title: Challenges of illness in metastatic breast cancer: a low-income African American perspective.
abstract: OBJECTIVE
  Disparities in breast cancer survival and treatment for African American and low income women are well documented, yet poorly understood. As care for women with metastatic breast cancer (MBC) evolves to a chronic care model, any inequities in optimal treatment and management of symptoms must also be identified and eliminated. The purpose of this study was to explore how race and income status influence women's experiences with MBC, particularly the management of symptoms, by describing the perceived challenges and barriers to achieving optimal symptom management among women with MBC and exploring whether the perceived challenges and barriers differed according to race or income.
  
  
  METHODS
  Quantitative techniques were used to assess demographics, clinical characteristics, symptom distress, and quality of life and to classify women into groups according to race and income. Qualitative techniques were used to explore the perceived challenges, barriers, and potential influences of race and income on management of symptoms in a prospective sample of 48 women with MBC.
  
  
  RESULTS
  Commonalities of themes across all groups were faith, hope, and progressive loss. Low-income African American women uniquely experienced greater physical and social distress and more uncertainty about treatment and treatment goals than the other delineated racial and economic groups.
  
  
  CONCLUSIONS
  There are many commonalities to the challenges of illness presented to women with MBC. There are also interesting, emerging thematic racial and economic differences, most compelling among the low income African American women with resultant practice and research implications.
authors.affiliation: University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania 15261, USA. mros@pitt.edu
authors.forename: Margaret Quinn
authors.initials: MQ
authors.lastname: Rosenzweig
authors.forename: Theresa
authors.initials: T
authors.lastname: Wiehagen
authors.forename: Adam
authors.initials: A
authors.lastname: Brufsky
authors.forename: Robert
authors.initials: R
authors.lastname: Arnold
mesh_terms: D001741:Black or African American / Q000523:psychology*; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000208:ethnology / Q000473:pathology*; D005260:Female; D015438:Health Behavior / Q000208:ethnology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010166:Palliative Care; D011203:Poverty / Q000208:ethnology / Q000523:psychology*; D011788:Quality of Life; D012944:Social Support; D014481:United States; D016387:Women's Health