There are currently over 2.5 million breast cancer survivors in the US. Dominant paradigms for cancer survivorship focus either on biomedical models of disease (institutional perspective) or psychosocial measures (individual perspective) but ignore the complex interactions between individuals and institutions (e.g., health care facilities, workplaces) that jointly contribute to survivorship outcomes. New models of survivorship care are urgently required to accommodate the changing healthcare needs of an aging population, anticipated in- creases in both the number of breast cancer survivors and their life expectancies, as well as healthcare dis- parities in medically underserved regions that are disproportionately affected by physician and specialist short- ages. The proposed interdisciplinary research combines the theoretical framework of social ecology with qualitative research methods to investigate breast cancer survivorship as an interactional process between embodied experience and institutional practices in California's Inland Empire, a region comprising Riverside and San Bernardino counties. This research will have significant implications for the design of healthcare and policy interventions that target change at the individual, institutional, and community levels.
Aim 1 : Investigate individual experiences of breast cancer survivorship. Using a longitudinal de- sign, in-depth semi-structured open-ended interviews will be conducted with Inland Empire breast cancer survivors at yearly intervals. Recruitment will be facilitated by collaborations with Inland Empire breast cancer organizations: The Pink Ribbon Place, Michelle's Place, and the Southern California Witness Project.
Aim 2 : Investigate institutional resources and their role in defining survivorship care. Survivor- ship resources comprising a broad range of services (i.e., transportation assistance, prosthesis fitting) extend beyond-but are integral to-survivorship medical care. Institutional resources in th Inland Empire will be surveyed, with an in-depth case study of one particular survivorship program and its institutional records.
Aim 3 : Map the survivor-institutional interface. Employing both visual and textual data collected in aims 1 and 2, mapping allows qualitative analysis of confluences and divergences between Inland Empire survivor and institutional perspectives regarding needs, resources, and resource use. Training program: The applicant aspires to become an independent cancer survivorship researcher. Mentoring by an interdisciplinary team in cancer survivorship, social ecology, and organizational studies con- tributes to accomplishment of this goal. The individualized training plan includes formal coursework; applied skills training; individual meetings with sponsors and advisers; monthly group mentoring, faculty-student reading group meetings, and Women's Cancer Cure ConneXion Disease Oriented Team meetings; participation in the Center for Organizational Research events and the annual Chao Family Comprehensive Cancer Center scientific retreat, as well as national conferences such as the NCI biennial survivorship research conference.
Although scientific advances and public health promotion of breast cancer screening for early detection have dramatically increased survival rates, survivors are at risk for developing numerous treatment sequelae and comorbidities. As yet, little research has investigated long-term breast cancer survivorship or the community health settings where the majority of patients in the US receive their cancer care. This study identifies potential barriers to effective care at the interface between individuals and institutions, with the goal of narrowing survivor health disparities across a diverse, geographically dispersed, and medically underserved population.
