title: The experience of treatment barriers and their influence on quality of life in American Indian/Alaska Native breast cancer survivors.
abstract: American Indian and Alaska Native (AI/AN) breast cancer survivors experience disparities in breast cancer incidence and age-adjusted mortality compared with non-Hispanic white (NHW) breast cancer survivors. In addition, mortality-to-incidence rates indicate that AI/ANs continue to have the poorest survival from breast cancer compared with other racial groups. "Native American Cancer Education for Survivors" (NACES) is a cultural education and support intervention for AI/AN patients with cancer that collects data from voluntary participants through the NACES quality-of-life (QOL) survey regarding their cancer experience and survivor journey.
  
  
  
  Data from the NACES QOL survey were analyzed to determine whether barriers accessing and during initial cancer treatment impacted QOL domains for AI/AN cancer survivors. Exploratory analyses of selected variables were conducted and were followed by Kruskal-Wallis tests to determine whether these barriers influenced survivorship QOL for AI/AN breast cancer survivors.
  
  
  
  AI/AN breast cancer survivors' social QOL was significantly affected by barriers to accessing cancer treatment. Many respondents experienced barriers, including a lack of cancer care at local clinics and the distance traveled to receive cancer care. During treatment, too much paperwork and having to wait too long in the clinic for cancer care were the most frequently reported barriers.
  
  
  
  Treatment barriers influence AI/AN breast cancer survivors' social QOL. Mediating these barriers is crucial to ameliorating AI/AN survivors' disparities when accessing and completing cancer treatment and improving survivorship QOL. Cancer 2017;123:861-68. © 2016 American Cancer Society.
authors.affiliation: Fay W. Whitney School of Nursing, University of Wyoming, Laramie, Wyoming.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Goodwin
authors.affiliation: Native American Cancer Research Corporation, Pine, Colorado.
authors.forename: Linda
authors.initials: L
authors.lastname: Burhansstipanov
authors.affiliation: Prevention Research Center, Department of Internal Medicine, Markey Cancer Center, Lexington, Kentucky.
authors.forename: Mark
authors.initials: M
authors.lastname: Dignan
authors.affiliation: Southeastern Program Evaluation, Markey Cancer Center, Lexington, Kentucky.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Jones
authors.affiliation: Native American Programs, Spirit of EAGLES, Mayo Clinic, Rochester, Minnesota.
authors.forename: Judith Salmon
authors.initials: JS
authors.lastname: Kaur
mesh_terms: D000328:Adult; D000368:Aged; D000072957:Alaska Natives; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007198:Indians, North American; D008875:Middle Aged; D011788:Quality of Life; D016019:Survival Analysis; D017741:Survivors; D014481:United States / Q000453:epidemiology; D044465:White People
keywords: American Indians; cancer; quality of life; survivor; treatment barriers