPOSE

This qualitative study explored issues that influence the participation of older AIAN women in mammography screening through tribally directed National Breast and Cervical Cancer Early Detection Programs (NBCCEDPs).

METHODS

We interviewed staff (n = 12) representing five tribal NBCCEDPs and conducted four focus groups with AIAN women ages 50 to 80 years (n = 33).

RESULTS

Our analysis identified four main areas of factors that predispose, enable, or reinforce decisions around mammography: financial issues and personal investments, program characteristics including direct services and education, access issues such as transportation, and comfort zone topics that include cultural or community-wide norms regarding cancer prevention.

CONCLUSION

This study has implications for nurse education and training on delivering effective mammography services and preventive cancer outreach and education programs in AIAN communities.

"Weaving balance into life": Development and cultural adaptation of a cancer symptom management toolkit for Southwest American Indians

INTRODUCTION

Self-management of cancer symptoms has the potential to decrease the suffering of cancer survivors while improving their health and quality of life. For many racial/ethnic groups, culturally appropriate self-management instruction is not readily available. This paper reports on the first symptom management toolkit developed for American Indian cancer survivors.

METHODS

Part of a larger research study, a three-phase project tested a cancer symptom self-management toolkit to be responsive to the unique learning and communication needs of American Indians in the Southwest U.S.A. American Indian cancer survivors and family members participated in 13 focus groups to identify cultural concepts of cancer and illness beliefs, communication styles, barriers, and recommendations for self-management techniques. Sessions were audiotaped and transcriptions were coded using grounded theory.

RESULTS

Participants expressed a need for an overview of cancer, tips on management of common symptoms, resources in their communities, and suggestions for how to communicate with providers and others. The "Weaving balance into life" toolkit is comprised of a self-help guide, resource directory, and video. Preferred presentation style and content for the toolkit were pilot tested.

DISCUSSION/CONCLUSIONS

American Indian survivors favor educational materials that provide information on symptom management and are tailored to their culture and beliefs. Suggestions for adapting the toolkit materials for other American Indian populations are made.

IMPLICATIONS FOR CANCER SURVIVORS

Many cancer survivors lack effective self-management techniques for symptoms, such as pain, fatigue, and depression. The toolkit promotes self-management strategies for survivors and provides family members/caregivers tangible ways to offer support.

Comparison of quality of life between Native and non-Native cancer survivors: Native and non-Native cancer survivors' QOL

This paper compares quality of life (QOL) outcomes between Native American and non-Native cancer survivors. Native Patient Navigators helped Native cancer patients complete a 114-item QOL survey and access survivorship information available on the NACES website. The survey was modified from Ferrell et. al’s QOL measure and assessed the four domains of cancer survivorship: physical, psychological, social, and spiritual. Findings from Native survivors were compared to Ferrell’s findings. This is the first time that QOL outcomes have been compared between Native and Non-Native cancer survivors. Natives scored lower for physical and social QOL, the same for psychological QOL, and higher for spiritual QOL in comparison to non-Natives. Overall QOL scores were the same. Although this is the largest sample of Native cancer survivors reported in peer-reviewed manuscripts, these Native survivorship data are based on a self-selected group and it is unknown if the findings are generalizable to others.

Satisfaction with telehealth for cancer support groups in rural American Indian and Alaska Native communities

A descriptive study was conducted to determine the information needs of American Indian (AI) and Alaska Native (AN) cancer survivors and assess satisfaction with and acceptability of telehealth support group services for cancer survivors in AI and AN rural communities. AI and AN cancer survivors were asked to complete the Telehealth Satisfaction Survey and two open-ended questions, one regarding information needs and one seeking comments and suggestions about cancer support group meetings. Thirty-two surveys were returned. Information about nutrition during treatment and treatment-related side effects were the most sought after topics. Participants valued the opportunity to interact with other AI and AN cancer survivors who also lived in remote locations and the usefulness of the information presented. The link with geographically distant survivors was valuable to participants as they felt they were no longer alone in their cancer experiences. Determining survivors' information needs provides meaningful topics for future support group education. Telehealth is a viable way to facilitate cancer support groups to AI and AN cancer survivors in rural communities.

Breast cancer education for Native American women: creating culturally relevant communications

In the Navajo language, the word for cancer translates as the sore that does not heal. This literal linkage to a sense of hopelessness reflects a cultural perspective that impedes cancer detection in its early, more treatable stages. As a coauthor of this article and a Navajo breast cancer survivor, Nellie Sandoval, BS, MS, explains that the very topic of cancer is taboo to discuss among the Navajo population, for to speak of cancer is to invite it. When statistical data from the San Juan Regional Tumor Registry supported the authors' anecdotal findings regarding late diagnoses, they created Breast Cancer: It Can Be Healed. The first Navajo-language video to address such cultural barriers, it discusses the triad of early detection-breast self-examination, clinical examination, and mammography. Its success sparked creation of a second video, sponsored by the Native American Cancer Research Partnership (NACRP). The 12-minute video, Breast Cancer: The Healing Begins, focuses on treatment options, including surgery, radiation, and hormone therapy. By conducting field screenings throughout the Navajo Nation, the NACRP team has enhanced the video's visual imagery and messages and has confirmed the value of cultural relevancy in cancer education.