Investigating Post-Treatment Health Needs of Black American Families after a Cancer Diagnosis

Background and Purpose. Physical activity and healthy eating after the completion of cancer treatment has been associated with a number of positive health outcomes, including enhanced physical functioning, decreased fatigue, and improved quality of life. These outcomes are particularly evident among adults treated for early-stage breast and colorectal cancers. Yet, lower levels of engagement among Black American cancer survivors compared to other racial groups highlight a need to understand and address post-treatment barriers to physical activity and healthy eating in this group. Support from family members may be helpful for promoting these health behaviors among survivors after treatment ends and provide opportunities for survivors to support the health of family members as well (i.e., mutual support). Limited studies, however, have examined post-treatment health and health behaviors of Black American survivors and family members. Moreover, few post-treatment lifestyle interventions exist that tailor to family resources and constraints within the broader sociocultural context. Guided by communal and ecological theoretical perspectives, the purpose of this study is to identify individual, social and contextual barriers and facilitators to physical activity, healthy eating and mutual support for healthy behavior engagement among this population and implications for family-based interventions.

Methods. Using a qualitative descriptive study design, we conducted semi-structured interviews with twenty dyads (N=20). Each dyad was comprised of a Black American who completed treatment for early-stage breast or colorectal cancer in the previous five years and a Black American family member who completed individual interviews. In addition, joint interviews were conducted with 9 dyads. A directed content analytic approach guided data analysis. Descriptive analysis was conducted on pre-interview surveys, which included background demographic, psychosocial and medical data.

Results. Cancer survivors and family members often provided mutual support for diet and exercise-related behaviors, and management of chronic condition and symptoms. The intensity and type of support varied based on their individual and combined health needs, the course of illness (including cancer and chronic health problems), and family norms regarding roles, responsibilities and communication. Support to and from others in the family network was also common, highlighting multiple caregivers and sizable networks of care mobilized to address needs and concerns. Contemporary contextual issues such as the coronavirus pandemic, racism, and civil unrest affected attention to and engagement in health-promoting behaviors. Significant levels of family comorbidity also informed participant experiences of individual and family symptom and disease management. Participants highlighted several ways in which interventions and programs could improve support provided to families after a cancer diagnosis.

Conclusions and Implications. Black American families described strengths and challenges in their discussions of health behavior engagement and chronic health concerns of multiple family members. Participants highlighted the existence and importance of mutually supportive relationships for health after cancer treatment along with their involvement in broader networks of care within the family. These findings have important implications for future intervention studies centered on designing and implementing culturally and contextually appropriate lifestyle interventions to enhance the post-treatment health of Black Americans using family-based approaches.