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Challenges of illness in metastatic breast cancer: A low-income African American perspective

  • Margaret Quinn Rosenzweig (a1), Theresa Wiehagen (a1), Adam Brufsky (a2) and Robert Arnold (a3)

Disparities in breast cancer survival and treatment for African American and low income women are well documented, yet poorly understood. As care for women with metastatic breast cancer (MBC) evolves to a chronic care model, any inequities in optimal treatment and management of symptoms must also be identified and eliminated. The purpose of this study was to explore how race and income status influence women's experiences with MBC, particularly the management of symptoms, by describing the perceived challenges and barriers to achieving optimal symptom management among women with MBC and exploring whether the perceived challenges and barriers differed according to race or income.


Quantitative techniques were used to assess demographics, clinical characteristics, symptom distress, and quality of life and to classify women into groups according to race and income. Qualitative techniques were used to explore the perceived challenges, barriers, and potential influences of race and income on management of symptoms in a prospective sample of 48 women with MBC.


Commonalities of themes across all groups were faith, hope, and progressive loss. Low-income African American women uniquely experienced greater physical and social distress and more uncertainty about treatment and treatment goals than the other delineated racial and economic groups.

Significance of results:

There are many commonalities to the challenges of illness presented to women with MBC. There are also interesting, emerging thematic racial and economic differences, most compelling among the low income African American women with resultant practice and research implications.

Corresponding author
Address correspondence and reprint requests to: Margaret Quinn Rosenzweig, University of Pittsburgh School of Nursing, 3600 Victoria Building, Room 329-A, Pittsburgh, PA 15261. E-mail:
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K. Ashing-Giwa (1999). Quality of life and psychosocial outcomes in long-term survivors of breast cancer: A focus on African-American women. Journal of Psychosocial Oncology, 17, 4762.

P.B. Bach , D. Schrag , O.W. Brawley , (2002). Survival of Blacks and Whites after a cancer diagnosis. Journal of the American Medical Association, 287, 21062113.

J.W. Berg , R. Ross & H.B. Latourette (1977). Economic status and survival of cancer patients. Cancer, 39, 467477.

N. Bickell , J. Wang & S. Oluwole (2006). Missed opportunities: Racial disparities in adjuvant breast cancer treatment. Journal of Clinical Oncology, 24, 13571361.

W. Born , A. Greiner , E. Sylvia , (2004). Knowledge, attitudes, and beliefs about end-of-life care among inner-city African Americans and Latinos. Journal of Palliative Medicine, 7, 247256.

M. Borum , J. Lynn & Z. Zhong (2000). The effects of patient race on outcomes in seriously ill patients in SUPPORT: An overview of economic impact, medical intervention, and end-of-life decisions. Journal of the American Geriatric Society, 48, S194S198.

A. Boyer-Chammard , T.H. Taylor & H. Anton-Culver (1999). Survival differences in breast cancer among racial/ethnic groups: A population-based study. Cancer Detection and Prevention, 23, 463473.

C.J. Bradley , C.W. Given & C. Roberts (2002). Race, socioeconomic status, and breast cancer treatment and survival. Journal of the National Cancer Institute, 94, 490496.

C.S. Cleeland , R. Gonin , L. Baez , (1997). Pain and treatment of pain in minority patients with cancer: The Eastern Cooperative Oncology Group Minority Outpatient Pain Study. Annals of Internal Medicine, 127, 813816.

L. Crawley (2005). Racial, cultural, and ethnic factors influencing end-of-life care. Journal of Palliative Medicine, 8, S58S69.

L. Crawley , R. Payne , J. Bolden , (2000). Palliative and end-of-life care in the African American community. Journal of the American Medical Association, 284, 25182521.

M. Dodd , S. Janson , N. Facione , (2001). Advancing the science of symptom management. Journal of Advanced Nursing, 33, 668676.

P.R. Ebright & B. Lyon (2002). Understanding hope and factors that enhance hope in women with breast cancer. Oncology Nursing Forum, 29, 561568.

L. Franzini , A.F. Williams , J. Franklin , (1997). Effects of race and socioeconomic status on survival of 1,332 Black, Hispanic, and White women with breast cancer. Annals of Surgical Oncology, 4, 111118.

H. Freeman (1991). Race, poverty, and cancer. Journal of the National Cancer Institute, 83, 526527.

H. Gordon , R. Street , B. Sharf , (2006). Racial differences in trust and lung cancer patients' perceptions of physician communication. American Journal of Clinical Oncology, 24, 904909.

R.E. Gray , V. Goel , M.I. Fitch , (2002). Supportive care provided by physicians and nurses to women with breast cancer: Results from a population based survey. Supportive Care in Cancer, 10, 647652.

J.J. Griggs , M.E. Sorbero , A.T. Stark , (2003). Racial disparity in the dose and dose intensity of breast cancer adjuvant chemotherapy. Breast Cancer Research and Treatment, 81, 2131.

P.D. Henderson , S.V. Gore , B.L. Davis , (2003). African American women coping with breast cancer: A qualitative analysis. Oncology Nursing Forum, 30, 641647.

K.S. Johnson , K.I. Elbert-Avila & J.A. Tulsky (2005). The influence of spiritual beliefs and practices on the treatment preferences of African Americans: A review of the literature. Journal of the American Geriatrics Society, 53, 711719.

S.A. Joslyn & M.M. West (2000). Racial differences in breast carcinoma survival. Cancer, 88, 114123.

E.L. Krakauer , C. Crenner & K. Fox (2002). Barriers to optimum end-of-life care for minority patients. Journal of the American Geriatrics Society, 50, 182190.

N. Kwate (2002). Race, socioeconomic status, and breast cancer treatment and survival. Journal of the National Cancer Institute, 94, 1254.

J.S. Mandelblatt , C.B. Schechter , K.R. Yabroff , (2004). Benefits and costs of interventions to improve breast cancer outcomes in African American women. American Journal of Clinical Oncology, 22, 25542566.

J.S. Mandelblatt , K.R. Yabroff & J.F. Kerner (1999). Equitable access to cancer services: A review of barriers to quality care. Cancer, 86, 23782390.

R. McCorkle & J. Quint-Benoliel (1983). Symptom distress, current concerns and mood disturbance after diagnosis of life threatening disease. Social Sciences in Medicine, 17, 431438.

L.S. McGinnis , H.R. Menck , H.J. Eyre , (2000). National Cancer Data Base survey of breast cancer management for patients from low income zip codes. Cancer, 88, 933945.

E.D. McKinley , J.M. Garret , A.T. Evans , (1996). Differences in end-of-life decision making among Black and White ambulatory cancer patients. Journal of General Internal Medicine, 11, 651656.

R. Moore (2001). African American women and breast cancer: Notes from a study of narrative. Cancer Nursing, 24, 3542.

R.S. Morrison , S. Wallenstein , D.K. Natale , (2000). “We Don't Carry That”: Failure of pharmacies in predominantly nonwhite neighborhoods to stock opioid analgesics. New England Journal of Medicine, 342, 10231026.

R. Payne , E. Medina & J. Hampton (2002). Quality of life concerns in patients with breast cancer: Evidence for disparity of outcomes and experiences in pain management and palliative care among African American women. Cancer, 97(Suppl.), 311317.

E. Phipps , G. True , D. Harris , (2003). Approaching the end of life: Attitudes, preferences, and behaviors of African-American and White patients and their family caregivers. American Journal of Clinical Oncology, 21, 549554.

B.N. Polite & O.I. Olopade (2005). Breast cancer and race: A rising tide does not lift all boats equally. Perspectives in Biology and Medicine, 48, S166S175.

R. Portenoy , C. Ugarte , I. Fuller , (2004). Population-based survey of pain in the United States: Differences among White, African American, and Hispanic subjects. Journal of Pain, 5, 317328.

M. Rosenzweig , T. Weihagen , A. Brufsky , (2009). The unique perspedtive of illness among women with metastatic breast cancer according to race and income. Journal of Hospice and Palliative, 11, 2739.

M.S. Simon & R.K. Severson (1997). Racial differences in breast cancer survival: The interaction of socioeconomic status and tumor biology. American Journal of Obstetrics and Gynecology, 176, S233S239.

C.M. Tammemagi , C. Neslund-Dudas , M. Simoff , (2004). Lung carcinoma symptoms: An independent predictor of survival and an important mediator of African-American disparity in survival. Cancer, 101, 16551663.

M.U. Yood , C.C. Johnson , A. Blount , (1999). Race and differences in breast cancer survival in a managed care population. Journal of the National Cancer Institute, 91, 14871491.

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Palliative & Supportive Care
  • ISSN: 1478-9515
  • EISSN: 1478-9523
  • URL: /core/journals/palliative-and-supportive-care
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