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Pilot Research Program to Assess Breast Cancer Treatment Experiences in Santa Cruz County’s Latina Community

PAMF Receives $212,000 Grant from the California Breast Cancer Research Program

The California Breast Cancer Research Program (CBCRP) has awarded the Palo Alto Medical Foundation (PAMF) a $212,000 Community Research Collaboration (CRC) grant to conduct a pilot research project called “Cancer de Mama: Latinas’ Experiences of Breast Cancer Treatment in Santa Cruz County.”  The research project will run for 18 months from September 2013 through February 2015.

Meghan Halley, Ph.D, MPH, an assistant research anthropologist at the PAMF Research Institute, and Carla Gomez, MSW, LCSW, the Healthy Breast Campaign’s outreach coordinator in Santa Cruz County, collaborated to develop the research proposal based on Gomez’s outreach work.

Carla Gomez at a community outreach event in May 2013.

Carla Gomez at a community outreach event in May 2013.

A second generation Mexican-American born and raised in Santa Cruz County, Gomez performs outreach to low-income Latinas at community events, community clinics and other venues throughout Santa Cruz County to educate women on the importance of breast cancer screening and the available resources for treatment. Since January 2011, Gomez has connected with more than 6,000 women and given dozens of presentations about breast cancer. For Latinas receiving breast cancer screening, she serves as a navigator, often accompanying them to their appointments to provide reassurance and interpretation. She also helps breast cancer patients navigate complicated insurance and referral issues.

“Through my work, I have seen firsthand the impact of a breast cancer diagnosis on low-income Latinas and recognize that this needs more study,” Gomez said.

“We will use in-depth interviews and surveys to gain a better understanding of low-income Latinas’ breast cancer treatment experiences and how they make decisions about breast cancer screening and treatment,” explained Dr. Halley.

“After our research is complete and our findings assessed, we intend to seek additional funding from the CBCRP to develop, implement and test an intervention to improve services provided to low-income Latinas diagnosed with breast cancer in the Santa Cruz community,” said Gomez.

Background

With advances in breast cancer treatment, different patterns of care have emerged among certain segments of the population, often with disparate health outcomes. While breast cancer is the leading cause of cancer death in women, Latinas are twice as likely to die from breast cancer as non-Hispanic white women, even though incidence rates are much lower.  While this is due in part to lower rates of screening and a later stage of diagnosis in many Latinas, there remains a significant variation in the type of treatment received by Latinas versus non-Hispanic white women with similar diagnosis and stage.

In particular, Latinas are more likely to receive a  mastectomy (as opposed to breast conserving surgery) than non-Hispanic white women, and those who do receive breast conserving surgery are less likely to receive radiation treatment following surgery, the standard of care in breast cancer treatment.   In addition, Latinas who receive mastectomy are less likely to receive reconstruction than non-Hispanic white women, despite government programs available to cover costs for these procedures for low-income or uninsured women.

“Though these different patterns of care among Latinas with breast cancer are well documented, available evidence to explain why these patterns exist is limited,” said Dr. Halley. “Existing research has primarily focused on external social, environmental and economic barriers contributing to disparities in breast cancer outcomes.  While these factors clearly play a role in shaping health disparities, a singular focus on these external factors obscures the perspective of the individual patient herself – and the role of her close caregivers and providers – in actively shaping her breast cancer treatment experiences and decision-making.”

While low-income Latina women may be subject to multiple social, environmental and economic barriers in the course of seeking breast cancer treatment, they also act upon their own goals, values and preferences in their medical decision-making. However, the literature examining the patient’s role in medical decision-making has focused primarily on middle class white patients.   As such, little is known about the importance of individual values and preferences in shaping patterns of breast cancer care among low-income Latina populations.

“Our pilot study will take a holistic, contextual approach to understand key underlying factors – including both external barriers and individual goals and preferences – shaping treatment experiences and decision-making among low-income Latina breast cancer patients or survivors.” Dr. Halley said.

The research will also assess the feasibility of developing a targeted, community-based intervention for low-income Latina breast cancer patients and survivors in Santa Cruz County.

“If successful, our long-term goal is to disseminate this intervention to improve breast cancer care for low-income Latina populations throughout California and the United States,” Gomez said.