Breast cancer is the most common form of cancer in American women across most ethnic groups. Although the psychosocial impact of breast cancer is being studied, there is little information on women from diverse ethnic and socioeconomic backgrounds.We conducted a qualitative study with breast cancer survivors (BCS) of various ethnicities. A total of 102 BCS participated in focus group interviews (24 African Americans, 34 Asians, 26 Latinas and 18 Caucasians); 20 health professionals participated in key informant interviews. Important ethnic differences in type of treatment were noted, Asians and Latinas were more likely to receive mastectomies and African American BCS were least likely to receive adjuvant therapies, including radiation and chemotherapy. These BCS enjoyed a fairly good overall health-related quality of life (HRQOL) with some persistent concerns. The prevailing concerns among all women included overall health, moderate physical concerns, cancer recurrence or metastases, psychosocial concerns related to worry about children and burdening the family, and body image and sexual health concerns. Additional challenges included: lack of knowledge about breast cancer; medical care issues such as insurance, cost and amount of time spent with physician; cultural sensitivity of providers, language barriers, cultural factors related to beliefs about illness, gender role and family obligations (e.g. selfsacrifice). These BCS, particularly the women of color, voiced that their spiritual beliefs and practices are central to their coping. This study accomplishes two goals; it adds to the sparse literature concerning the psychosocial sequelae of breast cancer among women of color, and it increases our knowledge of specific cultural influences (e.g. dietary practices, coping) and socio-ecological factors *Correspondence to: UCLA, Department of Psychiatry and Biobehavioral Sciences, 760 Westwood Plaza, Box 62, Los Angeles, CA, USA. E-mail: kashing@ucla.edu. NIH Public Access Author ManuscriptPsychooncology. Author manuscript; available in PMC 2006 October 20. Published in final edited form as:Psychooncology. 2004 June ; 13(6): 408-428. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript on HRQOL. More importantly, the study addressed areas that have not been studied before, specifically, an in-depth study on BCS QOL comparing multiple ethnic groups in the US. The results of this investigation will provide preliminary information to survivors and health-care providers about the impact of culture and socio-ecological contexts on survivorship.Among women of all major ethnic groups, breast cancer is the most common form of cancer and the second leading cause of cancer death (American Cancer Society (ACS), 2002). In 2002, over 203,000 women in the United States will be diagnosed with breast cancer (ACS, 2002). Ethnic disparities exist for cancer stage, diagnosis, survival, morbidity and mortality. In general, ethnic minority women are diagnosed with more advanced disease and experience greate...

Qualitative interviews were used to investigate the impact of breast cancer among Latina survivors. The findings revealed that Latina survivors were optimistic about their health, utilized cultural and religious recovery practices; and seemed to accept their diagnosis, fears and suffering as part of their personal journey. The survivors' narrative identified spirituality as central to their recovery and coping. Extended family and friends were the primary sources of support. Common issues were the impact of cancer on medical care problems, work concerns, the meaning of cancer, family well-being, emotional well-being, body image, and sexual health. Latina survivors, particularly those who are poor and speak limited English, often have inadequate insurance, receive unsatisfactory medical care, and experience poor physician-patient communication and relationship. These problems are directly related to health-care system factors as well as socio-ecological and language issues. In addition, many Latina survivors have inadequate resources and inaccurate beliefs that may affect their health care (e.g., delay, lack of follow-up), and overall quality of life. Results will inform a quantitative study with a larger sample of Latina breast cancer survivors.

Breast cancer is the most common form of cancer in women and affects women across all ethnic groups. Although the psychosocial impact of breast cancer is being studied, there is little information on ethnic minorities. To better understand the breast cancer experience of Asian American women, we conducted key informant and focus group interviews. Six professionals participated in the key informant interviews. A total of 34 Asian American breast cancer survivors participated in focus group interviews, including Korean (n=10), Chinese (n=11), and a mixed Asian group (n=13). The common themes identified in this series of qualitative studies included: lack of knowledge about breast cancer; medical care issues such as cost and amount of time spent with physician; cultural factors related to beliefs about illness, gender role and family obligations (e.g. self-sacrifice) and language barriers; the importance of spirituality; and psychosocial concerns related to worry about children, burdening the family, body image and sexual health concerns. A primary source of support and coping for Asian American women with breast cancer was their spiritual beliefs. The results from this qualitative study have been used to prepare a survey instrument to examine these issues in a larger sample of Asian American women.

HRQOL among this multiethnic sample ranged from fair to good. Bivariate analysis suggests that ethnic differences in HRQOL exist. However, regression analyses demonstrated that socio-ecological factors in conjunction with medical characteristics are more salient to HRQOL outcomes, and that ethnic group membership may be a proxy for socio-ecological context. Furthermore, the influence of ethnicity, culture, and social-ecology are complex; research with large, population-based samples are necessary to disentangle the impact of contextual factors on HRQOL.

Invasive CCA is primarily a cancer of women who are economically disenfranchised. Women with a CCA diagnosis are disproportionately challenged by lack of resources including quality, affordable health care and psychosocial services. CCS experience persistent medical, psychological, social, and relational concerns. Information concerning CCS is needed, particularly in Spanish, Vietnamese and Korean. There is an urgent need for further research to understand the risk factors, and the social and cultural mediators of cancer-related HRQOL for CCS.

BACKGROUNDThe inclusion of ethnic minorities in cancer‐related studies continues to be an important concern for researchers. In this article, the authors present 1) a brief discussion of recruitment and measurement challenges in conducting multiethnic survivorship research, and 2) recruitment outcomes and sample characteristics for a health‐related quality‐of‐life study with a multiethnic sample of breast cancer survivors (BCS).METHODSA case–control, cross‐sectional design with mixed sampling methods was used. The Contextual Model for Recruitment and Enrollment of Diverse Samples was used to guide the protocol. BCS were recruited from the California Cancer Surveillance Program, from hospital registries, and from community agencies. Participation rates, demographic factors, and medical factors were compared. The reliability of standard measures by ethnicity was assessed.RESULTSSeven hundred three women participated, including 135 African‐American women (19%), 206 Asian‐American women (29%), 183 Latina‐American women (26%), and 179 European‐American women (26%). Participation was influenced by ethnicity, age, and site of recruitment. Overall, African Americans were least likely to participate, and European Americans most likely to participate. African Americans and Asian Americans were more likely to refuse, European Americans and Latina Americans were more likely to agree to participate, and European Americans and Asian Americans were most likely to complete the survey after consenting. Measures possessed moderate to excellent reliability (0.64–0.91).CONCLUSIONSDespite important recruitment and measurement challenges, this study obtained acceptable participation rates and good internal consistency of the measures. The results demonstrate the utility of a culturally responsive approach to health disparities research. Cancer 2004. © 2004 American Cancer Society.

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Latinos are more likely to test late for HIV infection compared to other racial/ethnic groups in the United States. A population-based interview study was used to examine factors associated with late HIV testing for Latinos diagnosed with AIDS in Los Angeles County (LAC) to develop more effective HIV testing outreach strategies. Latinos testing for HIV within one year of an AIDS diagnosis were considered as late testers, while those diagnosed with AIDS more than one year after an HIV diagnosis were defined as non-late testers. After adjusting for age, education, country of birth, and injection drug use in a logistic regression analysis, completion of the interview in Spanish was the main factor associated with late testing (adjusted Odds Ratio (AOR) = 2.9, 95% Confidence Intervals (CIs): 1.4, 6.0). Latinos testing late for HIV were also more likely to test due to illness (p<0.0001) and less likely to test as part of a clinical screening (p<0.0001). Late testers were more likely to receive their first positive HIV test as a hospital inpatient (p<0.0001) and less likely to test positive at a community health center or public clinic (p=0.05). To accomplish widespread and timely HIV testing for Latinos in LAC, Spanish-language social marketing campaigns are needed and Spanish-speaking patients should be offered HIV testing in all clinical settings.