title: Cancer experiences and health-related quality of life among racial and ethnic minority survivors of young adult cancer: a mixed methods study.
abstract: Young adult (YA) racial and ethnic minority survivors of cancer (diagnosed ages 18-39) experience significant disparities in health outcomes and survivorship compared to non-minorities of the same age. However, little is known about the survivorship experiences of this population. The purpose of this study is to explore the cancer experiences and health-related quality of life (HRQOL) among YA racial/ethnic minorities in an urban US city.
  
  
  
  Racial and ethnic minority YA cancer survivors (0 to 5 years posttreatment) were recruited from a comprehensive cancer center using a purposive sampling approach. Participants (n = 31) completed semi-structured interviews, the FACT-G (physical, emotional, social well-being) and the FACIT-Sp (spiritual well-being). Mixed methods data were evaluated using thematic analysis and analysis of covariance (ANCOVA).
  
  
  
  The majority of survivors were women (65 %), single (52 %), and Hispanic (42 %). Across interviews, the most common themes were the following: "changes in perspective," "emotional impacts," "received support," and "no psychosocial changes." Other themes varied by racial/ethnic subgroups, including "treatment effects" (Hispanics), "behavior changes" (Blacks), and "appreciation for life" (Asians). ANCOVAs (controlling for gender and ECOG performance status scores) revealed that race/ethnicity had a significant main effect on emotional (P = 0.05), but not physical, social, or spiritual HRQOL (P > 0.05).
  
  
  
  Our findings suggest that minority YA cancer survivors report complex positive and negative experiences. In spite of poor health outcomes, survivors report experiencing growth and positive change due to cancer. Variations in experiences and HRQOL highlight the importance of assessing cultural background to tailor survivorship care among YA racial and ethnic minorities.
authors.affiliation: Rossier School of Education, University of Southern California, Los Angeles, CA, USA. alexismu@usc.edu.
authors.forename: Alexis R
authors.initials: AR
authors.lastname: Munoz
authors.affiliation: Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Kaiser
authors.affiliation: Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.
authors.forename: Betina
authors.initials: B
authors.lastname: Yanez
authors.affiliation: Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.
authors.forename: David
authors.initials: D
authors.lastname: Victorson
authors.affiliation: Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.
authors.forename: Sofia F
authors.initials: SF
authors.lastname: Garcia
authors.affiliation: Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Mallory A
authors.initials: MA
authors.lastname: Snyder
authors.affiliation: Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.|Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Salsman
mesh_terms: D000293:Adolescent; D000328:Adult; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D006801:Humans; D009369:Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000523:psychology; D011788:Quality of Life / Q000523:psychology*; D044469:Racial Groups / Q000523:psychology*; D015996:Survival Rate; D017741:Survivors / Q000523:psychology; D055815:Young Adult
keywords: Cancer; Disparity; Health-related quality of life; Minority; Survivorship; Young adult