Quality of Life among Latina Breast Cancer Survivors: A Systematic Review and Investigations of Culturally Relevant Contributors in the Medical Treatment Context.

摘要

Breast cancer diagnosis and treatment can be a stressful and potentially life-altering experience for women, with potentially deleterious physical and mental health outcomes. In light of the increases in cancer survival rates in the general population, healthcare researchers have devoted greater attention to the quality of life of breast cancer patients. In this important area of research, relatively few studies have focused on the breast cancer experience of Latinas. The burden of breast cancer for this group of women is grave, especially given many economic, cultural, and health disparities. The Latino population is the largest and fastest growing ethnic minority population in the United States. By 2050, Latinos are projected to account for approximately one quarter of the U.S. population. Recently, the literature has seen an increase in studies focusing on Latinas' quality of life following a diagnosis of breast cancer and treatment. Nonetheless, few studies investigate predictors of quality of life and additional relevant health-related outcomes within this population. In order to improve psychological approaches to the management of ethnically diverse patients with breast cancer, we sought to assess the level of quality of life among Latinas relative to other racial/ethnic groups of women and to elucidate potential explanatory mechanisms in the relationship between Latina ethnic status and quality of life within the context of breast cancer treatment.;In Chapter 2 we undertook a systematic review of the breast cancer quality of life (QOL) literature. The review was conducted among studies that provided a comparison of mental, physical, social, or sexual QOL between Latinas and other racial/ethnic groups. Of the 375 studies reviewed, 20 quantitative studies and two qualitative studies met criteria for inclusion.;Latinas were more likely to report poor mental, physical, and social QOL, relative to non-Latinas. Of these four QOL domains, the largest disparity was found in the area of mental health, in which Latinas reported poorer QOL compared to non-Latina Whites and Blacks. Explanatory mechanisms including socio-demographic, treatment-related, and culturally-relevant factors are discussed.;Findings from the systematic review informed the development of two subsequent longitudinal studies which focused on predictors of quality of life among predominantly low-income Spanish-speaking Latinas. Patient-physician communication during the surgical treatment decision-making process was of particular interest given culturally-relevant barriers low-acculturated Latinas may face during this process. In the context of surgical decision making for breast cancer and guided by models of patient-physician communication, the research presented in Chapter 3 sought to delineate pathways to quality of life which included factors salient to the Latina population, including acculturation, effectiveness in patient-physician communication, and treatment decision outcomes. Latinas with breast cancer (N = 326) completed measures to assess these constructs six months after diagnosis, and quality of life was assessed 18 months after diagnosis. Structural equation modeling was used to examine hypothesized relationships between acculturation, communication effectiveness in decision making, and outcomes. Less acculturation was related to less perceived patient-physician communication effectiveness. Effectiveness in communication was not related to congruency in surgical decision making but was related to greater treatment satisfaction. Greater treatment satisfaction predicted more favorable quality of life. The final model fit the data well Robust S-B chi2 (49, N= 326) = 54.72, p = .26, Robust CFI = .99, Robust RMSEA = .02.;Guided by conceptual models of patient-physician communication in conjunction with theories illness perceptions and adaptation to disease diagnosis and treatment, research described in Chapter 4 aimed to test a path model of factors salient to the Latina population as determinants of perceived surgical treatment consequences and change in cancer-specific distress. In this longitudinal study, Latinas with breast cancer (N= 43) completed measures to assess constructs of illness perceptions (i.e., fatalistic expectancies about cancer), efficacy in patient-physician communication, perceived surgical consequences in two domains (i.e., self-evaluation and curative) and cancer-specific distress. Path analysis was used to explore relationships between fatalistic expectancies, patient-physician communication, perceived surgical treatment consequences, and change in cancer-specific distress. High fatalistic expectancies and low efficacy in patient-physician communication predicted poorer perceived surgical consequences. Only perceived negative surgical consequences for self-evaluation significantly predicted an increase in cancer-specific distress. The model fit the data well chi2 (7) = 9.90, p = .19; CFI = .96; RMSEA = .10.;Understanding the contributions of social, economic, and cultural factors in facilitating or hindering quality of life among Latinas diagnosed and treated for breast cancer is of importance in informing targeted interventions for women in this rapidly growing population. Taken together, these chapters illuminate potential pathways through which factors salient to Latinas may contribute to quality of life.