Journal of Cancer Survivorship

, Volume 2, Issue 3, pp 215–223

Enhancing physical well-being and overall quality of life among underserved Latina-American cervical cancer survivors: feasibility study




Evidence for the effectiveness of behavioral interventions are lacking for cervical cancer survivors (CCS). Disparities in survivorship outcomes exist for CCS, especially Latina-Americans. This study assessed the feasibility of implementing a culturally sensitive intervention delivered in a telephonic format.


A convenience sample of 23 Latina-Americans diagnosed with stages 1–3 invasive cervical cancer who were 1–3 years post diagnosis and disease free participated. A random assignment, pre- and post-test design was used with 15 intervention and 8 control participants. Intervention group participants completed 6 sessions that included problem-focused, telephone counseling. The areas covered included family and partner concerns and communication; relaxation and stress management; psychological, medical and treatment concerns; and self-nurturing activities. Outcomes were measured by the FACT-G QOL scale.


Increases in physical well-being and overall QOL were observed for the intervention group only (p < 0.05). The intervention group showed a non significant trend towards improvements in family/social, emotional and functional well-being from pre- to post-test.


Results demonstrate the feasibility of implementing a culturally responsive, telephonic behavioral intervention. The intervention was associated with an improvement in physical and overall quality of life. A randomized controlled trial with a long term follow-up is warranted.

Implications for Cancer Survivors

An ethnically sensitive, behaviorally based telephone counseling approach with Latina Americans cervical cancer survivors can achieve short term improvements in physical well-being and overall QOL.


Cervical cancer HRQOL Ethnic minority Behavioral intervention 


  1. 1.
    Ries LAG, et al. SEER Cancer statistics review, 1975–2001. 2004 [cited 2006 December 28, 2006]; Available from:
  2. 2.
    Krieger N, Quesenberry C, Peng T, Horn-Ross P, Stewart S, Brown S, et al. Social class, race/ethnicity, and incidence of breast, cervix, colon, lung, and prostate cancer among Asian, Black, Hispanic and White residents of the San Francisco Bay Area, 1988–92 (United States). 10, 6;1999.Google Scholar
  3. 3.
    Liu T, Wang X, Waterbor J, Weiss HL, Soong SJ. Relationships between socioeconomic status and race-specific cervical cancer incidence in the United States 1973–1992. Journal of Health Care for the Poor and Underserved 1998;9:420–32.PubMedGoogle Scholar
  4. 4.
    Institute of Medicine. The unequal burden of cancer: an assessment of NIH research and programs for ethnic minorities and the medically underserved. Washington, DC: National Academy Press; 1999.Google Scholar
  5. 5.
    Aziz N, Rowland J. Cancer survivorship research among ethnic minority and medically underserved groups. Oncol Nurs Forum 2002;29:789–801. doi:10.1188/02.ONF.789-801.PubMedCrossRefGoogle Scholar
  6. 6.
    Freeman H. Race, poverty, and cancer. J Natl Cancer Inst 1991;83:526–7. doi:10.1093/jnci/83.8.526.PubMedCrossRefGoogle Scholar
  7. 7.
    Ashing-Giwa KT, Tejero JS, Kim J, Padilla GV, Hellemann G. Examining predictive models of HRQOL in a population-based, multiethnic sample of women with breast carcinoma. Qual Life Res 2007;16:413–28. doi:10.1007/s11136-006-9138-4.PubMedCrossRefGoogle Scholar
  8. 8.
    Ashing-Giwa K, Kim J, Tejero JS. Measuring quality of life among cervical cancer survivors: preliminary assessment of instrumentation validity in a cross-cultural study. Qual Life Res 2008;17:147–57. doi:10.1007/s11136-007-9276-3.PubMedCrossRefGoogle Scholar
  9. 9.
    Napoles-Springer A, Stewart AL. Use of health-related quality of life measures in older and ethnically diverse U.S. populations. J Ment Health Aging. 2001;7:173–9.Google Scholar
  10. 10.
    Ashing-Giwa K, Padilla G, Tejero J, Kim J. Breast cancer survivorship in a multiethnic sample: challenges in recruitment and measurement. Cancer 2004;101:450–65. doi:10.1002/cncr.20370.PubMedCrossRefGoogle Scholar
  11. 11.
    Meyerowitz B, Formenti S, Ell K, Leedham B. Depression among Latina cervical cancer patients. J Soc Clin Psychol 2000;19:352–71.Google Scholar
  12. 12.
    Meyerowitz B, Richardson J, Hudson S, Leedham B. Ethnicity and cancer outcomes: behavioral and psychosocial considerations. Psychol Bull 1998;123:47–70. doi:10.1037/0033-2909.123.1.47.PubMedCrossRefGoogle Scholar
  13. 13.
    Meyer T, Mark M. Effects of psychosocial interventions with adults cancer patients: a meta-analysis of randomized experiments. Health Psychol 1995;14:101–8. doi:10.1037/0278-6133.14.2.101.PubMedCrossRefGoogle Scholar
  14. 14.
    Rehse B, Pukrop R. Effects of psychosocial interventions on quality of life in adult cancer patients: metaanalysis of 37 published controlled outcome studies. Patient Educ Couns 2002;50:179–86.Google Scholar
  15. 15.
    Sheard T, Maguire P. The effect of psychological interventions on anxiety and depression in cancer patients: results of two meta analysis. Br J Cancer 1999;80:170–80.Google Scholar
  16. 16.
    Helgeson V, Cohen S. Social support and adjustment to cancer: reconciling descriptive, correlational, and intervention research. Health Psychol 1996;15:135–48. doi:10.1037/0278-6133.15.2.135.PubMedCrossRefGoogle Scholar
  17. 17.
    Compas B, Haaga D, Keefe F, Leitenberg H, Williams D. Sampling of empirically supported psychological treatments from health psychology: smoking, chronic pain, cancer, and bulimia nervosa. J Consult Clin Psychol 1998;66:89–112. doi:10.1037/0022-006X.66.1.89.PubMedCrossRefGoogle Scholar
  18. 18.
    Edelman S, Craig A, Kidman A. Group interventions with cancer patients: efficacy of psychoeducational versus supportive groups. J Psychosoc Oncol 2000;18:67–85. doi:10.1300/J077v18n03_05.CrossRefGoogle Scholar
  19. 19.
    Osborn RL, Demoncada AC, Feuerstein M. Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: meta-analyses. Int J Psychiatry Med 2006;36:13–34. doi:10.2190/EUFN-RV1K-Y3TR-FK0L.PubMedCrossRefGoogle Scholar
  20. 20.
    Ashing-Giwa K, Kagawa-Singer M, Padilla GV, Tejero JS, Hsiao E, Chhabra R, et al. The impact of cervical cancer and dysplasia: a qualitative, multiethnic study. Psycho-Oncol 2004;13:675–753. doi:10.1002/pon.779.CrossRefGoogle Scholar
  21. 21.
    Ashing-Giwa K, Padilla G, Bohorquez DE, Tejero JS, Garcia M, Meyers EA. Survivorship: a qualitative investigation of Latinas diagnosed with cervical cancer. J Psychosoc Oncol 2006;24:53–88. doi:10.1300/J077v24n04_04.PubMedCrossRefGoogle Scholar
  22. 22.
    Basen-Engquist K, Paskett ED, Buzaglo J, Miller SM, Schover L, Wenzel LB, et al. Cervical cancer: behavioral factors related to screening, diagnosis, and survivors’ quality of life. Cancer 2003;98:2009–14. doi:10.1002/cncr.11681.PubMedCrossRefGoogle Scholar
  23. 23.
    Eisemann M, Lalos A. Psycholosocial determinants of well-being in gynecology cancer patients. Cancer Nurs 1999;22:303–6. doi:10.1097/00002820-199908000-00007.PubMedCrossRefGoogle Scholar
  24. 24.
    Anderson B, Anderson B, deProsse C. Controlled, prospective longitudinal study of women with cancer: psychological outcomes. J Consult Clin Psychol 1989;57:692–7. doi:10.1037/0022-006X.57.6.692.PubMedCrossRefGoogle Scholar
  25. 25.
    Greimel E, Thiel I, Peintinger F, Cegnar I, Pongratz E. Prospective assessment of quality of life of female cancer patients. Gynecol Oncol 2002;85:140–7. doi:10.1006/gyno.2002.6586.PubMedCrossRefGoogle Scholar
  26. 26.
    Corney R, Everett H, Howells A, Crowther ME. Psychosocial adjustment following major gynecological surgery for carcinoma of the cervix and vulva. J Psychosom Res 1992;36:561–8. doi:10.1016/0022-3999(92)90041-Y.PubMedCrossRefGoogle Scholar
  27. 27.
    Whelan T, et al. The supportive care needs of newly diagnosed cancer patients attending a regional cancer center. Cancer 1997;80:1518–24. doi:10.1002/(SICI)1097-0142(19971015)80:8<1518::AID-CNCR21>3.0.CO;2-7.PubMedCrossRefGoogle Scholar
  28. 28.
    Lutgendorf S, et al. Quality of life and mood in women receiving extensive chemotherapy for gynecologic cancer. Cancer 2000;89:1402–11. doi:10.1002/1097-0142(20000915)89:6<1402::AID-CNCR26>3.0.CO;2-H.PubMedCrossRefGoogle Scholar
  29. 29.
    Auchincloss S. After treatment. Psychosocial issues in gynecologic cancer survivorship. Cancer 1995;76:2117–24. doi:10.1002/1097-0142(19951115)76:10+<2117::AID-CNCR2820761335>3.0.CO;2-7.PubMedCrossRefGoogle Scholar
  30. 30.
    Lalos A, M E. Social interaction and support related to mood and locus of control in cervical and endometrial cancer patients and their spouses. Support Care Cancer 1999;7:75–8. doi:10.1007/s005200050230.PubMedCrossRefGoogle Scholar
  31. 31.
    Paavonen J. Sexual dysfunction associated with treatment of cervical cancer. Sex Transm Infect 1999;75:375–6.PubMedGoogle Scholar
  32. 32.
    Cull A, Cowie VJ, Farquharson DI, Livingstone JR, Smart GE, Elton RA. Early stage cervical cancer: psychosocial and sexual outcomes of treatment. Br J Cancer 1993;68:1216–20.PubMedGoogle Scholar
  33. 33.
    Krumm S, Lamberti J. Changes in sexual behavior following radiation therapy for cervical cancer. J Psychosom Obstet Gynaecol 1993;14:51–63. doi:10.3109/01674829309084430.PubMedCrossRefGoogle Scholar
  34. 34.
    Schover L, Fife M, Gershenson D. Sexual dysfunction and treatment for early stage cervical cancer. Cancer 1989;63:204–12. doi:10.1002/1097-0142(19890101)63:1<204::AID-CNCR2820630133>3.0.CO;2-U.PubMedCrossRefGoogle Scholar
  35. 35.
    Anderson B. Sexual functioning morbidity among cancer survivors. Current status and future research directions. Cancer 1985;55:1835–42. doi:10.1002/1097-0142(19850415)55:8<1835::AID-CNCR2820550832>3.0.CO;2-K.CrossRefGoogle Scholar
  36. 36.
    Anderson B. Predicting sexual and psychologic morbidity and improving the quality of life for women with gynecologic cancer. Cancer 1993;71:1678–90.Google Scholar
  37. 37.
    Lamb M. Effects of cancer on the sexuality and fertility of women. Seminars in Oncology Nursing. 1995;120–7. doi:10.1016/S0749-2081(05)80019-1.
  38. 38.
    Zacharias D, Gilg C, Foxall M. Quality of life and coping in patients with gynecologic cancer and their spouses. Oncol Nurs Forum 1994;21:1699–706.PubMedGoogle Scholar
  39. 39.
    Anderson B. Surviving cancer. Cancer 1994;74:1484–95. doi:10.1002/1097-0142(19940815)74:4+<1484::AID-CNCR2820741614>3.0.CO;2-9.CrossRefGoogle Scholar
  40. 40.
    Andersen BL, van Der Does J. Surviving gynecologic cancer and coping with sexual morbidity: an international problem. Int J Gynecol Cancer 1994;4:225–40. doi:10.1046/j.1525-1438.1994.04040225.x.PubMedCrossRefGoogle Scholar
  41. 41.
    Andersen B, Woods X, Copeland L. Sexual self-schema and sexual morbidity among gynecologic cancer survivors. J Consult Clin Psychol 1997;65:221–9. doi:10.1037/0022-006X.65.2.221.PubMedCrossRefGoogle Scholar
  42. 42.
    Klee M, Thranov I, Machin D. The patients’ perspective on physical symptoms after radiotherapy for cervical and vaginal cancer. Gynecol Oncol 2000;76:14–23. doi:10.1006/gyno.1999.5642.PubMedCrossRefGoogle Scholar
  43. 43.
    Steginga SK, Dunn J. Women’s experiences following treatment for gynecological cancer. Oncol Nurs Forum 1997;28:1403–8.Google Scholar
  44. 44.
    Angen MJ, MacRae JH, Simpson JS, Hundleby M. A retreat program of support for persons living with cancer. Cancer Pract 2002;10:297–304. doi:10.1046/j.1523-5394.2002.106008.x.PubMedCrossRefGoogle Scholar
  45. 45.
    Napoles-Springer A, Perez-Stable E, Washington E. Risk factors for invasive cervical cancer in Latino women. J Med Syst 1996;20:277–93. doi:10.1007/BF02257041.PubMedCrossRefGoogle Scholar
  46. 46.
    Fawzy F. Psychosocial interventions for patients with cancer: what works and what doesn’t. Eur J Cancer 1999;35:1559–64. doi:10.1016/S0959-8049(99)00191-4.PubMedCrossRefGoogle Scholar
  47. 47.
    Heiney S, McWayne J, Hurley T, Lamb L, Bryant L, Butler W, et al. Efficacy of therapeutic group by telephone for women with breast cancer. Cancer Nurs 2003;26:439–47. doi:10.1097/00002820-200312000-00003.PubMedCrossRefGoogle Scholar
  48. 48.
    Allison PJ, Edgar L, Nicolau B, Archer J, Black M, Hier M. Results of a feasibility study for a psycho-educational intervention in head and neck cancer. Psycho-Oncol 2004;13:482–5. doi:10.1002/pon.816.CrossRefGoogle Scholar
  49. 49.
    Lev E, Owen S. Counseling women with breast cancer using principles developed by Alvert Bandura. Perspect Psychiatr Care 2000;36:2000.Google Scholar
  50. 50.
    Northouse L, Walker J, Schafenacker A. A family-based program of care for women with recurrent breast cancer and their family members. Oncol Nurs Forum 2002;29:1411–9. doi:10.1188/02.ONF.1411-1419.PubMedCrossRefGoogle Scholar
  51. 51.
    Gore-Felton C, Spiegel D. Enhancing women’s lives: the role of support groups among breast cancer patients. J Spec Group Work 1999;24:274–87. doi:10.1080/01933929908411436.CrossRefGoogle Scholar
  52. 52.
    Lev E, Daley K, Conner N, Reith M, Fernandez C, Owen S. An intervention to increase quality of life and self-care self-efficacy and decrease symptoms in breast cancer patients. Sch Inquiry Nurs Pract 2001;15:277–94.Google Scholar
  53. 53.
    Taylor KL, Lamdan RM, Siegel JE, Shelby R, Moran-Klimi K, Hrywna M. Psychological adjustment among African American breast cancer patients: one year follow-up results of a randomized psychoeducational group intervention. Health Psychol 2003;22:316–23. doi:10.1037/0278-6133.22.3.316.PubMedCrossRefGoogle Scholar
  54. 54.
    Antoni M, Lehman J, Kilbourn K, Boyers A, Culver J, Alferi S, et al. Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer. Health Psychol 2001;20:20–32. doi:10.1037/0278-6133.20.1.20.PubMedCrossRefGoogle Scholar
  55. 55.
    Edmonds C, Lockwood G, Cunningham A. Psychological response to long-term group therapy: a randomized trial with metastatic breast cancer patients. Psycho-Oncol 1999;8:74–91. doi:10.1002/(SICI)1099-1611(199901/02)8:1<74::AID-PON339>3.0.CO;2-K.CrossRefGoogle Scholar
  56. 56.
    Helgeson V, Cohen S, Schultz R, Yasko J. Long-term effects of educational and peer discussion group interventions on adjustment to breast cancer. Health Psychol 2001;20:387–92. doi:10.1037/0278-6133.20.5.387.PubMedCrossRefGoogle Scholar
  57. 57.
    Andersen B. Psychological interventions for cancer-patients to enhance the quality of life. J Consult Clin Psychol 1992;60:552–68. doi:10.1037/0022-006X.60.4.552.PubMedCrossRefGoogle Scholar
  58. 58.
    Burish T. Behavioral and psychosocial cancer research. Building on the past, preparing for the future. Cancer 1991;67:865–7. doi:10.1002/1097-0142(19910201)67:3+<865::AID-CNCR2820671420>3.0.CO;2-N.PubMedCrossRefGoogle Scholar
  59. 59.
    National Cancer Institute. Surveillance, epidemiology and end results program. 2001 [cited 2001; Available from:
  60. 60.
    Shingleton H, Orr J. Cancer of the cervix. Philadelphia, PA: JB Lippincott Co; 1995.Google Scholar
  61. 61.
    Donnelly J, Kornblith A, Fleishman S. A pilot study of interpersonal psychotherapy by telephone with cancer patients and their partners. Psycho-Oncol 2000;9:44–56. doi:10.1002/(SICI)1099-1611(200001/02)9:1<44::AID-PON431>3.0.CO;2-V.CrossRefGoogle Scholar
  62. 62.
    Hoskins CN, Haber J, Budin WC. Breast cancer: education, counseling, and adjustment—a pilot study. Psychol Rep 2001;89:677–704. doi:10.2466/PR0.89.7.677-704.PubMedCrossRefGoogle Scholar
  63. 63.
    Marcus AC, Garrett KM, Cella D. Telephone counseling of breast cancer patients after treatment: a description of a randomized clinical trial. Psycho-Oncol 1998;7:470–82. doi:10.1002/(SICI)1099-1611(199811/12)7:6<470::AID-PON325>3.0.CO;2-Z.CrossRefGoogle Scholar
  64. 64.
    Sandgren AK, McCaul KD, King B, O’Donnell S, Foreman G. Telephone therapy for patients with breast cancer. Oncol Nurs Forum 2000;27:683–8.PubMedGoogle Scholar
  65. 65.
    Mishel MH, Belyea M, Germino BB. Helping patients with localized prostate carcinoma manage uncertainty and treatment side effects: nurse delivered psychoeducational intervention over the telephone. Cancer 2002;94:1854–66. doi:10.1002/cncr.10390.PubMedCrossRefGoogle Scholar
  66. 66.
    Alter C, Fleishman S, Kornblith A. Supportive telephone intervention for patients receiving chemotherapy: a pilot study. Psychosomatics 1996;37:425–31.PubMedGoogle Scholar
  67. 67.
    Sandgren AK, McCaul KD. Short-term effects of telephone therapy for breast cancer patients. Health. Psychology (Savannah, Ga.) 2003;22:310–5.Google Scholar
  68. 68.
    Sandgren AK, McCaul KD. Long-term telephone therapy outcomes for breast cancer patients. Psycho-Oncol 2007;16:38–47. doi:10.1002/pon.1038.CrossRefGoogle Scholar
  69. 69.
    Badger T, Segrin C, Meek P, Lopez AM, Bonham E, Sieger A. Telephone interpersonal counseling with women with breast cancer: symptom management and quality of life. Oncol Nurs Forum 2005;32:273–9. doi:10.1188/05.ONF.273-279.PubMedCrossRefGoogle Scholar
  70. 70.
    Coleman EA, Tulman L, Samarel N, Wilmoth MC, Rickel L, Rickel M. The effect of telephone social support and education on adaptation to breast cancer during the year following diagnsois. Oncol Nurs Forum 2005;32:822–9. doi:10.1188/05.ONF.822-829.PubMedCrossRefGoogle Scholar
  71. 71.
    Meneses KD, McNees P, Loerzel VW, Su X, Zhang Y, Hassey LA. Transition from treatment to survivorship: effects of a psychoeducational intervention on quality of life in breast cancer survivors. Oncol Nurs Forum 2007;34:1007–16. doi:10.1188/07.ONF.1007-1016.PubMedCrossRefGoogle Scholar
  72. 72.
    Mishel MH, Germino BB, Gil KM, Belyea M, Laney IC, Stewart J. Benefits from an uncertainity managment intervention for African-American- and Caucasian older long-term breast cancer survivors. Psycho-Oncol 2005;14:962–78. doi:10.1002/pon.909.CrossRefGoogle Scholar
  73. 73.
    Ashing-Giwa K. The contextual model of HRQOL: a paradigm for expanding the HRQOL framework. Qual Life Res 2005;14:297–307. doi:10.1007/s11136-004-0729-7.PubMedCrossRefGoogle Scholar
  74. 74.
    Wenzel L, Robinson R, Blake D. the effects of problem-focused group counseling early stage gynecologic cancer. J Ment Health Couns 1995;17:81–93.Google Scholar
  75. 75.
    Office of Minority Health. Office of Minority Health publishes final standards for cultural and linguistic competence. In: editors. Closing the gap (pp.). Washington, DC: Office of Minority Health, DHHS; 2001.Google Scholar
  76. 76.
    Wenzel L, Dogan-Ates A, Habbal R. Reproductive concerns and quality of life in female cancer survivors. J Natl Cancer Inst Monographs. 2005 94–8. doi:10.1093/jncimonographs/lgi017.
  77. 77.
    American Cancer Society. Cancer facts and figures 2008. Atlanta, GA: American Cancer Society; 2007.Google Scholar
  78. 78.
    Ashing-Giwa K. The recruitment and retention of African American women into cancer control studies. J Natl Med Assoc 1999;91:255–60.PubMedGoogle Scholar
  79. 79.
    Ashing-Giwa K. Can a culturally responsive model for research design bring us closer to addressing participation disparities? Lessons learnt from cancer survivorship studies. Ethn Dis 2005;15:130–7.PubMedGoogle Scholar

Copyright information

© Government Employee: City of Hope 2008

Authors and Affiliations

  1. 1.Center of Community Alliance for Research and Education (CCARE), Division of Population SciencesCity of Hope National Medical CenterDuarteUSA
  2. 2.Department of Psychiatry and Biobehavioral SciencesUCLALos AngelesUSA

Personalised recommendations