March 28, 2011 -- The odds of survival for a woman treated for early-stage breast cancer are good, but many survivors worry about recurrence and communication difficulties appear to be a major contributor to this concern, a study shows.
Nearly half of Hispanic women in the study who spoke little English expressed a great deal of worry about their breast cancers returning, while non-Hispanic white and African-American women expressed far less concern.
Surprisingly, worry about recurrence was not closely related to a woman’s breast cancer stage, says study researcher Nancy K. Janz, PhD, of the University of Michigan School of Public Health.
“Women who had a very optimistic prognosis, based on their cancer stage and node involvement, were often the ones who worried the most,” she tells WebMD.
The study is published in the April 1 issue of the journal Cancer.
Janz says eight out of 10 women treated for early-stage breast cancer remain disease-free a decade later, yet anxiety about recurrence and death did not reflect this.
And while Janz says some anxiety is understandable, too much worry can affect decisions about treatment and screening as well as symptom reporting and overall quality of life.
Janz and colleagues surveyed 1,837 white, African-American and Hispanic women in Detroit and Los Angeles with breast cancer that had not spread between June 2005 and February 2007.
The average age of the study participants was 57, and most had graduated from high school.
A total of 46% of Hispanic women who indicated a preference for using Spanish reported that they worried “very much” about recurrence, compared to 25% who preferred the use of English, 14% of non-Hispanic white women, and 13% of African-Americans.
African-American women were the least concerned about recurrence, with 29% reporting that they were not at all worried, compared to 10% of Hispanic women who preferred use of Spanish.
Women who believed they had a good understanding of their treatment and those who reported satisfaction with symptom management were less likely to worry about recurrence.
“Many women continue to have pain and fatigue well into survivorship,” Janz says. “When health care providers recognize this and give their patients strategies to manage these symptoms, this reduces worries about recurrence.”
Impact of Language Barrier
University of California, San Francisco assistant professor of medicine Leah S. Karliner, MD, has spent much of her career researching the impact of language barriers on health care outcomes.
When she surveyed oncologists and surgeons in California who treat breast cancer patients, they reported that language barriers were a bigger challenge than educational barriers when communicating medical information to patients.
“They expressed concern that their non-English speaking patients didn’t ask as many questions and that they didn’t fully understand their treatment options and prognosis,” she says.
She adds that language barriers have been shown to be associated with poorer outcomes in many areas, including emergency care, diabetes management, and cancer survival.
Use of professional interpreters has been shown to improve patient care, but interpreters are not commonly found outside of large medical centers.
Karliner says language barriers pose a special challenge in breast cancer because there are so many different treatment options and treatment decisions are often nuanced.