Relationships of Selected Physiological, Psychosocial, and Spiritual Variables Associated with Survivorship in Socioeconomically Disadvantaged African American Women with Breast Cancer

Abstract

The purpose of this study was to test a theoretical model that postulates cancer survivorship as a function of selected age, marital status, life satisfaction (quality of life, social support, self concept and spirituality), and physiological status (immune status, stage of disease and treatment modality) in a population of socioeconomically disadvantaged African American women who had previously been diagnosed with breast cancer. The study was guided by a causal model that was composed of concepts derived from the body of literature related to breast cancer, survivorship, psychoneuroimmunology, and psychosocial oncology. A purposive sample of 135 women between the ages of 28 and 96 years of age diagnosed with Stage I, II, III and IV breast cancer were evaluated. The women were minimally six months post diagnosis and maximally 25 years post diagnosis. Valid and reliable instruments utilized for this study were Ferran’s Quality of Life-CV, Brandt and Wenert’s PRQ-85, Rosenberg’s Self-Esteem Scale, Reed’s Spiritual Perspective Scale and Dow’s Adaptation After Cancer Profile. Immune Status was measured by the laboratory value of Immunoglobulin M. A nonexperimental research design with structural equation modeling and latent variables was utilized in conduct of the study. Analysis of the findings revealed that further study is needed in order to construct and test the theoretical model underlying the phenomenom of survivorship. Life satisfaction was the only latent variable to merge; it was surprising to find that social support and not quality of life provided the majority of variance in the life satisfaction score. It was also found that survivorship was not a global phenomenon for this population, but is rather a combination of uncertainty over the future, mastery over cancer, transcendence and self- disclosure. Uncertainty over the future was found to be a major factor of survivorship, and social support was an enhancer of mastery over cancer. Spirituality was found to be positively associated with immunoglobulin levels but the magnitude of the relationship did not reach the accepted significance level of .05. Nor were significant differences found between the IgM levels of those women diagnosed less than five year versus those diagnosed post five years. The instruments used in this study were found to be somewhat culturally insensitive. In view of the probably sample bias, the findings from this study cannot be generalized to other populations of women surviving breast cancer without further investigation.