Occupational Engagement in Low-Income Latina Breast Cancer Survivors

PURPOSE: Latina women experience poorer quality of life as survivors after a breast cancer diagnosis (Yanez, Thompson, & Stanton, 2011), and they receive an overall lower quality of health care than non-Hispanic Whites (Institute of Medicine, 2002). In addition, socioeconomic and gender disparities contribute to the Latina population being underserved in health care in general (Ricker et al., 2007). Furthermore, nearly a quarter of Latinos in the United States live below the federal poverty line (DeNavas-Walt, Proctor, & Smith, 2015), and low socioeconomic status has been shown to significantly decrease quality of life for breast cancer survivors (Janz et al., 2005). Low-income Latina breast cancer survivors (LILBCS) are therefore disproportionately at risk for poor health outcomes. However, very little is known about the unique needs and challenges of this population, especially as they relate to occupational engagement and quality of life (QOL). Therefore, this study examines the experience of occupational engagement in LILBCS and suggests the potential for occupational therapy practitioners to improve health outcomes.

DESIGN: In this qualitative descriptive study, participants were recruited from the oncology clinic at a large, urban, public hospital with assistance from a bilingual, Spanish-speaking research assistant. Inclusion criteria were adults who (1) were age 18 or older; (2) self-identified as Latina; (3) reported an annual income below the U.S. Census Bureau’s low-income threshold; (4) were diagnosed with breast cancer; (5) had completed primary surgical treatment, chemotherapy, and/or radiation; and (6) were able to speak English and/or Spanish.

METHOD: Semistructured interviews were conducted with nine LILBCS. Interviews were recorded, transcribed, and translated from Spanish to English. Inductive analysis was used in order to code for themes and patterns related to occupational engagement and QOL.

RESULTS: Lack of occupational engagement negatively impacted QOL in study participants, while participation in certain occupations such as religious activity and caregiving promoted well-being. Financial concerns and communication barriers decreased QOL in this population.

CONCLUSION: Breast cancer can negatively impact occupational engagement in LILBCS; however, some occupations may increase QOL. Socioeconomic status and cultural values influence occupational engagement and QOL in LILBCS. Occupational therapists can improve health outcomes in this population through awareness of relevant sociocultural factors and attention to patient communication preferences.

IMPACT STATEMENT: This study provides key data about the influence of sociocultural factors on health behaviors and quality of life while providing insight into the unique experience of occupational engagement in low-income Latina breast cancer survivors, an understudied and underserved population.

References

DeNavas-Walt, C., Proctor, B. D., & Smith, J. C. (2015). Income and poverty in the United States: 2014. Washington, DC: U.S. Census Bureau.

Institute of Medicine. (2002). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press.

Janz, N. K., Mujahid, M., Lantz, P. M., Fagerlin, A., Salem, B., Morrow, M., . . . Katz, S. J. (2005). Population-based study of the relationship of treatment and sociodemographics on quality of life for early stage breast cancer. Quality of Life Research, 14, 1467–1479. https://doi.org/10.1007/s11136-005-0288-6

Ricker, C. N., Hiyama, S., Fuentes, S., Feldman, N., Kumar, V., Uman, G. C., . . . Weitzel, J. N. (2007). Beliefs and interest in cancer risk in an underserved Latino cohort. Preventive Medicine, 44, 241–245. https://doi.org/10.1016/j.ypmed.2006.08.018

Yanez, B., Thompson, E. H., & Stanton, A. L. (2011). Quality of life among Latina breast cancer patients: A systematic review of the literature. Journal of Cancer Survivorship, 5, 191–207. https://doi.org/10.1007/s11764-011-0171-0