Oncology Nursing Forum • Vol. 38, No. 5, September 2011 523
Coping Resources and Self-Rated Health
Among Latina Breast Cancer Survivors
Anna M. Nápoles, PhD, MPH, Carmen Ortíz, PhD, Helen O’Brien, BA,
Andrea B. Sereno, MD, MPH, and Celia P. Kaplan, PhD, MA
are not available for Latinas, but prevalence estimates
for 1990–2008 indicate that more than 101,000 Latina
breast cancer survivors lived in the United States in
January 2008 (Howlader et al., 2011). Although cancer
survivorship research among Latinas is sparse, evi-
dence is emerging that Latinas may be at higher risk for
psychosocial morbidity following breast cancer than
Caucasian women, suffering disproportionately from
issues related to distress, sexuality, pain symptoms,
relationships with partners, employment, and financial
hardships (Ashing-Giwa et al., 2004; Christie, Mey-
erowitz, & Maly, 2010; Eversley et al., 2005; Spencer et
al., 1999). Little has been done to assess the relationship
between coping resources and health status as Latinas
transition from an acute cancer phase to survivorship
(Aziz & Rowland, 2002).
reast cancer is the most frequently occurring
cancer and the leading cause of cancer death
among Latinas (Howlader et al., 2011). More
than 2.6 million people were living with
breast cancer in the United States in 2008
(Howlader et al., 2011). Complete prevalence estimates
Social-Cognitive Transition Theory, which integrates
stress and coping models (Lazarus & Folkman, 1984)
with social-cognitive theory (Bandura, 1997), is a psy-
chosocial model that views adaptation to cancer as
“psychological processes that occur over time as the
individual, and those in their social world, manage,
learn from and adapt to the multitude of changes which
have been precipitated by the illness and its treatment”
(Brennan, 2001, p. 1). That model was employed for the
current analysis because it emphasizes the social context
of an individual’s personal illness experience and pos-
tulates the importance of cognitive, spiritual, and social
dimensions of adaptation to cancer. Consistent with the
Purpose/Objectives: To examine relationships between
coping resources and self-rated health among Latina breast
Design: Cross-sectional telephone survey.
Setting: Four northern California counties.
Sample: 330 Latina breast cancer survivors within one to
five years of diagnosis.
Methods: Telephone survey conducted by bilingual and
Main Research Variables: Predictors were sociodemo-
graphic and clinical factors, cancer self-efficacy, spirituality,
and social support from family, friends, and oncologists.
Outcomes were functional limitations and self-rated health.
Findings: Twenty-two percent of women reported functional
limitations (n = 73) and 27% reported poor or fair self-rated
health (n = 89). Unemployment (adjusted odds ratio [AOR] =
7.06; 95% confidence interval [CI] [2.04, 24.46]), mastec-
tomy (AOR = 2.67; 95% CI [1.06, 6.77]), and comorbidity
(AOR = 4.09; 95% CI [1.69, 9.89]) were associated with
higher risk of functional limitations; cancer self-efficacy
had a protective effect (AOR = 0.4, 95% CI [0.18, 0.9]).
Comorbidity was associated with higher risk of poor or fair
self-rated health (AOR = 4.95; 95% CI [2.13, 11.47]); can-
cer self-efficacy had a protective effect (AOR = 0.3; 95%
CI [0.13, 0.66]).
Conclusions: Comorbidities place Latina breast cancer sur-
vivors at increased risk for poor health. Cancer self-efficacy
deserves more attention as a potentially modifiable protec-
Implications for Nursing: Nurses need to assess the impact
of comorbidity on functioning and can reinforce patients’
sense of control over cancer and clinician support.
theory, multilevel personal and environmental factors
can affect well-being among cancer survivors, including
intrapersonal factors (e.g., active coping), interpersonal
factors (e.g., social support), and socioeconomic fac-
tors (e.g., level of education) (Holland & Gooen-Piels,
2000). In the current study, the authors examined the
associations of intrapersonal and interpersonal coping
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