Online Exclusive Article

Social Disconnection in African American Women With Breast Cancer

Sue P. Heiney

African American, breast cancer, social disconnection, women
ONF 2013, 41(1), E28-E34. DOI: 10.1188/14.ONF.E28-E34

Purpose/Objectives: To identify antecedents and consequences of social disconnection in African American women diagnosed with breast cancer as described in the extant literature.

Data Sources: Literature review using broad exploration of a personal database and informal exploration of databases such as MEDLINE®, as well as clinical experience.

Data Synthesis: A formal definition, antecedents, and consequences of social disconnection were drawn from a review of the literature.

Conclusions: Antecedents included personal responses to a breast cancer diagnosis and cultural influences. Consequences included decreased well-being, partner abandonment, and decreased health.

Implications for Nursing: Areas for future research include using measurement tools for assessment, as well as creating categories for the trajectory of social disconnection and determining its severity and nature. Nurses should be alert to the possibility of social disconnection in patients with cancer. Nurses can assist the patient in talking to his or her family and friends about the cancer diagnosis and treatment.

Jump to a section


    American Cancer Society. (2013a). Cancer facts and figures, 2013. Atlanta, GA: Author.
    American Cancer Society (2013b). Cancer facts and figures for African Americans, 2013-2014. Atlanta, GA: Author.
    Ashing-Giwa, K.T., Padilla, G., Tejero, J., Kraemer, J., Wright, K., Coscarelli, A., … Hills, D. (2004). Understanding the breast cancer experience of women: A qualitative study of African American, Asian American, Latina and Caucasian cancer survivors. Psycho-Oncology, 13, 408-428. doi:10.1002/pon.750
    Beauboeuf-Lafontant, T. (2007). "You have to show strength": An exploration of gender, race, and depression. Gender and Society, 21, 28-51. doi:10.1177/0891243206294108
    Berz, J.P., Johnston, K., Backus, B., Doros, G., Rose, A.J., Pierre, S., & Battaglia, T.A. (2009). The influence of black race on treatment and mortality for early-stage breast cancer. Medical Care, 47, 986-992.
    Cacioppo, J.T., & Hawkley, L.C. (2009). Perceived social isolation and cognition. Trends in Cognitive Sciences, 13, 447-454. doi:10.1016/j.tics.2009.06.005
    Cacioppo, J.T., Hawkley, L.C., Norman, G.J., & Berntson, G.G. (2011). Social isolation. Annals of the New York Academy of Sciences, 1231, 17-22. doi:10.1111/j.1749-6632.2011.06028.x
    Cacioppo, S., & Cacioppo, J.T. (2012). Decoding the invisible forces of social connections. Frontiers in Integrative Neuroscience, 6, 51. doi:10.3389/fnint.2012.00051
    Cherlin, A.J. (1998). Marriage and marital dissolution among Black Americans. Journal of Comparative Family Studies, 29, 147-158.
    Cohen, E.L. (2009). Naming and claiming cancer among African American women: An application of problematic integration theory. Journal of Applied Communication Research, 37, 397-417. doi:10.1080/00909880903233176
    Eisenberger, N.I., & Cole, S.W. (2012). Social neuroscience and health: Neurophysiological mechanisms linking social ties with physical health. Nature Neuroscience, 15, 669-674. doi:10.1038/nn.3086
    Fatone, A.M., Moadel, A.B., Foley, F.W., Fleming, M., & Jandorf, L. (2007). Urban voices: The quality-of-life experience among women of color with breast cancer. Palliative and Supportive Care, 5, 115-125. doi:10.10170S1478951507070186
    Flynn, P.M., Betancourt, H., & Ormseth, S.R. (2011). Culture, emotion, and cancer screening: An integrative framework for investigating health behavior. Annals of Behavioral Medicine, 42, 79-90. doi:10.1007/s12160-011-9267-z
    Fowler, B.A. (2007). The influence of social support relationships on mammography screening in African-American women. Journal of National Black Nurses' Association, 18(1), 21-29.
    Gallia, K.S., & Pines, E.W. (2009). Narrative identity and spirituality of African American churchwomen surviving breast cancer survivors. Journal of Cultural Diversity, 16, 50-55.
    Gates, M.F., Lackey, N.R., & Brown, G. (2001). Caring demands and delay in seeking care in African American women newly diagnosed with breast cancer: An ethnographic, photographic study. Oncology Nursing Forum, 28, 529-537.
    Gladding, S.T. (2006). The counseling dictionary: Concise definitions of frequently used terms (2nd ed.). Upper Saddle River, NJ: Pearson Education.
    Grange, C.M., Matsuyama, R.K., Ingram, K.M., Lyckholm, L.J., & Smith, T.J. (2008). Identifying supportive and unsupportive responses of others: Perspectives of African American and Caucasian cancer patients. Journal Of Psychosocial Oncology, 26, 81-99. doi:10.1300/J077v26n01_06
    Greitemeyer, T., Fischer, P., & Kastenmüller, A. (2012). The effects of social exclusion on confirmatory information processing. European Journal of Social Psychology, 42, 462-469. doi:10.1002/ejsp.1851
    Gullatte, M.M., Brawley, O., Kinney, A., Powe, B., & Mooney, K. (2010). Religiosity, spirituality, and cancer fatalism beliefs on delay in breast cancer diagnosis in African American women. Journal of Religion and Health, 49, 62-72. doi:10.1007/s10943-008-9232-8
    Hamilton, J.B., Moore, C.E., Powe, B.D., Agarwal, M., & Martin, P. (2010). Perceptions of support among older African American cancer survivors. Oncology Nursing Forum, 37, 484-493. doi:10.1188/10.ONF.484-493
    Hamilton, J.B., & Sandelowski, M. (2003). Living the golden rule: Reciprocal exchanges among African Americans with cancer. Qualitative Health Research, 13, 656-674.
    Hamilton-Mason, J., Hall, J.C., & Everett, J.E. (2009). And some of us are braver: Stress and coping among African American women. Journal of Human Behavior in the Social Environment, 19, 463-482. doi:10.1080/10911350902832142
    Hawkins, N.A., Smith, T., Zhao, L., Rodriguez, J., Berkowitz, Z., & Stein, K.D. (2010). Health-related behavior change after cancer: Results of the American Cancer Society's studies of cancer survivors. Journal of Cancer Survivorship: Research and Practice, 4, 20-32. doi:10.1007/s11764-009-0104-3
    Henderson, P.D., Gore, S.V., Davis, B.L., & Condon, E.H. (2003). African American women coping with breast cancer: A qualitative analysis. Oncology Nursing Forum, 30, 641-647. doi:10.1188/03.ONF.641-647
    Hetherington, J.A., & Stoppard, J.M. (2002). The theme of disconnection in adolescent girls' understanding of depression. Journal of Adolescence, 25, 619-629. doi:10.1006/jado.2002.0509
    Joiner, T.E., Jr., Lewinsohn, P.M., & Seeley, J.R. (2002). The core of loneliness: Lack of pleasurable engagement—more so than painful disconnection—predicts social impairment, depression onset, and recovery from depressive disorders among adolescents. Journal of Personality Assessment, 79, 472-491. doi:10.1207/S15327752JPA7903_05
    Kroenke, C.H., Kubzansky, L.D., Schernhammer, E.S., Holmes, M.D., & Kawachi, I. (2006). Social networks, social support, and survival after breast cancer diagnosis. Journal of Clinical Oncology, 24, 1105-1111. doi:10.1200/JCO.2005.04.2846
    Lackey, N.R., Gates, M.F., & Brown, G. (2001). African American women's experiences with the initial discovery, diagnosis, and treatment of breast cancer. Oncology Nursing Forum, 28, 519-527.
    Lannin, D.R., Mathews, H.F., Mitchell, J., & Swanson, M.S. (2002). Impacting cultural attitudes in African-American women to decrease breast cancer mortality. American Journal of Surgery, 184, 418-423. doi:10.1016/S0002-9610(02)01009-7
    Laplanche, J., & Pontalis, J.B. (1974). Language of Psychoanalysis (D. Nicholson-Smith, Trans.). New York, NY: W.W. Norton.
    Lewis, P.E., Sheng, M., Rhodes, M.M., Jackson, K.E. & Schover, L.R. (2012). Psychosocial concerns of young African American breast cancer survivors. Journal of Psychosocial Oncology, 30, 168-184. doi:10.1080/07347332.2011.651259
    López, E.D., Eng, E., Randall-David, E., & Robinson, N. (2005). Quality-of-life concerns of African American breast cancer survivors within rural North Carolina: Blending the techniques of photovoice and grounded theory. Qualitative Health Research, 15, 99-115. doi:10.1177/1049732304270766
    Matthews, A.K., Tejeda, S., Johnson, T.P., Berbaum, M.L. & Manfredi, C. (2012). Correlates of quality of life among African American and white cancer survivors. Cancer Nursing, 35, 355-364. doi:10.1097/NCC.0b013e31824131d9
    Miller, J.B. (1976). Toward a new psychology of women. Boston, MA: Beacon Press.
    Muhajarine, N., & Vu, L.T. (2009). Neighbourhood contexts and low birthweight: Social disconnection heightens single parents risks in Saskatoon. Canadian Journal of Public Health, 100, 130-134.
    Phillips, J., & Cohen, M.Z. (2011). The meaning of breast cancer risk for African American women. Journal of Nursing Scholarship, 43, 239-247.
    Poindexter, C. (2001). "I'm still blessed": The assets and needs of HIV-affected caregivers over fifty. Families in Society: The Journal of Contemporary Human Services, 82, 525-536. doi:10.1606/1044-3894.172
    Porter, L.S., Clayton, M.F., Belyea, M., Mishel, M., Gil, K.M., & Germino, B.B. (2006). Predicting negative mood state and personal growth in African American and White long-term breast cancer survivors. Annals of Behavioral Medicine, 31, 195-204. doi:10.1207/s15324796abm3103_1
    Rando, T.A. (Ed.). (1986). Parental loss of a child. Champaign, IL: Research Press.
    Roxborough, H.M., Hewitt, P.L., Kaldas, J., Flett, G.L., Caelian, C.M., Sherry, S., & Sherry, D.L. (2012). Perfectionistic self-presentation, socially prescribed perfectionism, and suicide in youth: A test of the perfectionism social disconnection model. Suicide and Life-Threatening Behavior, 42, 217-233. doi:10.1111/j.1943-278X.2012.00084.x
    Russell, K.M., Monahan, P., Wagle, A., & Champion, V. (2007). Differences in health and cultural beliefs by stage of mammography screening adoption in African American women. Cancer, 109(Suppl.), 386-395. doi:10.1002/cncr.22359
    Russell, K.M., Von Ah, D.M., Giesler, R.B., Storniolo, A.M., & Haase, J.E. (2008). Quality of life of African American breast cancer survivors: How much do we know? Cancer Nursing, 31, E36-E45. doi:10.1097/01.NCC.0000339254.68324.d7
    Salant, T., & Gehlert, S. (2008). Collective memory, candidacy, and victimisation: Community epidemiologies of breast cancer risk. Sociology of Health and Illness, 30, 599-615.
    Sanders, L.D., Wilmoth, M.C., & Lowry, B. (2004). Overcoming: Breast cancer and its effect on intimacy in middle aged African-American women. Journal Of National Black Nurses' Association, 15(2), 32-39.
    Shapiro, J.P., McCue, K., Heyman, E.N., Dey, T., & Haller, H.S. (2010). Coping-related variables associated with individual differences in adjustment to cancer. Journal of Psychosocial Oncology, 28, 1-22. doi:10.1080/07347330903438883
    Shelby, R.A., Crespin, T.R., Wells-Di Gregorio, S.M., Lamdan, R.M., Siegel, J.E., & Taylor, K.L. (2008). Optimism, social support, and adjustment in African American women with breast cancer. Journal of Behavioral Medicine, 31, 433-444. doi:10.1007/s10865-008-9167-2
    Swinney, J.E., & Dobal, M.T. (2011). Older African American women's beliefs, attitudes, and behaviors about breast cancer. Research in Gerontological Nursing, 4, 9-18. doi:10.3928/19404921-20101207-01
    Thomas, E. (2006). Ring of silence: African American women's experiences related to their breasts and breast cancer screening. Qualitative Report, 11, 350-373.
    Thomas, E.C. (2004). African American women's breast memories, cancer beliefs, and screening behaviors. Cancer Nursing, 27, 295-302.
    Vona-Davis, L., & Rose, D.P. (2009). The influence of socioeconomic disparities on breast cancer tumor biology and prognosis: A review. Journal of Women's Health, 18, 883-893. doi:10.1089/jwh.2008.1127
    Von Ah, D.M., Russell, K.M., Carpenter, J., Monahan, P.O., Qianqian, Z., Tallman, E., … Champion, V.L. (2012). Health-related quality of life of African American breast cancer survivors compared with healthy African American women. Cancer Nursing, 35, 337-346. doi:101097/NCC.0b013e3182393de3
    Walker, L.O., & Avant, K.C. (1994). Strategies for theory construction in nursing (3rd ed.). Upper Saddle River, NJ: Prentice Hall.
    Walker, M. (2004). Race, self, and society: Relational challenges in a culture of disconnection. In J.V. Jordan, M. Walker, & L.M. Hartling (Eds.), The complexity of connection: Writings from the Stone Center's Jean Baker Miller Training Institute (pp. 90-102). New York, NY: Guildford Press.
    Way, B.M., Taylor, S.E., & Eisenberger, N.I. (2009). Variation in the mu-opioid receptor gene (OPRM1) is associated with dispositional and neural sensitivity to social rejection. Proceedings of the National Academy of Sciences of the United States of America, 106, 15079-15084. doi:10.1073pnas.0812612106
    Wilmoth, M.C., & Sanders, L.D. (2001). Accept me for myself: African American women's issues after breast cancer. Oncology Nursing Forum, 28, 875-879.
    Woods-Giscombé, C.L. (2010). Superwoman schema: African American women's views on stress, strength, and health. Qualitative Health Research, 20, 668-683. doi:10.1177/1049732310361892
    Yoo, G.J., Aviv, C., Levine, E.G., Ewing, C., & Au, A. (2010). Emotion work: Disclosing cancer. Supportive Care in Cancer, 18, 205-215. doi:10.1007/s00520-009-0646-y
    Zollinger, T.W., Champion, V.L., Monahan, P.O., Steele-Moses, S.K., Ziner, K.W., Zhao, Q., … Russell, K.M. (2010). Effects of personal characteristics on African-American women's beliefs about breast cancer. American Journal of Health Promotion, 24, 371-377. doi:10.4278/ajhp.07031727