title: A contextual approach to understanding breast cancer survivorship among Latinas.
abstract: OBJECTIVE
  The purpose of this review is to describe the empirical literature on the health-related quality of life (HRQOL) in Latina breast cancer survivors by exploring the social determinants of health. In framing the key domains of survivors' quality of life within a ecological-contextual model that evaluates individual and societal contributions to health outcomes, we provide a comprehensive landscape of the diverse factors constituting Latina survivors' lived experiences and their resultant quality of life outcomes.
  
  
  METHODS
  We retrieved 244 studies via search engines and reference lists, of which 37 studies met the inclusion criteria.
  
  
  RESULTS
  Findings document the importance of the social determinants of HRQOL, with studies documenting ecological and contextual factors accounting for significant variance in HRQOL outcomes. Our review identifies a dearth of research examining community-, institutional-, and policy-level factors, such as health care access, legal and immigration factors, physical and built environments, and health care affordability and policies affecting Latina breast cancer survivors' HRQOL.
  
  
  CONCLUSIONS
  Overall research on Latina breast cancer survivorship is sparse, with even greater underrepresentation within longitudinal and intervention studies. Results highlight a need for clear documentation of the comprehensive care needs of underserved cancer survivors and interventions considering integrated systems of care to address the medical and ecological factors known to impact the HRQOL of breast cancer survivors.
authors.affiliation: Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA. lopezclassm@mail.nih.gov
authors.forename: Maria
authors.initials: M
authors.lastname: Lopez-Class
authors.forename: Jessika
authors.initials: J
authors.lastname: Gomez-Duarte
authors.forename: Kristi
authors.initials: K
authors.lastname: Graves
authors.forename: Kimlin
authors.initials: K
authors.lastname: Ashing-Giwa
mesh_terms: D001943:Breast Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000523:psychology; D005260:Female; D006297:Health Services Accessibility; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D011788:Quality of Life; D012931:Social Environment; D015996:Survival Rate; D017741:Survivors / Q000523:psychology*; D014481:United States