Understanding Delays in Diagnosis and Treatment of Breast Cancer in Appalachia

Open Access
- Author:
- Glick, Lydia M
- Area of Honors:
- Communication Arts and Sciences
- Degree:
- Bachelor of Science
- Document Type:
- Thesis
- Thesis Supervisors:
- Rachel Annette Smith, Thesis Supervisor
Lori Ann Bedell, Thesis Honors Advisor - Keywords:
- Appalachia
rural
breast cancer
health disparity
barrier to care
theory of reasoned action
emotions - Abstract:
- Previous research has revealed that 10.4% of breast cancer deaths in white women in the United States occurred in Appalachia (Yao et. al, 2012). Rates of unstaged breast cancer, cancer for which there is not enough medical evidence to classify the disease progression (National Cancer Institute, 2013), are higher in the rural regions compared to the urban regions of Appalachia (Lengerich et. al, 2005). In the United States, the rates of adherence to adjuvant hormone therapy, a standard therapy prescribed for estrogen receptor positive breast cancer cases, are between 70-80%, while the rate of discontinuation of this treatment is 20%. However, in Appalachia, there is a 69% adherence rate and a 30% discontinuation rate to the same adjuvant hormone therapy. A disparity in breast cancer diagnosis and care exists not only between Appalachia and the rest of the United States but also between urban and rural areas of Appalachia (Lengerich et. al, 2005). While biological or environmental differences may contribute to the increased rates in rural Appalachia, there may be psycho-social-cultural barriers that prevent women with breast cancer in Appalachia from receiving equitable diagnosis or care for their cancer. Women in the United States are benefiting from advances in medical treatment for breast cancer (Elkin & Hudis, 2015); however, women in rural Appalachia still seem to suffer from the burden of this disease (Lengerich et. al, 2005; Yao et. al, 2012). They are more likely to be diagnosed with unstaged cancer, more likely to discontinue using critical therapies, and more likely to die of breast cancer than their urban counterparts. To develop effective interventions to increase optimal care in Appalachia, we need to understand why some women receive diagnosis and care for their breast cancer, while some do not. This thesis explores a facet of this complex issue by considering: of women in Appalachia with breast cancer who did receive care, what positively influenced their pursuit of care and treatment? Using the theory of reasoned action (Ajzen & Fishbein, 1980) as a framework, I sought to understand the experiences of women in Appalachia who pursued care for their breast cancer, and how these experiences influenced their entrance and continuation of care. The results of this study revealed consistencies and inconsistencies with the theory of reasoned action, as well as the need for consideration of factors not address by the theory. These findings have practical implications for how cancer centers support and educate patients, and how physicians present treatment plans.