Skip to main content

Design, development, and feasibility of a spanish-language cancer survivor support group



Latino cancer survivors experience lower psychosocial well-being compared to non-Latino Whites. This study describes the development of a culturally appropriate support group and reports on feasibility of implementation and preliminary outcomes.


Promotores (lay health workers) conducted all aspects of data collection and program implementation. Participants were 29 Spanish-speaking Latino cancer survivors (n = 12 men, 17 women) who took part in one of three study phases. Phase 1 included one-on-one interviews and focus groups (n = 14) to investigate psychosocial needs of survivors. During phase 2, a 10-week program was developed that integrated data from phase 1 and culturally relevant concepts. Session topics included stress, nutrition, physical activity, body image, sexuality, medical advocacy, and social support. In phase 3, the program was implemented within gender-specific groups (n = 15). Within-group pre-post comparisons of distress (distress thermometer, salivary cortisol) and quality of life (FACIT) were conducted. Follow-up focus groups assessed participant experience


Phase 1 activities identified survivor needs and interests (e.g., isolation, family and spirituality, supporting other Latinos with cancer). Evidence of program feasibility was demonstrated (e.g., 90–100 % attendance, 100 % data completion). While interpretation of significance is limited due to sample size, improvements in quality of life [functional (p = 0.05), social (p = 0.02), and meaning/purpose (p = 0.05)] were observed among women but not men. Qualitative follow-up revealed high satisfaction with group participation, but discomfort with the topic of sexuality in women.


This project demonstrates development and feasibility outcomes for providing culturally appropriate psychosocial support to Latino cancer survivors. Limitations, including lack of control group, and future directions are discussed.

This is a preview of subscription content, access via your institution.


  1. Kroenke CH et al (2006) Social networks, social support, and survival after breast cancer diagnosis. J Clin Oncol 24(7):1105–1111

    PubMed  Google Scholar 

  2. Bloom JR, Petersen DM, Kang SH (2007) Multi-dimensional quality of life among long-term (5+ years) adult cancer survivors. Psychooncology 16(8):691–706

    PubMed  Google Scholar 

  3. Galvan N, Buki LP, Garces DM (2009) Suddenly, a carriage appears: social support needs of Latina breast cancer survivors. J Psychosoc Oncol 27(3):361–382

    PubMed  Google Scholar 

  4. Ashing-Giwa KT et al (2007) Examining predictive models of HRQOL in a population-based, multiethnic sample of women with breast carcinoma. Qual Life Res 16(3):413–428

    PubMed  Google Scholar 

  5. Carver CS et al (2006) Quality of life among long-term survivors of breast cancer: different types of antecedents predict different classes of outcomes. Psychooncology 15(9):749–758

    PubMed  Google Scholar 

  6. Culver JL et al (2002) Coping and distress among women under treatment for early stage breast cancer: comparing African Americans, Hispanics and non-Hispanic Whites. Psychooncology 11(6):495–504

    PubMed  Google Scholar 

  7. Moadel AB, Morgan C, Dutcher J (2007) Psychosocial needs assessment among an underserved, ethnically diverse cancer patient population. Cancer 109(2 Suppl):446–454

    Article  PubMed  Google Scholar 

  8. Glaser R, Kiecolt-Glaser JK (2005) Stress-induced immune dysfunction: implications for health. Nat Rev Immunol 5(3):243–251

    CAS  PubMed  Google Scholar 

  9. Miller GE, Chen E, Zhou ES (2007) If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans. Psychol Bull 133(1):25–45

    PubMed  Google Scholar 

  10. Bower JE et al (2005) Diurnal cortisol rhythm and fatigue in breast cancer survivors. Psychoneuroendocrinology 30(1):92–100

    Article  CAS  PubMed  Google Scholar 

  11. Antoni MH et al (2006) The influence of bio-behavioural factors on tumour biology: pathways and mechanisms. Nat Rev Cancer 6(3):240–248

    PubMed Central  CAS  PubMed  Google Scholar 

  12. Sephton SE et al (2000) Diurnal cortisol rhythm as a predictor of breast cancer survival. J Natl Cancer Inst 92(12):994–1000

    CAS  PubMed  Google Scholar 

  13. Napoles-Springer AM et al (2009) Developing a culturally competent peer support intervention for Spanish-speaking Latinas with breast cancer. J Immigr Minor Health 11(4):268–280

    PubMed  Google Scholar 

  14. Lopez-Class M et al (2011) Quality of life among immigrant Latina breast cancer survivors: realities of culture and enhancing cancer care. J Cancer Educ 26(4):724–733

    PubMed Central  PubMed  Google Scholar 

  15. Ashing-Giwa KT et al (2006) Understanding the breast cancer experience of Latina women. J Psychosoc Oncol 24(3):19–52

    PubMed  Google Scholar 

  16. Livaudais JC et al (2010) A qualitative investigation of cancer survivorship experiences among rural Hispanics. J Psychosoc Oncol 28(4):361–380

    PubMed Central  PubMed  Google Scholar 

  17. Molina Y et al (2013) Breast cancer interventions serving US-based Latinas: current approaches and directions. Womens Health (Lond Engl) 9(4):335–348, quiz 349–50

    CAS  Google Scholar 

  18. Marin BV et al (1997) Condom use in unmarried Latino men: a test of cultural constructs. Health Psychol 16(5):458–467

    CAS  PubMed  Google Scholar 

  19. Creswell (2002) Research design: qualitative, quantitative, and mixed methods approaches. 2nd ed. Thousand Oaks, CA: Sage Publications, Inc

  20. U.S. Census Bureau (2010) American FactFinder. 2010 Census Data. [cited 2012 March 4th]; Available from:

  21. OIC of Washington (2011) Community needs assessment [cited 2014 March]; Available from:

  22. APHA (2014) Community health workers. [cited 2014 July]; Available from:

  23. DHHS (2007) Community health worker national workforce study, U.S.D.o.H.a.H. Services, Editor. p. 1–285.

  24. U.S. Congress (2009) H.R. 3590(111th): Patient Protection and Affordable Care Act, Sec. 5101 [cited 2014 April]; Available from:

  25. Office of Minority Health (2012) Definition of Promotores de Salud. [cited January 2013]; Available from:

  26. Adamo M, et al (2012) 2012 SEER program coding and staging manual, N.C. Institute, Editor: Bethesda, MD.

  27. Kitzinger J (1995) Qualitative research. Introducing focus groups. BMJ 311(7000):299–302

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  28. Cella D et al (1993) The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol 11(3):570–579

    CAS  PubMed  Google Scholar 

  29. National Comprehensive Cancer Network (2009) NCCN distress Thermometer for patients. [cited 2011 January]; Available from:

  30. Pruessner JC et al (1997) Free cortisol levels after awakening: a reliable biological marker for the assessment of adrenocortical activity. Life Sci 61(26):2539–2549

    CAS  PubMed  Google Scholar 

  31. Jankovic S et al (2013) The Cardiff Acne Disability Index (CADI): linguistic and cultural validation in Serbian. Qual Life Res 22(1):161–166

    PubMed  Google Scholar 

  32. Jankovic S et al (2013) The Children’s Dermatology Life Quality Index (CDLQI): linguistic and cultural validation in Serbian. J Cutan Med Surg 17(5):316–320

    PubMed  Google Scholar 

  33. Streubert HJ (2011) Designing data generation and management strategies. In: Streubert HJ, Carpenter DR (eds) Qualitative Research in Nursing: Advancing the Humanistic Perspective. Wolters Kluwer Lippincott Williams & Wilkins, Philadelphia, p 47

    Google Scholar 

  34. Vaismoradi M, Turunen H, Bondas T (2013) Content analysis and thematic analysis: implications for conducting a qualitative descriptive study. Nurs Health Sci 15(3):398–405

    PubMed  Google Scholar 

  35. Sandelowski M (2001) Real qualitative researchers do not count: the use of numbers in qualitative research. Res Nurs Health 24(3):230–240

    CAS  PubMed  Google Scholar 

  36. Greenhalgh T, Taylor R (1997) How to read a paper—papers that go beyond numbers (qualitative research). BMJ Br Med J 315(7110):740–743

    CAS  Google Scholar 

  37. Resnicow K et al (1999) Cultural sensitivity in public health: defined and demystified. Ethn Dis 9(1):10–21

    CAS  PubMed  Google Scholar 

  38. Zayas LH (2010) Seeking models and methods for cultural adaptation of interventions: commentary on the special section. Cogn Behav Pract 17(2)

  39. The Workgroup on Adapting Latino Services (2008) Adaptation guidelines for serving Latino children and families affected by trauma. Chadwick Center for Children and Families, San Diego

    Google Scholar 

  40. Donovan KA et al (2014) Validation of the distress thermometer worldwide: state of the science. Psychooncology 23(3):241–250

    PubMed  Google Scholar 

  41. Norman GR, Sloan JA, Wyrwich KW (2003) Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care 41(5):582–592

    PubMed  Google Scholar 

  42. Brucker PS et al (2005) General population and cancer patient norms for the Functional Assessment of Cancer Therapy-General (FACT-G). Eval Health Prof 28(2):192–211

    PubMed  Google Scholar 

  43. Lopez-Class M et al (2012) A contextual approach to understanding breast cancer survivorship among Latinas. Psychooncology 21(2):115–124

    PubMed Central  PubMed  Google Scholar 

  44. Law R et al (2013) State variation in the cortisol awakening response. Stress 16(5):483–492

    Article  PubMed  Google Scholar 

Download references


This work was supported by NIH 5U54CA153502 (PI: Thompson, B), new development funds from the Fred Hutchinson Cancer Research Center (FHCRC), and R25CA92408 (PI: Patrick D). Thank you to Norma Mariscal and Elizabeth Carosso for your assistance with transcription and translation. This manuscript is dedicated to the memory of our colleague and friend Ilda Islas.

Ethical standards

This research was approved by the Institutional Review Board at the Fred Hutchinson Cancer Research Center.

Conflict of interest

The authors have no competing interests to disclose, have full control of all primary data, and agree that the journal may review our data if requested.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Rachel M. Ceballos.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ceballos, R.M., Molina, Y., Malen, R.C. et al. Design, development, and feasibility of a spanish-language cancer survivor support group. Support Care Cancer 23, 2145–2155 (2015).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: