Social Support and QOL in Older Minority Women with BC

Institution: University of California, Los Angeles
Investigator(s): Yoshiko Umezawa, Ph.D. -
Award Cycle: 2006 (Cycle 12) Grant #: 12GB-0070 Award: $62,169
Award Type: Dissertation Award
Research Priorities
Community Impact of Breast Cancer>Sociocultural, Behavioral, and Psychological Issues: the human side



Initial Award Abstract (2006)
Non-technical introduction to the research topics: Older Latina and African-American women are more likely than white women to present with later stages of breast cancer, receive suboptimal treatment, and have lower survival rates. Support from family and the religious community may serve as vital, immediately available resources that enhance patient quality of life (QOL). While sources of support may vary by ethnic groups, breast cancer care typically addresses the individual patient alone or patient-partner pair, without acknowledging the role of cultural diversity in social support. Such cultural insensitivity may hinder the development of trusting partnerships between the patient, family, and providers, which may further exacerbate disparities in breast cancer treatment and survival.

The questions of the research in lay terms:
1) Are there ethnic group differences in social support, family caregiving burden, and physicians’ support of the family of older breast cancer patients and what are their unmet support needs?
2) What is the impact of social support, family caregiving burden, and physicians’ support of the family on patient QOL?
3) What can be done to enhance cultural sensitivity in healthcare for minority women with breast cancer?

The general methodology in lay terms: The data will be derived from a survey of 99 Latina, 66 African-American, and 92 white women (total number=257), aged 55 years or older, newly diagnosed with breast cancer in LA County. The survey question items include QOL, social support, family’s caregiving burden, and physicians’ support of family. The above research questions 1 and 2 will be answered using statistical analyses. A theoretical model corresponding to question 2 will be developed and statistically tested. This model and a comprehensive literature review will serve as the basis of developing an intervention to enhance culturally sensitive breast cancer care.

Innovative elements of the project in lay terms: The study will examine health-protective effects of family and religious community on QOL in older Latina and African-American women with breast cancer. It will inform healthcare policy-makers and providers of at-risk populations of women with breast cancer and their families who experience inadequate social support and who may need professional attention. Because the entire family may be distressed by the patient’s breast cancer, screening for family psychosocial needs may improve QOL in patients and families. Incorporation of family care may facilitate the development of trusting partnerships between patient, family, and providers. The study will develop a theoretical model on the impact of the partnership between patient, family and providers on patient QOL. This will provide the scientific basis for developing effective interventions aimed at both breast cancer patients and their families to improve their QOL. These culturally sensitive efforts will contribute to decreasing the unequal burden of breast cancer.

Advocacy involvement and human issues: Family and religious community are identified by ethnic minority advocates as vital sources of support. Advocates consider addressing the dynamics of family support as an important, yet often neglected issue. The study has received extensive feedback from the Women’s Cancer Resource Center, an advocate organization that serves Latina, African-American, and low-income women with cancer. The feedback has been incorporated in the study design to further address the specific needs for social support in minority women with breast cancer and their families.




Final Report (2008)
Older Latina and African-American women with breast cancer (BC) face multiple socio-structural disadvantages that may undermine health-related quality of life (HRQOL). This study compared and contrasted the socio-structural and the ‘cultural’ perspectives to better understand psychosocial pathways to racial/ethnic disparities in HRQOL. According to the socio-structural perspective, disadvantaged groups not only may be more exposed to stressful life events, but also may be more vulnerable to the stressors because their stratified social structure may constrain and overburden their psychosocial resources such as social and religious support and psychological coping skills. On the other hand, the ‘cultural’ perspective suggests that racial/ethnic minority groups may have developed stronger psychosocial resources, out of necessity in response to negative social pressures, and these resources may be more compelling to disadvantaged groups than to advantaged groups.

In this study, I compared the extent to which these two perspectives accounted for racial/ethnic differences in HRQOL among older African-American, Latina, and European-American women with BC. To ‘unpack’ the epistemological and empirical complexity involved in the racial/ethnic gap of health outcomes and illuminate the role of agency in diverse racial/ethnic groups as opposed to structural constraints, this study used an analytical framework that illuminates the impact of racial/ethnic group membership on HRQOL as mediated through psychosocial resources. Statistical analyses controlled for the direct and indirect effects of socio-structural stratification as mediated through psychosocial resources.

In this study sample, specific patterns of social and religious support for Latinas and religious support for African Americans were better explained by the ‘cultural’ thesis, rather than the socio-structural thesis. Compared to European Americans, being Latina had indirect salutary effects on HRQOL mediated through social and religious support and being African American had indirect salutary effect mediated through religious support. In contrast, professional support was explained by the socio-structural perspective and visit-specific social support did not mediate racial/ethnic disparities in professional support.

Thus, both the socio-structural perspective and the ‘cultural’ perspective were necessary to fully understand the differential impact of social, religious, and professional support on HRQOL in Latina and African-American women with BC. The two perspectives complementarily address the impact of the socio-structural disadvantages and the socio-cultural, active agency in Latina and African-American women. The use of both perspectives would help public-health practitioners develop more effective multi-level interventions that help minority groups overcome socio-structural disadvantages and maintain their ‘cultural’ advantages. All the study aims were successfully completed without major obstacles.


Symposium Abstract (2007)

Background: Support from family and religious community may serve as a vital, immediately available resource for older Latina and African-American women with breast cancer (BC) to enhance their quality of life. While sources of support may vary by ethnic groups, BC care typically addresses the individual patient alone or patient-partner pair, without acknowledging the role of cultural diversity in social support. Provider insensitivity to these differences may hinder the development of trusting partnerships between the patient, family, and providers, which may further exacerbate disparities in BC treatment and survival.

Specific Aims: To understand the role of social and religious support in older racial/ethnic minority women with BC.