Images provided by Dr. Rachel Ceballos and Mr. Nathan Marchello, respectively
Many cancer survivors face long-term social and psychological burdens that last far beyond their initial diagnosis and treatment. While social support can help alleviate some of these burdens, this support is often less available to Latino cancer survivors due to linguistic, social, and cultural barriers. As Latino cancer survivors often experience lower psychosocial well-being compared to non-Latino Whites, there is a need to develop culturally appropriate methods for providing adequate psychosocial support. To address this gap, Dr. Rachel Ceballos and Mr. Nathan Marchello in the Public Health Sciences Division developed and tested a ten week Spanish language support group. As reported in Supportive Care in Cancer, this approach is feasible and effective for improving several aspects of well-being in Latino cancer survivors.
In addition to the physical and medical toll of their diagnosis, cancer survivors are often faced with a large number of social and psychological burdens even long after successful treatment. To identify and help address some of these concerns, the authors first conducted focus groups and one-on-one interviews with Latino cancer survivors. Importantly, these interviews were conducted by promotores, bilingual and bicultural lay health workers who provide health-related support, education, and advocacy for the Latino community. These promotores worked with 29 Mexican American members of a rural Washington community to identify the needs and burdens of Latino cancer survivors. These wide-ranging burdens included thoughts about the impact of cancer on the family, changes in body- and self-image, depression and isolation, fear of recurrence, stress, and lack of support.
Based on these community-identified concerns, the authors developed a support group intervention protocol. Ten weekly 90 minute sessions included topics like stress, nutrition, physical activity, body image, sexuality, medical advocacy, and social support. Each session included components of didactic learning, dynamic group discussion, and an activity that explored behavioral strategies for the topic. Led by promotores, these sessions additionally integrated cultural concepts such as personalismo (sharing of personal information) and familismo (importance of family) into the curriculum. To also accommodate potential differences in how men and women address and discuss these topics, male and female specific support groups were held. To evaluate the effect of the intervention on quality of life, the participants filled out pre- and post-session questionnaires. Changes in distress were also assessed, through pre- and post-session reporting of stress and measurement of saliva cortisol levels.
From follow-up participant focus groups, the feedback for the ten week session was overwhelmingly positive. "Participants left the groups with a profound new sense of hope and a drive that was fueled with and in one another," said co-author Mr. Marchello. "They shared on the various ways they have grown, such as 'I value life much more', 'I have a better relationship with my family', 'I make healthier choices in my eating habits', and 'I thought it was not going to be worth my time'." Furthermore, comparing pre- and post-session surveys demonstrated a significant improvement in both functional and social well-being. Distress and cortisol levels were also lower after the ten week program.
Overall, the authors demonstrated that this targeted intervention strategy can be beneficial to Latino cancer survivors. "With our support groups, these survivors are able to engage in the process of healing and finding their new normal in a way that otherwise would not have been available to them," said lead author Dr. Ceballos. Furthermore, the near 100% participation rate suggests that such a program is both feasible and desired. The authors point out that the promotores played a key role in this intervention, and should be strongly considered for any future implementation of these sessions. Moving forward, additional work is needed to evaluate the improvements in stress and well-being in larger groups, and to ensure that this approach is generalizable to other Latino groups.
"A study building on this project is already under way," said Dr. Ceballos. "We are currently running a randomized control trial with a larger sample of Latinas who are survivors of breast and gynecological cancers. This study involves more in-depth evaluation of psychosocial variables and biomarkers of distress and inflammation including cortisol, C-reactive protein, and telomere length. We have been building relationships with community medical organizations for some time keeping them abreast of our progress. Assuming the current project is effective, future studies will focus on dissemination and sustainability in the current community and, potentially, other regions across the United States."
Other PHS researchers contributing to this project were Ms. Rachel Malen, Ms. Genoveva Ibarra, and Ms. Monica Escareño.
Ceballos RM, Molina Y, Malen RC, Ibarra G, Escareño M, Marchello N. 2015. Design, development, and feasibility of a spanish-language cancer survivor support group. Support Care Cancer. doi: 10.1007/s00520-014-2549-9.