|by Pat Kramer
Latinas are at greater risk of being diagnosed with premenopausal breast cancer than non-Latina whites, and Latinas appear more likely to have advanced cancer and poor outcomes. City of Hope researchers want to help change that.
Multidisciplinary scientists such as Kimlin Ashing-Giwa, Ph.D., director of the Center of Community Alliance for Research & Education, and Gloria Juarez, R.N., Ph.D., assistant research scientist in the Department of Nursing Research and Education, look for answers to questions about how Latinas and other women of color deal with a breast cancer diagnosis and access health care.
Ashing-Giwa, professor of population sciences, is conducting a variety of projects addressing quality of life among Latina breast cancer survivors. Among them is the largest multiethnic population study to date on breast cancer survivorship outcomes, which she recently completed. Findings will soon be published in Quality of Life Research.
Recently, the Department of Defense granted her $928,000 for another study, called “Increasing psychosocial well-being and reducing the burden of breast cancer for Latinas and African-Americans,” which strives to reduce the psychological social and familial burdens many women of color face in dealing with breast cancer.
In addition to conducting focus groups and a survey on quality of life, Ashing-Giwa and her team will provide interventions to Latinas and African-American women diagnosed with the disease. About 300 participating women are assigned to receive either eight weeks of telephone counseling by a mental health professional and an educational survivorship kit or the survivorship kit alone. Investigators hope that providing women with culturally sensitive and relevant health information will improve their participation in health care, including clinical trials, and improve quality of life.
Burdens are complex and often come from a lack of resources for the underserved, she said.
According to her earlier studies, Latina breast cancer survivors report the worst emotional, family and social wellbeing of all ethnic groups and face important physical, financial and work challenges.
“Culturally, Latinas are taught modesty, causing feelings of shame associated with performing breast self-examinations and contributing to low participation in breast cancer screenings,” she said. “Within this ethnic group, many believe that prayer and being a ‘good person’ will promote recovery. These cultural beliefs and practices need to be understood and even utilized in interventions to promote health practices and wellbeing.”
Among Latinas, she said, the belief still persists that cancer is a punishment from God. Such women also may distrust medical authorities, feel overwhelmed by health-care paperwork and fear asking their doctors questions.
Despite these challenges, the women are resilient. “They are managing, they are surviving and many are thriving, drawing on their spiritual beliefs,” Ashing-Giwa said. “Many find appreciable meaning in their lives, feeling they have been given a second chance.”
Just across the City of Hope campus, Juarez, of the Department of Nursing Research and Education, also focuses on Latino families. Moreover, the National Cancer Institute (NCI) recently backed her work, awarding Juarez the nursing research group’s first K07 grant for budding scientists.
Juarez’s $700,000 NCI grant funds her five-year project, “Support for Hispanic Breast Cancer Patients and Caregivers,” which will develop an intervention program for breast cancer survivors and their caregivers.
She will use a quality of life model developed by the department’s Betty R. Ferrell, Ph.D., R.N., to measure the intervention’s impact on the physical, social, spiritual and psychological effects of breast cancer on the lives of a pilot group of 104 Latina breast cancer survivors and caregivers. Focus groups will then opine on the intervention’s effectiveness and make suggestions for language appropriateness and other factors to best reach Latinas.
Juarez’s study mentors include Marjorie Kagawa–Singer, Ph.D., R.N., associate professor in the UCLA School of Public Health, and Geraldine Padilla, Ph.D., professor and associate dean for research at the University of California, San Francisco School of Nursing.
Ashing-Giwa’s collaborators on the Department of Defense-backed study include Padilla as well as Judith Tejero, M.P.H., of the UCLA David Geffen School of Medicine, Jinsook Kim, Ph.D., D.D.S., of the UCLA School of Public Health, and UCLA biostatistician Gerhard Hellemann, Ph.D.