Practice and research implications include the need for greater attention to QOL outcomes among at-risk lower socioeconomic status survivors and the recognition of the unique contributions of socioeconomic status, socioecologic stress, and ethnicity on physical and mental health QOL.

BACKGROUND: Several publications reporting on health disparities document that ethnic minorities disproportionately experience delays in healthcare access, delivery, and treatment. However, few studies examine factors underlying access and receipt of healthcare among cancer survivors from the patient perspective. This study explores diagnostic and therapeutic care delays among a multiethnic sample of breast and cervical cancer survivors and examines contextual factors influencing diagnostic and therapeutic care delays. METHODS: Population-based sampling and a cross-sectional design were used to recruit 1377 survivors (breast cancer, n ¼ 698; cervical cancer, n ¼ 679). This multiethnic sample included 449 European American, 185 African American, 468 Latina American, and 275 Asian American survivors. RESULTS: Latina Americans were more likely to report diagnostic delays (P ¼.003), whereas African Americans were more likely to report therapeutic delays (P ¼.007). In terms of cancer type, cervical cancer survivors were more likely to report diagnostic (P ¼.004) and therapeutic delays (P ¼.000) compared with breast cancer survivors. ''Fear of finding cancer'' was the most frequently cited reason for diagnostic delays, and ''medical reasons'' were most frequently cited for therapeutic delays. CONCLUSIONS: Due in part to a higher proportion of diagnostic and therapeutic delays, ethnic minorities endure greater cancer burden, including poorer survival and survivorship outcomes. The medical community must recognize the impact of existing psychological and cultural dimensions on diagnostic care, as well as the personal and healthcare system level barriers that contribute to therapeutic delays. Cancer 2010;116:3195-204.

This study adds to the existing literature in that no study has focused on cultural health beliefs and health behaviors between Latina and Asian-American BCS. Evidence that Latinas and Asian Americans varied in the patterns of cultural factors influencing health behaviors and HRQOL might lead to the development of culturally sensitive breast cancer interventions for promoting positive health behavior and ultimately increasing HRQOL.

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