Experiences of Cervical Cancer Survivors in Rural Eastern North Carolina: a Qualitative Assessment

Abstract

Little qualitative research has been conducted with cervical cancer survivors. We sought to understand the experiences of survivors in rural Eastern North Carolina and identify any barriers which may have kept women from receiving preventive Papanicolaou screenings or follow-up care. We conducted semi-structured in-depth interviews with 15 low-income and underserved cervical cancer survivors living in Eastern North Carolina. Participants included English-speaking women who attended a large cancer center for care between March 2012 and March 2013. Participants ranged from being recently diagnosed with cervical cancer to being 15 years post-diagnosis. Interviews lasted approximately 1 h and were audio-tape-recorded. On average, women were 55 years old (range 35-85) and were diagnosed with cervical cancer 3 years prior to the interview (range 0.2 to 180 months). A good proportion was uninsured or Medicaid-insured (60 %). Half reported an annual household income of less than $20,000, and 13 % reported having a college degree. The majority of survivors had limited understanding of cervical cancer, experienced persistent symptoms related to their cancer before seeking care, and were nonadherent to Papanicolaou screening recommendations. The main barriers to care reported by participants was lack of money and health insurance, followed by the perception of overall health (which equated to the belief that medical care was not needed), transportation issues, and discomfort with provider. Health professionals should focus educational efforts on the benefits of Papanicolaou screenings, the symptoms sometimes associated with cervical cancer, and the free or low-cost services available to low-income women.

Experiences of cervical cancer survivors in Chitwan, Nepal: A qualitative study

“…The study was conducted from January 2019 to October 2019. An interview guide was prepared by an expert panel of faculty with the help of already published articles [10,13]. FGD was conducted in the Nepali language using the interview guide by the principal investigator (GS) along with a female Nepalese researcher (RM).…”

“…Females diagnosed with cervical cancer often face many difficulties associated with cancer itself, cancer treatments and their side-effects, social understandings, and monetary constraints [10]. With a very strong association of cervical cancer with sexual practices in women, cervical cancer has a very strong impact on the quality of life of cancer survivors [11].…”

Experiences of cervical cancer survivors in Chitwan, Nepal: a qualitative study

“…For example, in a study in Rukum, Nepal only 5% of the 600 participants had ever heard about cervical cancer and only 30% among themselves were able to relate HPV as its causative agent [6]; in a study in Eastern Nepal, only 21.5% of women could identify HPV as a causative agent of cervical cancer [7], and in another study in rural Nepal 76.24% (1928) of women did not know anything about cervical cancer [8]. A similar finding was present in a study among cervical cancer survivors in North Carolina, USA [9]. The study in Rukum, Nepal articulated a lower level of knowledge about cervical cancer in women to their low level of education and lower monthly income [6].…”

“…As this study indicates, the women’s sense of well-being and inability to relate their symptoms to a possible serious disease or attributing their symptoms to normal physiological changes like menopause possibly explain their delayed healthcare-seeking behavior. Similarly, delayed healthcare-seeking behavior despite persistent symptoms was also noted in cervical cancer survivors in North Carolina [9]. On the other hand, some studies articulated the delayed healthcare seeking to the stigma related to cervical cancer [15].…”

“…Similarly, a cross-sectional study in Morocco also reported poor awareness in women about cervical cancer and have no symptoms at all as a cause for poor Pap screening uptake practice [14]. Moreover, stigma related to cervical cancer was identified as a barrier to cervical cancer screening in Karnataka, India [15], and poor finances and lack of insurance, sense of well-being, transportation issues and dissatisfaction with the behavior of service provider were some issues related to poor screening behavior among survivors in North Carolina, USA [9]. Prior bad experiences with the detection of cancer were also described as a barrier to cervical cancer screening among older African American and Hispanic urban women [16].…”