No votes yet

Cancer Survivorship Research Among Ethnic Minority and Medically Underserved Groups

Noreen M. Aziz
Julia H. Rowland
ONF 2002, 29(5), 789-801 DOI: 10.1188/02.ONF.789-801

Purpose/Objectives: To review the current state of knowledge about the impact of cancer on ethnoculturally diverse and medically underserved survivors.

Data Sources: MEDLINE®, CancerLit, and Psychlit searches from 1966-present were conducted to locate articles about survivorship outcomes among minority and underserved populations.

Data Synthesis: 65 articles were identified and grouped into one of four content areas: physiologic; psychosocial; health services, patterns of care, and quality of care; and health-promoting behaviors and lifestyles.

Conclusions: Despite limited information, researchers found a consistent theme: the need to recognize and address the socioeconomic and cultural variables that affect adaptation to and survival from cancer among diverse groups of survivors.

Implications for Nursing: The researchers found specific variations in risk for, response to, and recovery from cancer that provide direction for changes in nursing practice that may reduce the burden of cancer in these often vulnerable populations.


Adams-Campbell, L.L., Kim, K.S., Dunston, G., Laing, A.E., Bonney, G., & Demenais, F. (1996). The relationship of body mass index to reproductive factors in pre- and postmenopausal African-American women with and without breast cancer. <i>Obesity Research</i>, 4, 451-456.

Alferi, S.M., Antoni, M.H., Ironson, G., Kilbourn, K.M., & Carver, C.S. (2001). Factors predicting the use of complementary therapies in a multiethnic sample of early-stage breast cancer patients. <i>Journal of the American Medical Women's Association</i>, 56, 120-123, 126.

American Cancer Society. (2002). <i>Cancer facts and figures 2002.</i> Atlanta, GA: Author.

Ashing-Giwa, K. (1999). Health behavior change models and their socio-cultural relevance for breast cancer screening in African American women. <i>Women's Health</i>, 28(4), 53-71.

Ashing-Giwa, K., Ganz, P.A., & Petersen, L. (1999). Quality of life of African-American and Caucasian long term breast carcinoma survivors. <i>Cancer</i>, 85, 418-426.

Aziz, H., Hussain, F., Sohn, C., Mediavillo, R., Saitta, A., Hussain, A., et al. (1999). Early onset of breast carcinoma in African American women with poor prognostic factors. <i>American Journal of Clinical Oncology</i>, 22, 436-440.

Aziz, N.M. (2002). Long-term survivorship: Late effects. In A.M. Berger, R.K. Portenoy, & D.E. Weissman (Eds.), <i>Principles and practice of palliative care and supportive oncology</i> (2nd ed., pp. 1019-1033). Philadelphia: Lippincott, Williams, and Wilkins.

Baquet, C.R., & Commiskey, P. (2000). Socioeconomic factors and breast carcinoma in multicultural women. <i>Cancer</i>, 88(Suppl. 5), 1256-1264.

Barg, F.K., & Gullatte, M.M. (2001). Cancer support groups: Meeting the needs of African Americans with cancer. <i>Seminars in Oncology Nursing</i>, 17, 171-178.

Beder, J. (1995). Perceived social support and adjustment to mastectomy in socioeconomically disadvantaged black women. <i>Social Work in Health Care</i>, 22(2), 55-71.

Berkman, L.F., & Syme, S.L. (1979). Social networks, host resistance, and mortality: A nine-year follow-up study of Alameda County residents. <i>American Journal of Epidemiology</i>, 109, 186-204.

Bourjolly, J.N. (1998). Differences in religiousness among black and white women with breast cancer. <i>Social Work in Health Care</i>, 28(1), 21-39.

Bourjolly, J.N., Kerson, T.S., & Nuamah, I.F. (1999). A comparison of social functioning among black and white women with breast cancer. <i>Social Work in Health Care</i>, 28(3), 1-20.

Burman, M.E., & Weinert, C. (1997). Concerns of rural men and women experiencing cancer. <i>Oncology Nursing Forum</i>, 24, 1593-1600.

Byrne, J., Lewis, S., Halamek, L., Connelly, R.R., & Mulvihill, J.J. (1989). Childhood cancer survivors' knowledge of their diagnosis and treatment. <i>Annals of Internal Medicine</i>, 110, 400-403.

Canales, S., Ganz, P.A., & Coscarelli, C.A. (1995). Translation and validation of a quality of life instrument for Hispanic American cancer patients: Methodological considerations. <i>Quality of Life Research</i>, 4, 3-11.

Cella, D., Hernandez, L., Bonomi, A.E., Corona, M., Vaquero, M., Shiomoto, G., et al. (1998). Spanish language translation and initial validation of the functional assessment of cancer therapy quality-of-life instrument. <i>Medical Care</i>, 36, 1407-1418.

Cohen, S., & Syme, S.L. (Eds.). (1985). <i>Social support and health.</i> New York: Academic Press.

Committee on Health and Behavior, Research, Practice, and Policy, Board on Neuroscience and Behavioral Health, Institute of Medicine. (2001). <i>Health and behavior. The interplay of biological, behavioral and societal influences.</i> New York: National Academy of Sciences.

Compas, B.E., Keefe, F.J., Haaga, D.A., Leitenberg, H., & Williams, D.A. (1998). Sampling of empirically supported psychological treatments from health psychology: Smoking, chronic pain, cancer, and bulimia nervosa. <i>Journal of Consulting and Clinical Psychology</i>, 66, 89-112.

Deimling, G.T., Schaefer, M.L., Kahana, B., & Bowman, K. (in press). Racial differences in the health of older adult long-term cancer survivors. <i>Journal of Psychosocial Oncology.</i>

Devine, E.C., & Westlake, S.K. (1995). The effects of psychoeducational care provided to adults with cancer: Meta-analysis of 116 studies. <i>Oncology Nursing Forum</i>, 22, 1369-1381.

Dignam, J.J., Redmond, C.K., Fisher, B., Costantino, J.P., & Edwards, B.K. (1997). Prognosis among African-American women and white women with lymph node negative breast carcinoma: Findings from two randomized clinical trials of the National Surgical Adjuvant Breast and Bowel Project (NSABP). <i>Cancer</i>, 80, 80-90.

El-Tamer, M.B., Homel, P., & Wait, R.B. (1999). Is race a poor prognostic factor in breast cancer? <i>Journal of the American College of Surgeons</i>, 189, 41-45.

Eyre, H.J., & Feldman, G.E. (1998). Status report on prostate cancer in African Americans: A national blueprint for action. <i>CA: A Cancer Journal for Clinicians</i>, 48, 315-319.

Farrow, D.C., Hunt, W.C., & Samet, J.M. (1992). Geographic variation in the treatment of localized cancer. <i>New England Journal of Medicine</i>, 326, 1102-1107.

Foltz, A., & Sullivan, J. (1996). Reading level, learning presentation preference, and desire for information among cancer patients. <i>Journal of Cancer Education</i>, 11, 32-38.

Ford, M.E., Havstad, S.L., & Kart, C.S. (2001). Assessing the reliability of the EORTC QLQ-C30 in a sample of older African American and Caucasian adults. <i>Quality of Life Research</i>, 10, 533-541.

Germino, B.B., Mishel, M.H., Belyea, M., Harris, L., Ware, A., & Mohler, J. (1998). Uncertainty in prostate cancer. Ethnic and family patterns. <i>Cancer Practice</i>, 6, 107-113.

Grant, M., Anderson, P., Ashley, M., Dean, G., Ferrell, B., Kagawa-Singer, M., et al. (1998). Developing a team for multicultural, multi-institutional research on fatigue and quality of life. <i>Oncology Nursing Forum</i>, 25, 1404-1412.

Green, B.L., Krupnick, J.L., Rowland, J.H., Epstein, S.A., Stockton, P., Spertus, I., et al. (2000). Trauma history as a predictor of psychologic symptoms in women with breast cancer. <i>Journal of Clinical Oncology</i>, 18, 1084-1093.

Gregoire, I., Kalogeropoulos, D., & Corcos, J. (1997). The effectiveness of a professionally led support group for men with prostate cancer. <i>Urological Nursing</i>, 17(2), 58-66.

Grenier, M.A., & Lipshultz, S.E. (1998). Epidemiology of anthracycline cardiotoxicity in children and adults. <i>Seminars in Oncology</i>, 25(4, Suppl. 10), 72-85.

Guidry, J.J., Aday, L.A., Zhang, D., & Winn, R.J. (1997). The role of informal and formal social support networks for patients with cancer. <i>Cancer Practice</i>, 5, 241-246.

Guidry, J.J., Aday, L.A., Zhang, D., & Winn, R.J. (1998a). Cost considerations as potential barriers to cancer treatment. <i>Cancer Practice</i>, 6, 182-187.

Guidry, J.J., Aday, L.A., Zhang, D., & Winn, R.J. (1998b). Information sources and barriers to cancer treatment by racial/ethnic minority status of patients. <i>Journal of Cancer Education</i>, 13, 43-48.

Hamilton, A.S., Stanford, J.L., Gilliland, F.D., Albertsen, P.C., Stephenson, R.A., Hoffman, R.M., et al. (2001). Health outcomes after external-beam radiation therapy for clinically localized prostate cancer: Results from the Prostate Cancer Outcomes Study. <i>Journal of Clinical Oncology</i>, 19, 2517-2526.

Haynes, M.A., & Smedley, B.D. (Eds.). (1999). <i>The unequal burden of cancer: An assessment of NIH research and programs for ethnic minorities and the medically underserved.</i> Washington, DC: Institute of Medicine, National Academy Press.

Helgeson, V.S., Cohen, S., & Frits, H.L. (1998). Social ties and cancer. In J.C. Holland (Ed.), <i>Psycho-oncology</i> (pp. 99-109). New York: Oxford University Press.

Horner, R.D. (1998). Racial variation in cancer care: A case study of prostate cancer. <i>Cancer Treatment Research</i>, 97, 99-114.

Jones, B.A., Kasi, S.V., Curnen, M.G., Owens, P.H., & Dubrow, R. (1997). Severe obesity as an explanatory factor for the black/white difference in stage at diagnosis of breast cancer. <i>American Journal of Epidemiology</i>, 146, 394-404.

Kagawa-Singer, M. (1995). Socioeconomic and cultural influences on cancer care of women. <i>Seminars in Oncology Nursing</i>, 11, 109-119.

Kagawa-Singer, M., Wellisch, D.K., & Durvasula, R. (1997). Impact of breast cancer on Asian American and Anglo American women. <i>Culture, Medicine, and Psychiatry</i>, 21, 449-480.

Kaur, J.S. (1996). The potential impact of cancer survivors on Native American cancer prevention and treatment. <i>Cancer</i>, 78(Suppl. 7), 1578-1581.

Koopman, C., Angell, K., Turner-Cobb, J.M., Kreshka, M.A., Donnelly, P., McCoy, R., et al. (2001). Distress, coping, and social support among rural women recently diagnosed with primary breast cancer. <i>Breast Journal</i>, 7, 25-33.

Lafata, J.E., Johnson, C.C., Ben-Menachem, T., & Morlock, R.J. (2001). Sociodemographic differences in the receipt of colorectal cancer surveillance care following treatment with curative intent. <i>Medical Care</i>, 39, 361-372.

Lancee, W.J., Vachon, M.L., Ghadirian, P., Adair, W., Conway, B., & Dryer, D. (1994). The impact of pain and impaired role performance on distress in persons with cancer. <i>Canadian Journal of Psychiatry</i>, 39, 617-622.

Lannin, D.R., Mathews, H.F., Mitchell, J., Swanson, M.S., Swanson, F.H., & Edwards, M.S. (1998). Influence of socioeconomic and cultural factors on racial differences in late-stage presentation of breast cancer. <i>JAMA</i>, 279, 1801-1807.

Lee, M.M., Lin, S.S., Wrensch, M.R., Adler, S.R., & Eisenberg, D. (2000). Alternative therapies used by women with breast cancer in four ethnic populations. <i>Journal of the National Cancer Institute</i>, 92, 42-47.

Lubeck, D.P., Kim, H., Grossfeld, G., Ray, P., Penson, D.F., Flanders, S.C., et al. (2001). Health related quality of life differences between black and white men with prostate cancer: Data from the cancer of the prostate strategic urologic research endeavor. <i>Journal of Urology</i>, 166, 2281-2285.

Lyman, G.H., Kuderer, N.M., Lyman, S.L., Cox, C.E., Reintgen, D., & Baekey, P. (1997). Importance of race on breast cancer survival. <i>Annals of Surgical Oncology</i>, 4, 80-87.

McGrath, P. (2001). Follow-up of patients with haematological malignancies and their families in regional, rural, and remote Queensland: The GP's perspective. <i>Supportive Care in Cancer</i>, 9, 199-204.

McGrath, P., Patterson, C., Yates, P., Treloar, S., Oldenburg, B., & Loos, C. (1999). A study of postdiagnosis breast cancer concerns for women living in rural and remote Queensland. Part 1: Personal concerns. <i>Australian Journal of Rural Health</i>, 7, 34-42.

Meyer, T.J., & Mark, M.M. (1995). Effects of psychosocial interventions with adult cancer patients: A meta-analysis of randomized experiments. <i>Health Psychology</i>, 14, 101-108.

Meyerowitz, B.E., Richardson, J., Hudson, S., & Leedham, B. (1998). Ethnicity and cancer outcomes: Behavioral and psychosocial considerations. <i>Psychological Bulletin</i>, 123, 47-70.

Mickley, J., & Soeken, K. (1993). Religiousness and hope in Hispanic and Anglo-American women with breast cancer. <i>Oncology Nursing Forum</i>, 20, 1171-1177.

Moadel, A., Morgan, C., Fatone, A., Grennan, J., Carter, J., Laruffa, G., et al. (1999). Seeking meaning and hope: Self-reported spiritual and existential needs among an ethnically-diverse cancer patient population. <i>Psycho-Oncology</i>, 8, 378-385.

Moore, R.J. (2001). African American women and breast cancer: Notes from the study of narrative. <i>Cancer Nursing</i>, 24, 35-42.

Musick, M.A., Koenig, H.G., Hays, J.C., & Cohen, H.J. (1998). Religious activity and depression among community-dwelling elderly persons with cancer: The moderating effect of race. <i>The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences</i>, 53(4), S218-S227.

Myers, H.F., Kagawa-Singer, M., Kumanyika, S.K., Lex, B.W., & Markides, K.S. (1995). Behavioral risk factors related to chronic diseases in ethnic minorities. <i>Health Psychology</i>, 14, 613-621.

Naranjo, L.E., & Dirksen, S.R. (1998). The recruitment and participation of Hispanic women in nursing research: A learning process. <i>Public Health Nursing</i>, 15, 25-29.

Nattinger, A.B., Gottlieb, M.S., Veum, J., Yahnke, D., & Goodwin, J.S. (1992). Geographic variation in the use of breast-conserving treatment for breast cancer. <i>New England Journal of Medicine</i>, 326, 1102-1107.

Northouse, L.L., Caffey, M., Deichelbohrer, L., Schmidt, L., Guziatek-Trojniak, L., West, S., et al. (1999). The quality of life of African American women with breast cancer. <i>Research in Nursing and Health</i>, 22, 449-460.

Olson, A.L., Boyle, W.E., Evans, M.W., & Zug, L.A. (1993). Overall function in rural childhood cancer survivors. The role of social competence and emotional health. <i>Clinical Pediatrics</i>, 32, 334-342.

Penson, R.T., Castro, C.M., Seiden, M.V., Chabner, B.A., & Lynch, T.J. (2001). Complementary, alternative, integrative, or unconventional medicine? <i>The Oncologist</i>, 6, 463-473.

Perczek, R., Carver, C.S., Price, A.A., & Pozo-Kaderman, C. (2000). Coping, mood, and aspects of personality in Spanish translation and evidence of convergence with English versions. <i>Journal of Personality Assessment</i>, 74, 63-87.

Perkins, P., Cooksley, C.D., & Cox, J.D. (1996). Breast cancer. Is ethnicity an independent prognostic factor for survival? <i>Cancer</i>, 78, 1241-1247.

Phillips, J.M., Cohen, M.Z., & Moses, G. (1999). Breast cancer screening and African American women: Fear, fatalism, and silence. <i>Oncology Nursing Forum</i>, 26, 561-571.

Potosky, A.L., Harlan, L.C., Stanford, J.L., Gilliland, F.D., Hamilton, A.S., Albertsen, P.C., et al. (1999). Prostate cancer practice patterns and quality of life: The Prostate Cancer Outcomes Study. <i>Journal of the National Cancer Institute</i>, 91, 1719-1724.

Presberg, B.A., & Levenson, J.L. (1993). A survey of cancer support groups provided by National Cancer Institute (NCI) clinical and comprehensive centers. <i>Psycho-Oncology</i>, 2, 215-217.

President's Cancer Panel. (1998). <i>Cancer care issues in the United States: Quality of care, quality of life.</i> Bethesda, MD: National Cancer Institute.

Reynolds, P., Hurley, S., Torres, M., Jackson, J., Boyd, P., & Chen, V.W. (2000). Use of coping strategies and breast cancer survival: Results from the Black/White Cancer Survival Study. <i>American Journal of Epidemiology</i>, 152, 940-949.

Rodrigue, J.R. (1997). An examination of race differences in patients' psychological adjustment to cancer. <i>Journal of Clinical Psychology and Medical Screening</i>, 4, 271-280.

Roetzheim, R.G., Pal, N., Tennant, C., Voti, L., Ayanian, J.Z., Schwabe, A., et al. (1999). Effects of health insurance and race on early detection of cancer. <i>Journal of the National Cancer Institute</i>, 91, 1409-1415.

Rowland, J.H., Aziz, N.M., Tesauro, G., & Feuer, E.J. (2001). The changing face of cancer survivorship. <i>Seminars in Oncology Nursing</i>, 17, 236-240.

Rowland, J.H., Desmond, K.A., Meyerowitz, B.E., Belin, T.R., Wyatt, G.E., & Ganz, P.A. (2000). Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. <i>Journal of the National Cancer Institute</i>, 92, 1422-1429.

Sandgren, A.K., McCaul, K.D., King, B., O'Donnell, S., & Foreman, G. (2000). Telephone therapy for patients with breast cancer. <i>Oncology Nursing Forum</i>, 27, 683-688.

Scott-Findlay, S., & Chalmers, K. (2001). Rural families' perspectives on having a child with cancer. <i>Journal of Pediatric Oncology Nursing</i>, 18, 205-216.

Sklar, C.A. (1999). Overview of the effects of cancer therapies: The nature, scale and breadth of the problem. <i>Acta Paediatrica Supplement</i>, 88, 1-4.

Spencer, S.M., Lehman, J.M., Wynings, C., Arena, P., Carver, C.S., Antoni, M.H., et al. (1999). Concerns about breast cancer and relations to psychosocial well-being in a multiethnic sample of early-stage patients. <i>Health Psychology</i>, 18, 159-168.

Spitz, M.R., Fueger, J.J., Eriksen, M.P., & Newell, G.R. (1988). Profiles of cigarette smoking among patients in a cancer center. <i>Journal of Cancer Education</i>, 3, 265-271.

Stanford, J.L., Feng, Z., Hamilton, A.S., Gilliland, F.D., Stephenson, R.A., Eley, J.W., et al. (2000). Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: The Prostate Cancer Outcomes Study. <i>JAMA</i>, 283, 354-360.

Taylor, E.J. (2001). Spirituality, culture, and cancer care. <i>Seminars in Oncology Nursing</i>, 17, 197-205.

Trock, B.J. (1996). Breast cancer in African American women: Epidemiology and tumor biology. <i>Breast Cancer Research and Treatment</i>, 40, 11-24.

Velanovich, V., Yood, M.U., Bawle, U., Nathanson, S.D., Strand, V.F., Talpos, G.B., et al. (1999). Racial differences in the presentation and surgical management of breast cancer. <i>Surgery</i>, 125, 375-379.

Wellisch, D., Kagawa-Singer, M., Reid, S.L., Lin, Y.J., Nishikawa-Lee, S., & Wellisch, M. (1999). An exploratory study of social support: A cross-cultural comparison of Chinese-, Japanese-, and Anglo-American breast cancer patients. <i>Psycho-Oncology</i>, 8, 207-219.

Wilmoth, M.C., & Sanders, L.D. (2001). Accept me for myself: African American women's issues after breast cancer. <i>Oncology Nursing Forum</i>, 28, 875-879.

Wojcik, B.E., Spinks, M.K., & Optenberg, S.A. (1998). Breast carcinoma survival analysis for African American and white women in an equal-access health care system. <i>Cancer</i>, 82, 1310-1318.

Wortman, C.B. (1984). Social support and the cancer patient. Conceptual and methodologic issues. <i>Cancer</i>, 53(Suppl. 10), 2339-2362.

Wyatt, G.E., Desmond, K.A., Ganz, P.A., Rowland, J.H., Ashing-Giwa, K., & Meyerowitz, B.E. (1998). Sexual functioning and intimacy in African American and white breast cancer survivors: A descriptive study. <i>Women's Health</i>, 4, 385-405.

Yan, Y., Carvalhal, G.F., Catalona, W.J., & Young, J.D. (2000). Primary treatment choices for men with clinically localized prostate carcinoma detected by screening. <i>Cancer</i>, 88, 1122-1130.

Yood, M.U., Johnson, C.C., Blount, A., Abrams, J., Wolman, E., McCarthy, B.D., et al. (1999). Race and differences in breast cancer survival in a managed care population. <i>Journal of the National Cancer Institute</i>, 91, 1487-1491.

Zeltzer, L.K., Chen, E., Weiss, R., Guo, M.D., Robison, L.L., Meadows, A.T., et al. (1997). Comparison of psychologic outcome in adult survivors of childhood acute lymphoblastic leukemia versus sibling controls: A cooperative Children's Cancer Group and National Institutes of Health Study. <i>Journal of Clinical Oncology</i>, 15, 547-556.

Zietman, A., Moughan, J., Owen, J., & Hanks, G. (2001). The Patterns of Care Survey of radiation therapy in localized prostate cancer: Similarities between the practice nationally and in minority-rich areas. <i>International Journal of Radiation Oncology, Biology, and Physics</i>, 50, 75-80.