E33: Breast Cancer Survivors as Enablers of Change: Results from a Pilot Feasibility Study of a Stigma Reduction Intervention in Tanzania

In Sub-Saharan Africa, majority of patients are diagnosed with advanced breast cancer. Cancer-related stigma is one of the key drivers. Survivors challenge the assumption that cancer equals death and are uniquely positioned to facilitate stigma reduction in this region. Therefore, this study’s purpose was to assess the impact of a survivor-led stigma reduction intervention on intrapersonal stigma and treatment adherence of women newly diagnosed with breast cancer.

Methods:

Breast cancer survivors were trained on breast cancer knowledge and motivational interviewing. A trained survivor delivered a stigma reduction intervention (standardized flipchart breast education talk, personal testimony, and motivational interviewing) to a newly diagnosed breast cancer patient.  Patients completed a pre and post intervention knowledge survey and intrapersonal stigma scale which were analyzed via Fisher’s exact test and Wilcoxon rank-sum tests. 

Results:

Thirty patients with an average age of 55 participated in this study; 25 (83.3%) were Christian, 27 (90%) completed at least elementary education, and 11 (36.7%) were married. Four (13.3%) of the patients were employed. Availability of electricity, piped water, television, and refrigerator at home were reported by 26 (86.7%), 5 (16.7%), 12 (40%), and 6 (20%) of the patients, respectively. Among the newly diagnosed women, there was a significant increase in breast cancer knowledge (median overall correct: 27.27% to 84.84% pre-post, p < 0.001) and a significant decrease in intrapersonal stigma following the intervention (median total stigma score: 75 (pre) to 52.5 (post), p = 0.003). Furthermore, all participants were willing to pursue hospital-based breast cancer treatment after undergoing the intervention. Major factors for this included belief in evidence-based medicine (n = 9, 30%), worse outcomes or care delays caused by previous traditional medicine use (n = 10, 33.3%), and the influence of survivors (n = 6, 20%).

Conclusions:

Leveraging breast cancer survivors through a brief, one-time intervention meaningfully increased knowledge and decreased stigma for newly diagnosed women with breast cancer. This implies that survivors are a powerful group to combat lack of knowledge and stigma in community and healthcare settings. Expanding the scope and scale of this intervention holds promise for improving treatment-seeking behavior and ultimately breast cancer outcomes.