African American Women Breast Cancer Survivors: Coping with the COVID-19 Pandemic

Abstract

African American women breast cancer survivors are among those with the greater burden of cancer. Breast cancer is the second leading cause of death among black women, and this death rate is 40% higher than that of white women. The COVID-19 pandemic increased the burden of morbidity and mortality among this population of cancer survivors. In this report, we explore the ways in which the COVID-19 pandemic was a source of stress for African American women breast cancer survivors and their subsequent responses to these stressors. This is a qualitative descriptive study with content analysis of data from the narratives of 18 African American breast cancer survivors. Participants were interviewed via phone and video conferencing platform and asked questions related to their experiences with the COVID-19 pandemic. The findings suggest stressors associated with (1) potential COVID-19 spreaders in their immediate environments; (2) closures and restricted access to social- and faith-based activities; (3) televised news broadcasts of COVID-19; and (4) disruptions to planned cancer prevention and control healthcare. Three categories emerged that captured the ways in which these women responded to stressors during the early phase of this pandemic: (1) seeking control in their social environments; (2) following the rules; and (3) seeking support from God, family, and friends. These findings can be used to better support breast cancer patients during the early phases of a pandemic.

African American women with breast cancer suffer healthcare disparities that adversely affect their overall state of wellbeing. They are twice as likely to be diagnosed at an advanced stage or with an aggressive cancer than women from other racial/ethnic groups [2]. Moreover, African American women who have survived breast cancer are more likely to have received chemotherapy and radiation treatments which likely resulted in more severe and long-term side effects [27]. Compounding these disparities in severity of staging at diagnosis and more aggressive treatments are disparities in mortality rates that are a constant threat to these women. African American women who are survivors of breast cancer constantly face the threat of recurrence from a cancer that is classified among those with the highest death rates [2].

In addition to the constant threat of recurrence and increased mortality rates, African American women who are survivors of breast cancer encounter challenges from treatment side effects. Common side effects that persist long after the end of treatment include fatigue, difficulty in sleeping, upper extremity weakness, sexual dysfunction, and an increased risk from infections due to immunosuppression [10]. African American women with breast cancer are at a higher risk for diminished health and emotional support information for survivorship from healthcare providers [7] and negative responses from family and friends. A social connectedness to others is an important aspect of survivorship for African American women with breast cancer, and yet, many of these women encounter feelings of social isolation within their networks of family and friends who may not understand the psychosocial issues encountered during post-treatment [13]. These challenges were likely heightened for African American women with breast cancer during the COVID pandemic.

Conceptual Framework

This study is guided by concepts of threat appraisal and coping from the Lazarus and Folkman Stress and Coping Theory. According to this framework, a threat is defined as the degree and likelihood that an event or situation will be harmful [18]. The degree of threat is determined by meanings attached to the illness experience [14]. Coping refers to constantly changing the cognitive and behavioral strategies used to manage a threatening situation or problem. In this report, conceptualizations of threat and coping were used to guide an exploration of the ways in which African American breast cancer survivors perceive the COVID-19 pandemic as threatening and how they cope with this perceived threat.

African American women who are survivors of breast cancer were among those individuals with a higher risk for contracting and dying from COVID-19 (Louis-Jean, Cenat, Njoku, Angelo, & Sanon, 2020). In comparison to other racial/ethnic groups, African Americans are nearly four times more likely to die from COVID-19 [19]. Comorbidities such as heart disease, asthma, and obesity that are prevalent among African American breast cancer patients increased the threat of COVID-19 among this population; if contracted, their disease course of COVID-19 was more likely to be severe and possibly resulting in death. In order to mitigate the threat of contracting this potentially deadly disease, it was crucial for this population to respond by physically distancing themselves from family, friends, and traditional faith-based activities. As a result, this population likely experienced higher levels of social isolation and loneliness [3, 6, 29] and possibly higher levels of psychological distress, such as anxiety and depression [1].

Purpose

The purpose of this study was to explore among African American women breast cancer survivors, the perceived stressors that threaten their survivorship during the COVID-19 pandemic. We were especially interested in the ways in which these women responded to these stressors during the early phases of this pandemic. We have previously reported the ways in which these women responded through their spirituality.

Design and Methods

In this report, we used a qualitative descriptive design including purposive sampling, open-ended semi-structured interviews, and qualitative content analysis. A conventional qualitative content analysis included the interpretation of narrative responses (appraisal of COVID-19-related stress and coping strategies used in response to those stressors) through a process of coding that generated categories or a typology of expressions [15]. Approval for this study was obtained from the Institutional Review Board of Emory University.

Participants

The interviews included in this report are from 18 African American women residing in the southeastern USA, African American ethnicity by self-report, at least 18 years old but less than 89 years, and survivors of breast cancer. Participants for these interviews were generally recruited through announcements about the study through an African American breast cancer support group with whom the sixth author of this report is founding member.

Procedures

The first author conducted semi-structured interviews lasting an average of 30 min. Participants were interviewed via phone or a video conferencing platform and asked to respond to questions related to stressors encountered during the COVID-19 pandemic and the strategies used to manage those stressors. Participants were given a $30 gift card for each interview. All interviews were conducted in April and May of 2020.

Interview questions included whether the COVID-19 pandemic was a source of stress in their lives, especially as a breast cancer survivor, and the coping strategies that were useful during this time. Interview questions consisted of the following: (1) can you describe the ways in which this COVID-19 pandemic has been stressful to you as a breast cancer survivor; and (2) can you describe the strategies useful to you in response to the stressor you have experienced?

Data Analysis

In order to content analyze the data, a table was initially constructed to organize each participant’s responses by category of text related to the breast cancer survivorship experience during this pandemic and drawn from these participants’ narrative responses. These responses included perceived threats as well as the strategies to minimize those stressors.

Results

Participant Characteristics

The interviews included in this report are from 18 older African American woman cancer survivors residing in the southeastern USA (see Table 1). The participants were on average 58 years old with stage 2 breast cancer (50%); married (38.9%); college educated (44.4%); employed full time (55.6%); and resided in rural areas (67%).

Table 1.

Demographic characteristics of study participants

Variables	Participants (n = 18)
Age (mean, SD)	57.89 (8.07)
Gender (n, %)
Female	18 (100%)
Marital status (n, %)
Married	7 (38.9%)
Single	5 (27.8%)
Divorced	4 (22.2%)
Widowed	2 (11.1%)
Education (n, %)
College degree	8 (44.4%)
High school	5 (27.8%)
Graduate/professional	5 (27.8)
Employment status (n, %)
Full-time	10 (55.6%)
Retired	4 (22.2%)
None	4 (22.2%)
Type of employment (n, %)
Admin	7 (38.9%)
Professional	7 (38.9%)
None	4 (22.2)
Live alone (n, %)
Yes	9 (50%0
No	9 (50%)
Cancer stage (n, %)
0–2	16 (88.9%)
3–4	2 (11.1%)
Years survived (n, %)
1–5	7 (38.9%)
> 5	11 (61.1%)

In the paragraphs to follow, we describe with participant quotes, the perspectives of the ways in which the COVID-19 pandemic was a source of stress. These women perceived themselves as immunocompromised and vulnerable to COVID-19. Therefore, the stress from their inability to control their social environments was especially demanding. Specifically, these women described a sense of vulnerability during this pandemic due to (1) potential COVID-19 spreaders in their immediate environments; (2) closures and restricted access to social and faith-based activities; (3) televised news broadcasts of COVID-19; and (4) disruptions to planned cancer prevention and control healthcare. Additionally, we describe with quotes, how these women responded to stressors. Three categories emerged that captured the ways in which these women responded to the stressors imposed by the COVID-19 pandemic, including (1) seeking control in their social environments; (2) following the rules; and (3) seeking support from God, family, and friends. Participants have been provided fictitious names in this study to protect their identity.

Breast Cancer Survivors Perceived Threat during the COVID-19 Pandemic

Potential COVID-19 Spreaders in Their Immediate Environments

Participants described being especially vulnerable to contracting this virus that could prove deadly given their immunocompromised system. These women spoke of the stress they felt when encountering family members who were not as careful about adhering to COVID-19 guidelines. Adhering to guidelines while living in a household with family members who were frontline workers or in occupations where social distancing was a challenge was especially frightening for these women. Mrs. Howard, a 59-year-old married, two-year survivor of stage 2 breast cancer, spoke of the threat of contracting COVID-19 from multiple factors including her family.

Because you know it’s up in the air. This virus is so unknown that you know, we don’t know what the effects are for people who have our own immune suppressed medications and not only that, my age and all this kind of stuff so I’m very stressed out. I have not been out of the house more than twice in two or three weeks. And when I do go out, I wear my mask or gloves and stuff. And I’m not even in contact with anybody that has gone out. I don’t even do a lot of contact with my husband. My children. None of that. Because you know I just want to isolate myself. Because I don’t want to be exposed. And that in itself—not getting out, not going around doing stuff—that’s stressful in itself.

Closures and Restricted Access to Social- and Faith-Based Activities

Disruptions to church services and other social activities were especially stressful to these women. For Mrs. Cone, a 75-year-old, widowed, and 19-year survivor of stage 2 breast cancer, attending church was a major place for socialization with friends. However, she was not able to attend church during the pandemic. She described her feelings:

And so, I’m very active in my church so therefore I miss my church family. I miss the times that we get to come together on Sunday or on Wednesday evening or simply for just a meal. Not that we’re not doing things online but it’s different when we can’t hug and greet each other. And yes, I am a very sociable woman, but I’m not stressed out to the fact to where I’m going to lose it if I don’t have some type of social things going on.

Dr. Savage is a 63-year-old, married, and two-year breast cancer survivor. As a survivor of stage 4 breast cancer who was previously treated more aggressively with chemotherapy and radiation, Dr. Savage was especially concerned about contracting the COVID-19 virus. Upon hearing about the virus and the threat of hospitalization and death, she immediately self-isolated herself to her home, which was extremely stressful. According to Dr. Savage:

But corona—it’s kind of stressful for you to be in the house all day long. It’s very stressful.

For Mrs. Cone, the constant request for her husband, a minister, to give the funeral rites among those who had died from COVID-19, was a constant reminder of her vulnerability. She spoke to the stress from constant reminders of death from funeral services for individuals with similar co-morbid conditions:

I have to turn down just this week alone, there’s been two deaths that came in my community. My husband just left a few minutes ago to do a graveside service. And also, as a Type 2 diabetic, some of those things have crossed my mind about, you know, being one of those persons with a high risk, you know?

Televised News Broadcasts of COVID-19

Mrs. Cone, the 75-year-old, widowed, and 19-year survivor of stage 2 breast cancer, compared the threat of the virus to that of breast cancer as much more serious and deadly. Her source of information on the virus was primarily from televised news until that became overwhelming.

. . . I watch the news all the time, all the time, all the time and then I had to stop, you know? I limit my portals of what’s coming in because I was consumed with it, because I was in fear. And it seems like I was more scared of this than I was of breast cancer. Why is the virus more threatening than cancer . . .? Because you heard more about the deaths than the survival of it and I think that’s what did it? You know with breast cancer you hear about survivors. I’m a survivor. You hear about everybody who survived. So that made you feel like, okay, I can survive too. In the beginning with this pandemic, they just made you focus on who was dying. Then you think about the bodies and seeing all that on TV, it just seemed like it was more publicized than cancer - even though cancer you hear about it a lot. But it just focused more on the deaths. And then the fact that it was spreading from country to country like waves. So, it just seemed like it put more fear because there’s no cure. Even though there’s no cure for the cancer but you know you can get treatments and that type of thing. With the pandemic, what are the treatments? There are none. You have to just wait it out, you know? So that’s what made it fearful.

Disruptions to Planned Appointments for Cancer Preventative and Control Healthcare

A second theme that emerged as stressful for these breast cancer survivors was the disruptions to healthcare. There were concerns related to accessing prescribed medications as well as making decisions of whether or not to attend routine cancer screenings. Ms. Johnson is a 48-year-old single, eight-year breast cancer survivor who described her fears of not being able to get medications from the drugstore due to limited supplies:

My rheumatologist she had to give me a three-month supply of my Proximal because that is the drug they are using to treat Covid-19. As I’ve been, you know, reading some of what my friends have on Facebook about having to go to the drugstore, you know, and they cannot get their medication because they are out. I’m in a panic, you know?

This pandemic is a source of stress for other participants who did not know whether or not to take the risk of keeping appointments for their mammograms or follow-up appointments with their oncologists. Mrs. West, a 72-year-old, married, 21-year, and two-time survivor of stage 3 breast cancer, but who is now in treatment for a third time, described her concerns regarding the impact the pandemic has had on her survivorship experience. She described the ways in which coping with this pandemic required a change in her lifestyle; one included delaying treatment. One example was the stress associated with scheduled cancer treatments. According to Mrs. West:

I’m a people person. I like to talk. I like to hug. So, you know you have to change your whole outlook on life. And then whether to go to these appointments. Because I’m supposed to be going to an appointment to see my oncologist the twenty-eighth of this month, but I called them and asked them if I could put it off for a month because I’m afraid to go to the hospital. I’ve got to have a PET scan and lab work and all of that. And then you know last January and February I was in the hospital. I’m going for infusions every eight weeks. My next infusion is due May the fifth. Do I go for my infusion? I’m still stumbling a little but I’m walking pretty good. I walk without my cane. Just trying to make safe decisions.

Ms. Lovett, a 59-year-old, married, and nine-year survivor of stage 1 breast cancer, shared a similar concern with her scheduled mammograms.

The, the thing that bothers me every—like, at the end of the month, since we had this pandemic, I usually go every May to have the mammogram done. Well, I couldn’t do this time; Emory closed. So, couldn’t go, and then finally they sent a letter in the mail that, you know, they’re open again and to schedule your appointment.

Coping Responses to the Stressors Imposed by the COVID-19 Pandemic

Three themes emerged that captured the ways in which these African American breast cancer survivors responded to the stressors encountered during the early phase of the COVID-19 pandemic.

Seeking COVID-19 Information

Self-isolation was used as a method of protection from contracting the virus. In doing so, this prevented these African American women from gaining further information regarding the pandemic at culturally important gatherings with family, friends, and fellow church members. Instead, they relied heavily on television and social media platforms for pandemic information. However, Mrs. Johnson, the 48-year-old survivor of stage 2 breast cancer, did get information on preventive measures from her primary care physician. This healthcare provider was instructive:

I learned about it like everybody else did—on TV. And then when it came to be as bad as it is, my primary care physician she was on me like ‘[Mrs. Johnson] make sure that you wash your hands every chance you get. . . Make sure that you wear your mask wherever you go’ because my immune system is double compromised now, you know? So, I have to be extra cautious on even if I’m going out to the store to get my essentials.

Following the Rules 

Wearing masks, wearing gloves, social distancing, and not going out unless absolutely necessary were the rules these participants lived by to prevent contracting COVID-19. Even though many of them were several years post-treatment, these African American breast cancer survivors were aware of their vulnerability and potentially immunocompromised status. Mrs. Gates, a 47-year-old married, five-year survivor of stage 1 breast cancer, spoke of the importance of following the guidelines for the safety of her entire family:

When I heard about that and the different health causes and stuff that are very receptive to it, your immune system and everything of course going through what I’ve gone through with chemo, radiation - all of that, I definitely was like okay trying to be as safe as possible. Wearing my mask, my gloves. I don’t want to go out unless it’s to the store. I try to definitely do the distancing. I try to; well within my family we promote it.

Mrs. Lincoln is a 61-year-old married, four-year survivor of stage 2 breast cancer who spoke of initially going out to stores without wearing a mask but changing her behavior once COVID-19 death rates increased.

We did go get the gloves - well I had gloves here. But we went and bought masks and more gloves. And we go out. When it first started you know, we would go to the grocery store without the mask and everything. But when it got worse, that’s when we started doing the gloves and the mask and everything.

Mrs. West, a 72-year-old, married, two-time breast cancer survivor, and current breast cancer patient, spoke of the protective nature of her son but also of the stress of not being able to go to the grocery store to pick out her own fruits and other favorite foods. She was especially fearful of an immunosuppressed status and self-isolated for fear of contracting COVID-19.

My son has been going to get groceries. ‘Mama, you don’t need to go anywhere. You’re too old.’ So that’s stressful. I like to look at my bananas. I don’t want them too green. I don’t want them too yellow. I want them straight. Then they send you substitutes if they don’t have what you want. I wanted pineapple juice and they sent me grape juice. Grape juice got too much sugar in it.

Seeking Support from Family, Church Family, and Friends

Participants attempted to remain connected to family, church family, and friends during this pandemic while maintaining the social distancing guidelines. Churches closed their doors, and this further limited the ability of these participants to connect with family and friends. Communication through social media and telephone became the alternative approach for maintaining social connections. Ms. Williams, a 62-year-old, widowed, and two-year survivor of stage 2 breast cancer, described her experience with socializing with family and friends during the COVID-19 pandemic:

My communication is not as prevalent as it was, and that kind of gets me down sometimes because of this. Not able to go out and socialize. They [family and friends] do call and check on me and see how I’m doing. But I’m a hugger. I like to hug, and I like to socialize. That has been taken away. It’s one thing if you don’t go out because it’s your choice. It’s another thing when you don’t have a choice or say in the matter. It kind of gets me down sometimes. And I’ve had some little emotional ‘bouts in my home being by myself. I talk to God a lot. I have to, you know? That keeps me going. I talk to my family every day. We’re on the phone every day. We can even do video chats and it’s so nice. On Saturday we [support group] got together, and we did a Zoom.

Church attendance is traditionally an important faith-based activity that encourages socialization for older African Americans. Mrs. Cone, one of the older and longer-term breast cancer survivors (75-year-old, widowed, and 19-year survivor of stage 2 breast cancer), was especially affected when not able to attend church services. Mrs. Cone missed socialization through her church but looked forward to the time when it would be safe to return:

And so I’m very active in my church, so therefore I miss my church family. I miss the times that we get to come together on Sunday or on Wednesday evening or simply for just a meal. Not that we’re not doing things online but it’s different when we can’t hug and greet each other. And yes, I am a very sociable woman, but I’m not stressed out to the fact to where I’m going to lose it if I don’t have some type of social things going on. Yeah, I’m ready for it to be opened back up like everybody else. But I also believe that when we do open back up it’s going to be a lot of social activities going on and maybe . . . we will understand. . . and we’ll remember, you know, these times right here and how even though it was inconvenient, but they also were important.

Discussion

The purpose of this study was to explore the ways in which the COVID-19 pandemic was a source of stress among African American women during their breast cancer survivorship experience and the ways in which these women responded to those stressors. We purposively selected African American breast cancer survivors for this exploration given their high-risk status for both cancer mortality and poor outcomes should they contract the COVID-19 virus [21, 23]. The narratives of these African American women illustrated the ways in which they perceived stress and also the unique strategies they used to quickly adapt in this new environment. One perceived stressor and threat to breast cancer survivorship was of the fear of death from contracting COVID-19 within the context of an immunocompromised system. The fear of death from COVID-19 was far more frightening than that of breast cancer. In their opinion, there were treatment options with breast cancer; however, there was limited knowledge about the effective treatment of COVID-19. In other words, even if cancer could not be cured, at least there were treatments to prolong life. Much of what they had witnessed on televised news consisted of patients dying in hospitals while separated from family and loved ones. From their perspective, contracting COVID-19 guaranteed a rapid and lonely death. Breast cancer patients have previously said that their most frequent fear of dying was from a relapse in their disease [17]; however, during a pandemic, the source of that fear is likely to be attributed to the effect of a deadly virus on their immunocompromised status.

The women in this study were knowledgeable of the perceived health risk and the importance of adhering to guidelines of physical distancing, wearing masks, and frequent handwashing. The threat, however, was their inability to control the safety in their home environment, particularly in multi-person households. This finding is consistent with other reports on COVID-19 for persons living in multi-family households [30]. Similarly, the women in this report who were married or living with adult children who worked outside of the home perceived they were at higher risk for exposure to COVID-19 [30].

The perceived stress from an inability to socialize through cultural gatherings, such as funerals, church services, and family reunions, expressed among these women was another finding. Faith-based and familial gatherings have historically been important, as these social activities have functioned to permit the release of pent-up emotions and exchange of encouraging words during stressful life events such as life-threatening illness and bereavement. Moreover, African Americans have generally relied on the support from faith-based institutions instead of mental health services when depressed [20]. Similarly, the inability to attend social gatherings at faith-based institutions was a source of added stress for these women.

A reliance on social media for information on COVID-19 was a source of confusion and stress among these women. This finding is similar to other research whereby African American women reported that information from social media sources was confusing and untrustworthy [8]. For the women in this study, information from televised news and social media, with the constant display of dead bodies, was overwhelming and stressful—a reminder of their own vulnerability. Similarly, research conducted on a national sample of USA adults suggests that while mainstream media influenced adherence to pandemic guidelines, social media sites were also sources of misinformation and stress [25, 26]. Among African American populations, the receipt of COVID-19 information from trusted sources is important in not only the efforts to increase testing and decrease vaccine hesitancy but also in the promotion of infection prevention strategies [4].

A final stressor reported among these women was related to changes and disruptions to cancer prevention and control healthcare that resulted in delays to breast cancer screenings, cancer treatments, and follow-up appointments. The finding that these women postponed scheduled healthcare appointments due to the fear of contracting COVID-19 is consistent with other research [28]. For some patients, the postponement of scheduled breast cancer care was likely the result of healthcare systems’ implementation of a priority system of care that aimed to prevent overloading of healthcare environments and to protect the community at-large [11, 12]. Ironically, the challenge for these women was with managing threats to their health from the COVID-19 pandemic while engaging in healthcare to ensure a positive and healthy survivorship experience.

In this research, three coping strategies were reportedly used among these African American women to protect themselves from COVID-19 while remaining connected to family and friends. One strategy was seeking health-promoting information on COVID-19. In the early phases of the pandemic, access to health-related information generally shared through attendance at faith-based activities, face to face support groups, and other family gatherings was restricted. In addition, access to healthcare clinics where health-related information might have been available was also restricted. Similar to other research, social media and televised news became the primary source of information on COVID-19 [8]. Research conducted during COVID also found that one source of COVID-19 information was disseminated through social media sites developed through partnerships with health agencies and Black Churches [5]. However, as suggested by other research, it is likely that COVID-19 messages that did not originate from Clergy within the community or through relationships that developed over time would not be as trusted among this population [24].

A second coping strategy used among these breast cancer survivors was an adherence to CDC guidelines and those recommended by their primary care physicians. Wearing masks, wearing gloves, social distancing, and not going out unless necessary were the rules these participants followed to prevent contracting COVID-19. However as previously reported, living with family members who were employed outside of the home posed an additional threat and exposure to COVID-19 that was not within their control. In other research, Black men working outside of the home had a greater chance of not only personal exposure and infection but also of infecting family members [9]. African Americans are more likely, compared to other racial/ethnic groups, to contract COVID-19 which is attributed to increased rates of employment as essential employees and exposure to known positive cases [30].

The third coping strategy used among these women in response to their experienced stressors during the COVID-19 pandemic was to quickly adapt to CDC guidelines for social distancing while simultaneously seeking much needed social support from family, church family, and friends. In other research conducted pre-COVID-19, African American breast cancer survivors reported a desire for social support from family and friends [22]. However, given the lack of face-to-face meetings during the early phases of this pandemic, these women shifted to social media to stay connected to family and friends and seek much needed social support. Although face-to-face sessions for the receipt of social support are preferable, these participants found video conferencing to be an acceptable alternative for social connectedness to others [16].

Strengths and Limitations

The strengths of this research are from the capturing of coping strategies used to manage the threat of the COVID-19 pandemic among an at-risk population. The interviews were conducted early in the pandemic and therefore captured early adaptations to the guidelines for social distancing during this pandemic.

There are a few limitations of this study. Due to social distancing mandates, participants were interviewed via telephone or social media, and it is still unclear whether this mode of collecting data provides the same level of ease as a person-to-person format. Secondly, the data in this report was from one-time interviews conducted relatively early in the pandemic. Therefore, we did not capture any changes in responses to the virus that likely occurred post-interview given the dynamic nature of this COVID-19 virus. Similarly, we were not able to capture any subsequent changes in COVID-19’s effect on the African American community in general or African American breast cancer survivors in particular.

Implications for Cancer Education

The breast cancer survivors in this report encountered social issues and a social isolation in which their support systems may not have understood, fears and anxieties related to cancer recurrence, and increased risk of mortality during pandemics. The findings from this research may be useful to cancer educators in their quest to better understand the specific situations, whereby breast cancer survivors feel threatened. Secondly, the findings might inform cancer educators on how to expand or adapt initiatives to incorporate culturally relevant strategies grounded in the experiences of this population. For example, healthcare practitioners and cancer educators might assist breast cancer survivors and family members to interpret messages about COVID-19 vaccines and treatment and clarify inconsistent messages communicated through televised sources and social media. Finally, healthcare practitioners and cancer educators may play a greater role in partnering with faith-based institutions to communicate information to congregations that enable the support networks of breast cancer survivors to understand the COVID-19-related fears of this population and the importance of adhering to CDC guidelines even as restrictions are being lifted.

Conclusion

The COVID-19 pandemic was especially threatening to African American populations and survivors of breast cancer who are especially at high risk for not only contracting but also dying from viruses. For these African American women with breast cancer, this pandemic was a reminder of their vulnerability, which in their opinion, was far more stressful than their initial breast cancer diagnosis. Although these interviews were conducted very early in the COVID-19 pandemic, the findings suggest the need for healthcare providers and cancer educators to be especially attentive to the needs of this population for support and information that are specific to cancer survivors. Cancer survivors may struggle to obtain the emotional support they need while living with family and within communities that may not understand the long-term effects of the illness. During the early phase of this pandemic, the constant news and display of dead bodies on televised news and social media were particularly stressful for these women. Adding to this stress was the limited access to healthcare providers and supportive systems. An understanding of the stressors likely to occur for these immunocompromised women might be of tremendous benefit to healthcare practitioners and cancer educator during the early phases of the next pandemic.