Critical Areas to Promote Resilience Amid Cancer Treatment Environments among Black Women-A Commentary

Commentary

Many studies have shown that Black cancer survivors have poorer cancer survival rates when compared with White cancer survivors [1]. This occurs even after controlling for socioeconomic factors such as education and income. According to the CDC, Black women and White women get breast cancer about the same rate [2]. However, Black women die from breast cancer at a higher rate than White women [3, 2]. Breast cancer deaths are 40% higher among Black women than White women. These deaths are attributed to the aggressive form of breast cancer Black women are diagnosed with that returns after treatment. To counter this, treatment must be as aggressive and holistic [4]. In addition to chemotherapy and radiation, treatment must be strengths-based to promote resilience. Professionals should embrace all aspects of the person to promote healing. The lived experiences that are immersed in resilience can promote coping with cancer [5]. Creating a support system is one thing. But encouraging the survivor to make an investment in the lives of similarly diagnosed cancer survivors will affect change in the survivor’s life and their own. This action promotes resilience to overcome the stressors of the disease.

Resilience

Resilience is the ability to bounce back from a crisis and persevere through difficult times [5]. Further, resilience is the capacity to exhibit positive outcomes despite being at significant risk. Examples of resilience are hardiness of character (i.e. good adaptation despite stressful experiences); self-coherence (i.e. able to see self as a “cohesive self”); self-efficacy (i.e. the belief that one is in control of the outcomes of one’s life) and post- traumatic growth (i.e. post the trauma an individual can Commentary find meaning in life overall) [6]. Resilience is being able to exhibit good outcomes and successes in spite of high risk and presenting high levels of social competence when under stress [7]. A resilient individual is able to recruit assistance from others when faced with trials, challenges and insurmountable odds.

Who presents as resilient? This would be a person with a high sense of self-esteem and self-worth; realistic understanding of the environment and what can be controlled; effective problem solving skills; great degree of empathy; evidence of familial investment and presence of a confident caretaker with their own level of self- efficacy [6]. During treatment, breast cancer survivors need a strengths-based, holistic treatment that engages all aspects of their personhood and draws them into a community [7]. There are seven critical areas to promote resilience in cancer treatment environment among Black women.

Critical Areas to Promote Resilience in Cancer Treatment

The first critical area is purpose (Figure A). The patient must have valued goals they would like to achieve. These goals can be to learn more about the disease, spend more time with family, or take up a new hobby. The goals can be short term or long term. But they need to be tangible. The second area is to partake in inspiring activities. This can include going to a support group, or volunteering with a breast cancer organization. The next area is social trust. It is the belief that most people can be trusted. One way to achieve this is to perform an act for someone who is in a dire state and needs support and guidance. This can uplift and affirm the individual the survivor is supporting.

The next area is self-efficacy. This is the belief that one is in control of the outcomes of one’s life. The breast cancer diagnosis can diminish self-efficacy. One way to increase self-efficacy is to partner with the professional staff to know the efficacy of the treatment and to understand new treatments that may prove useful and healing. The next area is social desirability and openness. This refers to satisfaction in one’s appearance. This is difficult at times with breast cancer treatment as the disease can rob a woman of her physical appearance. The patient must find ways to renew their appearance to their liking. This can include decorative head scarves or reconstructive surgery.

The next area is spirituality. According to Walton, spirituality is critical in breast cancer treatment [5]. Many women renew their relationship with a higher power and place enormous trust in that relationship. Spirituality has a tendency to lengthen life expectancy. Finally, positive emotionality/agreeableness is critical in breast cancer treatment as the stress of the disease can precipitate depression. To counter that, the patient must approach the disease looking at their strengths and what in their life they are most thankful for. By concentrating on those things, they can cling to the positive areas of their life and embrace hope. Hope is the critical factor in breast cancer treatment as it fills the individual with well-being and internal support.

The most important area is self-efficacy. It is the fervent belief that one is able to obtain desired goals, with ability to problem solve, plan for long range treatment goals, and have an overall sense of general worth. This self-efficacy (or internality) is the degree to which the individual sees their success or failure attributed to their own efforts and not external factors. It is this author’s contention that self-efficacy is positively correlated with optimal treatment efficacy. When Black cancer survivors take control of their treatment and lead the treatment team with problem solving, they are more likely to have positive outcomes in treatment.

These are critical areas to promote resilience amid an investing, supportive and affirming cancer treatment environment. The patient is the leader of the treatment team. Their hopes, beliefs and actions are paramount to maintaining remission and living life cancer free.