An Exploration of the Lives of Young, African American Women with Triple-Negative Breast Cancer

Background and Purpose: Compared to other subtypes of breast cancer, triple-negative breast cancer (TNBC) accounts for a disproportionate number of metastatic cases and cancer death. Glaring disparities are present in the occurrence of TNBC, such that those diagnosed are more likely to be African American (prevalence of 26% vs. 16% in non–African Americans) and premenopausal (24% vs. 15% postmenopausal). A critical factor to consider regarding the disparities associated with TNBC is the evidence documenting the link between psychosocial stress over the life course and the occurrence of large, aggressive tumors that are characteristic of this subtype. It is therefore imperative that these psychosocial factors are also examined in light of how young, African American women live with a diagnosis of TNBC. Because issues such as crime, isolation, stress, discrimination, and other factors associated with poverty have been found to significantly affect etiology of breast cancer among young, African American women, it is critical to also consider these issues after diagnosis occurs. To our knowledge, there have been no scientific explorations of the biopsychosocial factors that are relevant in the lives of women facing a specific diagnosis of TNBC. Despite the fact that many of these factors impact the etiology of TNBC, little is known about how these factors come into play once the diagnosis has occurred. This study qualitatively explored the biopsychosocial history and current environment of women facing such a diagnosis with the goal of shedding light on the experience of TNBC. The purpose was to build a conceptual framework for understanding the contextual lives of these women, with the long-term goal of informing the development and provision of appropriate social work interventions.

Methods: Using a grounded theory approach, in-depth, qualitative interviews were conducted with women with TNBC and with a small comparison group of women with ER+ breast cancer.  A prospective, longitudinal design was used to collect data throughout the course of treatment. Data collection occurred in three waves, corresponding with three critical points in the cancer care trajectory. These three time points were the first course of treatment, adjuvant treatment, and survivorship or palliative care. As per grounded theory methodology, observation techniques were also a critical method of data collection. Analyses involved co-coding of the data with two research assistants looking for major themes toward the construction of a theoretical model.

Findings: Data analysis reveals women with TNBC as compared to women with ER+ breast cancer reported significantly more burdens of responsibility, similar experiences of trauma (namely sudden and unexpected death of loved ones), and disconnection from spiritual communities. Using these common themes, a conceptual framework was built for understanding the contextual lives of young, African American women with TNBC.

Conclusion and Implications: Given the lack of available psychosocial interventions for these young women, the intention of this study was to lay groundwork for providing appropriate, interdisciplinary care to underserved women with breast cancer. This is specifically applicable to oncology social workers who seek to provide holistic services to clients in the context of their environment.