Mapping Breast Cancer Survivorship and the Survivor Institutional Interface
Improved treatment options for breast cancer have resulted in longer life expectancy and a rapidly growing population of survivors, generating new service needs and challenges. Cancer research has focused predominantly on treatment outcomes and paid significantly less attention to the post-treatment needs of breast cancer survivors, or how best to address those needs through survivorship care.
This case study employs a social ecological framework and actor-network theory (ANT) to map survivorship care in Southern California’s Riverside and San Bernardino counties. The study draws on semi-structured interviews with 82 breast cancer survivors and 84 providers of a broad range of services including patient navigation, prosthesis fitting, psychosocial support, transportation, and financial assistance. In addition, it includes in-depth analysis of database records documenting service interactions between breast cancer survivors and one nonprofit organization over a six-year period.
This inquiry accomplishes four shifts away from the traditional foci of cancer survivorship research, thereby opening up new perspectives for practice and policy as well as directions for future research. First, by moving outside the medical examining room and the physician-patient dyad, the empirical analyses make visible the contributions of many actors in community nonprofits and government agencies that have remained largely unacknowledged in previous research. Second, this study shifts analytical focus from individual actors to the service interaction, suggesting that survivorship care requires interactional solutions rather than interventions that target providers or survivors independently. Third, focusing on service interactions yields new insights into health disparities and how individuals may become disadvantaged through processes of service delivery. Fourth, using the ANT analytical strategy of tracing connections to map the network of connections among survivors, service providers, and healthcare policies and laws reveals opportunities for working towards health equity within a challenging and medically underserved region.