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Nechuta S, Chen WY, Goerge A, Boopathy D, Sanderson M. The role of breast cancer-related arm lymphedema in physical functioning and physical activity participation among long-term African American breast cancer survivors. Support Care Cancer 2024; 32:446. [PMID: 38900224 DOI: 10.1007/s00520-024-08648-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE Breast cancer-related arm lymphedema (BCRL) is a common chronic and debilitating condition that involves accumulation of lymphatic fluid in the arm or hand. Limited data are available on BCRL in African American women. Lack of physical activity (PA) and poor physical functioning (PF) are both associated with increased morbidity and mortality among breast cancer survivors. We examined the association of BCRL with PA and PF among African American breast cancer survivors. METHODS 323 African American women who previously participated in a case-only study in three states (TN, GA, SC) completed a survivorship-focused questionnaire (mean: 4.2 years post-diagnosis) in 2015-2016. Validated measures were used to determine BCRL, PF, and PA. Adjusted binary logistic regression models estimated ORs and 95% CIs for the association of BCRL and meeting PA guidelines (≥ 150 min/week), while multinomial logistic regression was used for PF and PA (minutes/week) categorized based on tertiles. RESULTS Approximately 32% reported BCRL since diagnosis; 25.4% reported BCRL in the last 12-months. About 26% and 50% reported that BCRL interfered with exercise and ability to do daily activities, respectively. The mean PF among those with BCRL was 51.0(SD:29.0) vs. 68.5(SD:30.1) among those without BCRL. BCRL was associated with lower PF (adjusted-OR for tertile 2: 2.12(95% CI:1.03-4.36) and adjusted-OR for tertile 1: 2.93(95% CI:1.44-5.96)). CONCLUSIONS BCRL was associated with lower PF among long-term African American breast cancer survivors. Continued monitoring by health care professionals and increased education and behavioral interventions to support PA and improved PF among survivors living with BCRL are warranted.
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Affiliation(s)
- Sarah Nechuta
- School of Interdisciplinary Health, College of Health Professions, Grand Valley State University, 500 Lafayette Street, Grand Rapids, MI, USA.
| | - Wendy Y Chen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Deptartment of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Ally Goerge
- School of Interdisciplinary Health, College of Health Professions, Grand Valley State University, 500 Lafayette Street, Grand Rapids, MI, USA
| | - Deepika Boopathy
- School of Interdisciplinary Health, College of Health Professions, Grand Valley State University, 500 Lafayette Street, Grand Rapids, MI, USA
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA
| | - Maureen Sanderson
- School of Medicine, Meharry Medical College, 1005 Dr. DB Todd Jr. Blvd, Nashville, TN, USA
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Lee E, Hines RB, Zhu J, Nam E, Rovito MJ. Racial and Ethnic Variations in Pre-Diagnosis Comorbidity Burden and Health-Related Quality of Life Among Older Women with Breast Cancer. J Racial Ethn Health Disparities 2024; 11:1587-1599. [PMID: 37219735 DOI: 10.1007/s40615-023-01634-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND This study examined racial/ethnic differences in comorbidity burden and health-related quality of life (HRQOL) among older women before breast cancer diagnosis. METHODS From Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS) linked data resource, 2513 women diagnosed with breast cancer at ≥ 65 years between 1998 and 2012 were identified and grouped based on comorbidity burden using latent class analysis. Pre-diagnosis HRQOL was measured using SF-36/VR-12 and summarized to physical (PCS) and mental component summary (MCS) scores. The adjusted least-square means and 95% confidence intervals were obtained according to comorbidity burden and race/ethnicity. The interactions were examined with 2-way ANOVA. RESULTS The latent class analysis revealed four comorbid burden classes, with Class 1 being the most healthy and Class 4 being the least healthy. African American (AA) and Hispanic women were more likely to be in Class 4 than non-Hispanic white (NHW) women (18.6%, 14.8%, and 8.3%, respectively). The mean PCS was 39.3 and differed by comorbidity burden and race/ethnicity (Pinteraction < 0.001). There were no racial/ethnic differences in Classes 1 and 2, while NHW women reported significantly lower PCS scores than AA women in Classes 3 and 4. The mean MCS was 51.4 and differed by comorbidity burden and race/ethnicity (Pinteraction < 0.001). There was no racial/ethnic difference in Class 3; however, AA women reported lower MCS scores than Asian/Pacific Islander women in Class 1, and AA and Hispanic women reported lower MCS scores than NHW women in Classes 2 and 4. CONCLUSION Comorbidity burden negatively affected HRQOL but differentially for racial/ethnic groups. As the comorbidity burden increases, NHW women are more concerned with physical HRQOL, while AA and Hispanic women are more concerned with mental HRQOL.
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Affiliation(s)
- Eunkyung Lee
- Department of Health Sciences, University of Central Florida College of Health Professions and Sciences, 4364 Scorpius Street, Orlando, Orlando, FL, USA.
| | - Robert B Hines
- Department of Population Health Sciences, University of Central Florida College of Medicine, FL, Orlando, USA
| | - Jianbin Zhu
- Department of Statistics and Data Science, University of Central Florida College of Sciences, Orlando, FL, USA
- Research Institute, Advent Health, Orlando, FL, USA
| | - Eunji Nam
- Department of Social Welfare, Incheon National University, Incheon, South Korea
| | - Michael J Rovito
- Department of Health Sciences, University of Central Florida College of Health Professions and Sciences, 4364 Scorpius Street, Orlando, Orlando, FL, USA
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Robins VR, Gelcich S, Absolom K, Velikova G. The impact of age on physical functioning after treatment for breast cancer, as measured by patient-reported outcome measures: A systematic review. Breast 2024; 76:103734. [PMID: 38691921 PMCID: PMC11070762 DOI: 10.1016/j.breast.2024.103734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/04/2024] [Accepted: 04/15/2024] [Indexed: 05/03/2024] Open
Abstract
PURPOSE This systematic review aims to explore the impact of age on physical functioning post-treatment for early-stage, locally advanced, or locally recurrent breast cancer, as measured by patient-reported outcome measures (PROMs), identify PROMs used and variations in physical functioning terms/labels. METHODS MEDLINE, EmBase, PsycINFO, CINAHL and AMED were searched, along with relevant key journals and reference lists. Risk of bias (quality) assessment was conducted using a Critical Appraisal Skills Programme checklist. Data was synthesised through tables and narrative. RESULTS 28,207 titles were extracted from electronic databases, resulting in 44 studies with age sub-groups, and 120 without age sub-groups. Of those with findings on the impact of age, there was variability in the way findings were reported and 21 % found that age did not have a significant impact. However, 66 % of the studies found that with older age, physical functioning declined post-treatment. Comorbidities were associated with physical functioning declines. However, findings from sub-groups (breast cancer stage, treatment type and time post-treatment) lacked concordance. Twenty-eight types of PROM were used: the EORTC QLQ-C30 was most common (50.6 %), followed by the SF-36 (32.3 %). There were 145 terms/labels for physical functioning: 'physical functioning/function' was used most often (82.3 %). CONCLUSIONS Findings point towards an older age and comorbidities being associated with more physical functioning declines. However, it was not possible to determine if stage, treatment type and time since treatment had any influence. More consistent use of the terminology 'physical functioning/function' would aid future comparisons of study results.
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Affiliation(s)
- V R Robins
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, England, UK.
| | - S Gelcich
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, England, UK.
| | - K Absolom
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, England, UK; Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK.
| | - G Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, England, UK; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, England, UK.
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You KL, Sereika SM, Bender CM, Hamilton JB, Mazanec SR, Brufsky A, Rosenzweig MQ. Health-related quality of life over chemotherapy course among individuals with early-stage breast cancer: the association of social determinants of health and neighborhood socioeconomic disadvantage. Support Care Cancer 2024; 32:224. [PMID: 38472437 DOI: 10.1007/s00520-024-08429-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/08/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE This study aimed to examine relationships between health-related quality of life (HRQOL), social determinants of health, and neighborhood socioeconomic disadvantage in individuals with early-stage breast cancer (ESBC) during chemotherapy. METHODS This is a longitudinal study that recruited Black and White women with ESBC receiving chemotherapy. Participants completed questionnaires recording their sociodemographic information at baseline and the Functional Assessment of Cancer Therapy-General (FACT-G) to report their HRQOL before each chemotherapy cycle. Linear mixed modeling was employed to examine the associations between FACT-G scores, self-reported race, and area deprivation index (ADI) before and at the last chemotherapy cycle, with the duration of chemotherapy treatment as a covariate. RESULTS A total of 84 Black and 146 White women with ESBC completed the surveys. Linear mixed modeling results suggested that women with ESBC who reported being Black experienced significantly worse physical well-being than those who reported being White throughout chemotherapy, with a 0.22-point lower average (p = 0.02). Both Black and White women with ESBC experienced decreased functional well-being over the chemotherapy, and Black women consistently reported lower scores than White women, with the change in functional well-being over time differing between racial groups (p = 0.03). Participants' ADI national percentiles were not significantly associated with their HRQOL throughout chemotherapy. CONCLUSIONS These findings underscore possible racial differences in some dimensions of HRQOL during chemotherapy among women with ESBC. Future research should consider further assessing life stressors and past experiences of discrimination and racism that may contribute to these disparities and guide proactive interventions.
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Affiliation(s)
- Kai-Lin You
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA, USA.
| | - Susan M Sereika
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA, USA
| | - Catherine M Bender
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA, USA
| | - Jill B Hamilton
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Susan R Mazanec
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Adam Brufsky
- Division of Hematology/Oncology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Quimby AE, Salmon MK, Zhao CH, Y K Lee J, Bigelow DC, Ruckenstein MJ, Brant JA. Socioeconomic determinants impact quality of life at vestibular schwannoma diagnosis. J Clin Neurosci 2024; 119:122-128. [PMID: 38007900 DOI: 10.1016/j.jocn.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/06/2023] [Accepted: 11/23/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Socioeconomic variables including race, education, and income have been shown to affect vestibular schwannoma incidence, treatment, and outcomes. We sought to determine the impact of socioeconomic factors on quality of life at the time of vestibular schwannoma diagnosis. METHODS Retrospective cohort study conducted at a tertiary academic center. All patients evaluated for vestibular schwannoma from March 1, 2010 to December 31, 2021 who completed at least one Penn Acoustic Neuroma Quality of Life (PANQOL) questionnaire at presentation or prior to any intervention were included. PANQOL scores were compared across income quintiles, racial groups, and health insurance categories. RESULTS Two-hundred and ninety-six patients who had non-missing information on variables of interest were included. Compared to White/Caucasian patients (84.5 %), Black/African American patients (4.7 %) had significantly lower PANQOL total scores (b = -12.8[-21.7, -4.0], p = 0.005). Compared to patients with Commercial insurance (53 %), patients who were Uninsured/ Self-pay (1.7 %) had significantly lower PANQOL total scores (b = -16.7[-31.4, -1.9], p = 0.027). Patients in higher income quintiles had significantly higher PANQOL total scores (b = 11.7[3.9, 19.5], p = 0.004 comparing highest income quintile to lowest). After controlling for potential confounders, income quintile (b = 9.6[1.3, 17.9], p = 0.023 comparing highest quintile to lowest) and insurance (b = -17.0[-31.9, -21], p = 0.025 comparing Uninsured/Self-pay to Commercial insurance) remained predictors of total PANQOL score. CONCLUSIONS Socioeconomic factors including race, health insurance, and income appear to contribute to quality of life at the time of vestibular schwannoma diagnosis. These variables are interrelated and the effects of race may be mediated in part by differences in income and health insurance coverage.
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Affiliation(s)
- Alexandra E Quimby
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA; Department of Otolaryngology and Communication Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Mandy K Salmon
- Department of Otolaryngology, Oregon Health & Science University, Portland, OR, USA
| | | | - John Y K Lee
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas C Bigelow
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael J Ruckenstein
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason A Brant
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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Maxwell CM, Bhat A, Falls SJ, Yin Y, Wagner PL, Bartlett DL, Allen CJ. Socioeconomic Factors Predict Long-Term Quality of Life of Cancer Survivors: An International Survey. J Surg Res 2024; 293:389-395. [PMID: 37806226 DOI: 10.1016/j.jss.2023.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 08/16/2023] [Accepted: 09/03/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Despite advances in cancer treatment, the quality of life (QOL) of survivors varies significantly. We assessed the correlation between socioeconomic factors and long-term QOL in a global cohort of cancer survivors. MATERIALS AND METHODS Patients were offered surveys via online support groups. Using the Short Form-12 validated questionnaire, physical QOL (PQOL) and mental QOL (MQOL) well-being were compared to the general population. Socioeconomic factors were assessed with regression analysis for impact on QOL. RESULTS Seven hundred eighty two survivors from six continents responded. They were 57 ± 13 y and 68% female, 90.8% White, with 43 distinct cancer diagnoses. All survivors had PQOL and MQOL scores lower than the general population. Lower education level, household income, and non-White race all correlated with reduced PQOL and/or MQOL. Age was negatively correlated with PQOL (r = -0.08, P = 0.03) and positively correlated with MQOL (r = 0.142, P < 0.001). Care at large regional/academic centers was associated with higher MQOL (42 ± 14 versus 38 ± 11, P = 0.005). Age (β = -0.1, P = 0.04), education (β = 1.1, P = 0.005), and income (β = 2.0, P < 0.001) were predictors of PQOL, while age (β = 0.2, P < 0.001), income (β = 1.7, P = 0.002), and community hospital care (β = -3.6, P = 0.013) were predictors of MQOL. CONCLUSIONS In a large international survey of cancer survivors, we identified socioeconomic factors and their associations with QOL. Further work should be directed to provide durable support across all socioeconomic classes.
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Affiliation(s)
- Conor M Maxwell
- Allegheny Health Network Singer Research Institute, Pittsburgh, Pennsylvania
| | - Akash Bhat
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Samantha J Falls
- Allegheny Health Network Singer Research Institute, Pittsburgh, Pennsylvania
| | - Yue Yin
- Allegheny Health Network Singer Research Institute, Pittsburgh, Pennsylvania
| | - Patrick L Wagner
- Division of Surgical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania
| | - David L Bartlett
- Division of Surgical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania
| | - Casey J Allen
- Division of Surgical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania.
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Conti I, Davidson M, Cutress RI, McIntosh SA, Head MG. Global trends in psycho-oncology research investments 2016-2020: A content analysis. Psychooncology 2024; 33:e6273. [PMID: 38141045 DOI: 10.1002/pon.6273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE An estimated one-third of cancer patients experience a clinically significant psychological disorder, however it is unclear to what extent this is reflected in research funding. To address this a systematic analysis the allocation of psycho-oncology research funding globally between 2016 and 2020 was conducted. METHODS A global dataset of 66,388 cancer research awards, from 2016 to 2020 inclusive and totalling $24.5 billion USD was assembled from public and philanthropic funders. Each award was previously categorised by cancer site type and research theme, including psychosocial research and these awards were further sub-categorised for this analysis. RESULTS There was $523m of funding awarded for psychological research across 1122 studies: 2.14% of all cancer research funding during this period ($24.5 billion). Median funding per award was $97,473 (IQR $36,864 - $453,051). Within psychological research, mental health received most funding ($174m, 33.5% of psychological funding). Cognitive behavioural therapy (CBT) focused research was the specific psychological support with the highest proportion of funding at $14 million. By country of funder, the USA provided most investment ($375.5 m, 71.8%). CONCLUSIONS Psycho-oncology research received relatively little funding, for example, when compared with pre-clinical cancer research. There needs to be a shift from pre-clinical science to research that benefits cancer patients in the shorter-term. Low- and middle-income countries, and ethnic minorities in higher-income settings, were underrepresented despite having a large cancer burden, indicating inequities that need to be addressed.
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Affiliation(s)
| | - Mitchell Davidson
- Patrick G Johnston Centre for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Ramsey I Cutress
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Stuart A McIntosh
- Patrick G Johnston Centre for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Michael G Head
- Clinical Informatics Research Unit, Faculty of Medicine, Southampton, UK
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Black LL, Peugh JL, Pai ALH. Health Competence Beliefs and Health-Related Quality of Life Among Adolescent and Young Adult Survivors of Childhood Cancer and Healthy Peers. J Adolesc Young Adult Oncol 2023; 12:653-661. [PMID: 36862533 DOI: 10.1089/jayao.2022.0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Purpose: Adolescent and young adult (AYA) survivors of childhood cancer are at risk for late-effects that can impact how one perceives their health and well-being. Understanding beliefs about health competence and well-being among survivors can help identify support needs and increase adherence to long-term follow-up guidelines. This study examined differences in health competence beliefs and health-related quality of life (HRQOL) between AYA survivors of childhood cancer and matched healthy peers. In addition, the relationship between health competence beliefs and HRQOL, as well as the moderating effect of cancer survivorship, was investigated. Methods: Survivors (n = 49) and healthy peers (n = 54) completed measures about health competence beliefs (i.e., Health Perception, Cognitive Competence, Autonomy, and School/Work Functioning) and HRQOL. Multiple group analysis was used to investigate differences in health competence beliefs and HRQOL between survivors and peers. Multivariate multiple regression analyses were used to investigate the relationships between health competence beliefs and HRQOL. Finally, a history of cancer was examined as a possible moderator using additional multivariate multiple regression analyses. Results: Survivors reported significantly lower Health Perception, Cognitive Competence, Autonomy, and School/Work Functioning scores compared to healthy peers. Among both groups, Health Perception and Cognitive Competence scores were associated with multiple domains of HRQOL. These relationships were not moderated by having a history of cancer. Conclusions: Perceptions about one's health and cognitive abilities may impact HRQOL among AYA survivors of childhood cancer and health peers. Identifying those at risk for poor well-being may help to guide interventions aimed at increasing adherence to medical recommendations.
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Affiliation(s)
- Lora L Black
- Department of Psychiatry & Behavioral Sciences, University of Kansas Medical Center, Kansas City, Kansas, USA
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - James L Peugh
- Department of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati Medical School, Cincinnati, Ohio, USA
| | - Ahna L H Pai
- Department of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati Medical School, Cincinnati, Ohio, USA
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Johnson HM, Lin H, Shen Y, Diego EJ, Krishnamurthy S, Yang WT, Smith BD, Valero V, Lucci A, Sun SX, Shaitelman SF, Mitchell MP, Boughey JC, White RL, Rauch GM, Kuerer HM. Patient-Reported Outcomes of Omission of Breast Surgery Following Neoadjuvant Systemic Therapy: A Nonrandomized Clinical Trial. JAMA Netw Open 2023; 6:e2333933. [PMID: 37707811 PMCID: PMC10502524 DOI: 10.1001/jamanetworkopen.2023.33933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/07/2023] [Indexed: 09/15/2023] Open
Abstract
Importance Patients should have an active role in decisions about pursuing or forgoing specific therapies in treatment de-escalation trials. Objective To evaluate longitudinal patient-reported outcomes (PROs) encompassing decisional comfort and health-related quality of life (HRQOL) among patients who elected to enroll in a clinical trial evaluating radiotherapy alone, without breast surgery, for invasive breast cancers with exceptional response to neoadjuvant systemic therapy (NST). Design, Setting, and Participants Prospective, single-group, phase 2 clinical trial at 7 US medical centers. Women aged 40 years or older with invasive cT1-2 N0-1 M0 triple-negative or human epidermal growth factor receptor 2 (ERBB2)-positive breast cancer with no pathologic evidence of residual disease following standard NST enrolled from March 6, 2017, to November 9, 2021. Validated PRO measures were administered at baseline and 6, 12, and 36 months post-radiotherapy. Data were analyzed from January to February 2023. Interventions PRO measures included the Decision Regret Scale (DRS), Functional Assessment of Cancer Therapy-Lymphedema (FACT-B+4), and Breast Cancer Treatment Outcomes Scale (BCTOS). Main Outcomes and Measures Changes in PRO measure scores and subscores over time. Results Among 31 patients, the median (IQR) age was 61 (56-66) years, 26 (84%) were White, and 26 (84%) were non-Hispanic. A total of 15 (48%) had triple-negative disease and 16 (52%) had ERBB2-positive disease. Decisional comfort was high at baseline (median [IQR] DRS score 10 [0-25] on a 0-100 scale, with higher scores indicating higher decisional regret) and significantly increased over time (median [IQR] DRS score at 36 months, 0 [0-20]; P < .001). HRQOL was relatively high at baseline (median [IQR] FACT-B composite score 121 [111-134] on a 0-148 scale, with higher scores indicating higher HRQOL) and significantly increased over time (median [IQR] FACT-B score at 36 months, 128 [116-137]; P = .04). Perceived differences between the affected breast and contralateral breast were minimal at baseline (median [IQR] BCTOS score 1.05 [1.00-1.23] on a 1-4 scale, with higher scores indicating greater differences) and increased significantly over time (median [IQR] BCTOS score at 36 months, 1.36 [1.18-1.64]; P < .001). At 36 months postradiotherapy, the cosmetic subscore was 0.45 points higher than baseline (95% CI, 0.16-0.74; P = .001), whereas function, pain, and edema subscores were not significantly different than baseline. Conclusions and Relevance In this nonrandomized phase 2 clinical trial, analysis of PROs demonstrated an overall positive experience for trial participants, with longitudinal improvements in decisional comfort and overall HRQOL over time and minimal lasting adverse effects of therapy. Trial Registration ClinicalTrials.gov Identifier: NCT02945579.
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Affiliation(s)
- Helen M. Johnson
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Heather Lin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Emilia J. Diego
- Division of Breast Surgery, University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, Pennsylvania
| | | | - Wei T. Yang
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston
| | - Benjamin D. Smith
- Department of Breast Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Vicente Valero
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Anthony Lucci
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Susie X. Sun
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Simona F. Shaitelman
- Department of Breast Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Melissa P. Mitchell
- Department of Breast Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Judy C. Boughey
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Richard L. White
- Division of Surgical Oncology, Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Gaiane M. Rauch
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston
| | - Henry M. Kuerer
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
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Manne S, Devine K, Hudson S, Kashy D, O’Malley D, Paddock LE, Bandera EV, Llanos AAM, Fong A, Singh N, Frederick S, Evens AM. Factors associated with health-related quality of life in a cohort of cancer survivors in New Jersey. BMC Cancer 2023; 23:664. [PMID: 37452275 PMCID: PMC10349446 DOI: 10.1186/s12885-023-11098-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/21/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Although there is extensive literature on correlates of health-related quality of life (HRQoL) among cancer survivors, there has been less attention paid to the role of socioeconomic disadvantage and survivorship care transition experiences in HRQoL. There are few large cohort studies that include a comprehensive set of correlates to obtain a full picture of what is associated with survivors' HRQ0L. This cohort study of recent cancer survivors in New Jersey aimed to explore the association between social determinants of health, health history, health behaviors, survivorship care experiences, and psychosocial factors in HRQoL. METHODS Eligible survivors were residents of New Jersey diagnosed with genitourinary, female breast, gynecologic, colorectal, lung, melanoma, or thyroid cancers. Participants completed measures of social determinants, health behaviors, survivorship care experiences, psychosocial factors, and HRQoL. Separate multiple regression models predicting HRQoL were conducted for each of the five domains (social determinants, health history, health behaviors, survivorship care experiences, psychosocial factors). Variables attaining statistical significance were included in a hierarchical multiple regression arranged by the five domains. RESULTS 864 cancer survivors completed the survey. Lower global HRQoL was associated with being unemployed, more comorbidities, a less healthy diet, lower preparedness for survivorship, more unmet support needs, and higher fear about cancer recurrence. Two psychosocial factors, unmet support needs and fear of recurrence, played the most important role in HRQoL, accounting for more than 20% of the variance. Both unmet support needs and fear of recurrence were significant correlates of physical, functional, and emotional HRQoL domains. CONCLUSIONS Interventions seeking to improve cancer survivors' HRQoL may benefit from improving coordinated management of comorbid medical problems, fostering a healthier diet, addressing unmet support needs, and reducing survivors' fears about cancer recurrence.
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Affiliation(s)
- Sharon Manne
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ USA
| | - Katie Devine
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ USA
| | - Shawna Hudson
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ USA
| | - Deborah Kashy
- Department of Psychology, College of Social Science, Michigan State University, East Lansing, MI USA
| | - Denalee O’Malley
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ USA
| | - Lisa E. Paddock
- Cancer Surveillance Research Program, Cancer Epidemiology Services, Department of Health, Rutgers Cancer Institute of New Jersey, New Jersey State Cancer Registry, New Brunswick, Trenton, New Jersey USA
| | | | | | - Angela Fong
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ USA
| | - Neetu Singh
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ USA
| | - Sara Frederick
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ USA
| | - Andrew M. Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ USA
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11
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Garza RH, Williams MY, Ntiri SO, Hampton MD, Yan AF. Intersectionality Impacts Survivorship: Identity-Informed Recommendations to Improve the Quality of Life of African American Breast Cancer Survivors in Health Promotion Programming. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912807. [PMID: 36232105 PMCID: PMC9564905 DOI: 10.3390/ijerph191912807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 05/31/2023]
Abstract
(1) Background: African American women breast cancer survivors face unique experiences that impact their quality of life as they transition beyond treatments. Experiences may be complicated by living at the intersection of systemically oppressed identities, including gender, race, social class, and cancer-related disability. Using the Black Feminist Thought (BFT) framework and the PEN-3 cultural model, this qualitative study sought to: (a) understand African American women breast cancer survivors' lived experiences; (b) examine how the multiple intersecting factors of race, gender, social class/socioeconomic status, and cancer-related disability impact their quality of life; and (c) inform future health promotion programming that is culturally relevant to AAWBCS to improve their quality of life. (2) Methods: Seven focus groups were conducted with 30 African American breast cancer survivors in a Midwestern metropolitan region. Focus groups were audiotaped and transcribed verbatim. Framework analyses were conducted to identify themes with NVivo qualitative analysis software. (3) Results: Four themes emerged: (a) caregiving roles provide both support and challenges for survivors, (b) the "strong Black woman" is inherent in survivor experiences, (c) intersectionality impacts survivorship, and (d) African American women resist oppression through culturally specific supports and advocacy. (4) Conclusions: The intervention point of entry should be at the peer support group level and centered on family and provide community-based support and services. Future research should move upstream to address social determinants of health, including racism, sexism, and ableism; there is a critical need to discuss how structural racism affects health care and develop interventions to address racial discrimination and racial bias in health care.
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Affiliation(s)
- Rose Hennessy Garza
- Joseph J Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI 53205, USA
| | - Michelle Y. Williams
- Division of Research, Patient Care Services, Stanford Healthcare, Palo Alto, CA 94304, USA
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Shana O. Ntiri
- Department of Family & Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | | | - Alice F. Yan
- Division of Research, Patient Care Services, Stanford Healthcare, Palo Alto, CA 94304, USA
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12
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Lake PW, Conley CC, Pal T, Sutton SK, Vadaparampil ST. Anxiety and depression among Black breast cancer survivors: Examining the role of patient-provider communication and cultural values. PATIENT EDUCATION AND COUNSELING 2022; 105:2391-2396. [PMID: 35440374 PMCID: PMC10777429 DOI: 10.1016/j.pec.2021.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/29/2021] [Accepted: 12/11/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Breast cancer survivors frequently experience anxiety and depression post-treatment. Patient-provider communication and cultural values may impact these psychological outcomes. We examined the impact of patient-provider communication and cultural values on anxiety and depression among Black breast cancer survivors. METHODS Using an observational, cross-sectional design, 351 survivors self-reported patient-provider communication (quality, confidence), cultural values (religiosity, collectivism, future time orientation), anxiety, and depression. Patients were categorized into high, moderate, and low levels of communication and cultural values. Separate linear regressions examined the effect of levels of communication and cultural values on anxiety and depression, controlling for sociodemographic variables. RESULTS A subset of breast cancer survivors reported clinically significant symptoms of anxiety (40%) and depression (20%). Communication was associated with anxiety (β = -0.14, p = 0.01) and depression (β = -0.10, p = 0.04). Specifically, women reporting higher levels of communication quality/confidence reported lower levels of anxiety and depression. There was a trend towards a significant association between cultural values and depression (β = -0.09, p = 0.06). CONCLUSIONS Black breast cancer survivors experience poor psychological functioning. Effective patient-provider communication may reduce anxiety and depression post-treatment. PRACTICE IMPLICATIONS Patient-provider relationships and patient empowerment may be key components of cancer survivorship. Special attention should be paid to patient-centered communication for Black breast cancer survivors.
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Affiliation(s)
- Paige W Lake
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, Tampa, FL, USA
| | - Claire C Conley
- Georgetown University, Department of Oncology, Washington, DC, USA
| | - Tuya Pal
- Vanderbilt University Medical Center, Department of Medicine, Nashville, TN, USA
| | - Steven K Sutton
- Moffitt Cancer Center, Department of Biostatistics and Bioinformatics, Tampa, FL, USA
| | - Susan T Vadaparampil
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, Tampa, FL, USA.
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13
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Rosenberg SM, O’Neill A, Sepucha K, Miller KD, Dang CT, Northfelt DW, Sledge GW, Schneider BP, Partridge AH. Quality of Life Following Receipt of Adjuvant Chemotherapy With and Without Bevacizumab in Patients With Lymph Node-Positive and High-Risk Lymph Node-Negative Breast Cancer. JAMA Netw Open 2022; 5:e220254. [PMID: 35226083 PMCID: PMC8886546 DOI: 10.1001/jamanetworkopen.2022.0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
IMPORTANCE Breast cancer treatment can impact not only short-term health but may also affect longer-term quality of life (QOL). OBJECTIVE To describe and evaluate factors associated with diminished QOL following completion of active treatment. DESIGN, SETTING, AND PARTICIPANTS This was a secondary analysis of a randomized clinical trial included patients with lymph node-positive or high-risk lymph node-negative breast cancer who had undergone definitive surgery and were enrolled in ECOG-ACRIN E5103, a multisite phase 3 trial. A survey was administered 18 months after enrollment to patients enrolled between January and June 2010. Final analysis of the data took place from March to December 2021. INTERVENTIONS Patients received adjuvant doxorubicin, cyclophosphamide, and paclitaxel with either bevacizumab or placebo. MAIN OUTCOMES AND MEASURES QOL and health status assessed with the EuroQol 5-Dimension 3-Levels (EQ-5D-3L), EQ-visual analog scale (EQ-VAS), and the Functional Assessment of Cancer Therapy-Breast Cancer, with arm subscale (FACT-B+4). Groups were compared by Fisher exact test, Wilcoxon rank sum, or Kruskal-Wallis test. Multivariable linear regression was used to assess factors independently associated with FACT-B scores. RESULTS Data at 18 months were available from 455 of 519 patients (87.7%) enrolled in the trial. Median (range) age at enrollment was 52 (25-76) years. No differences in QOL (median [range] FACT-B scores: group A, 123 [67-146]; group B, 114 [54-148]; group C, 117 [42-148]; P = .23) or health status (median [range] EQ-5D-3L index scores: group A, 0.83 [0.28-1.00]; group B, 0.83 [0.20-1.00]; group C, 0.83 [0.17-1.00], P = .80; median EQ-VAS: group A, 85 [20-100]; group B, 85 [0-100]; group C, 85 [0-100]; P = .79) were observed across treatment groups; results for subsequent analyses were therefore reported irrespective of primary treatment. Overall, half of patients (258 of 444 [58%]) reported at least some pain or discomfort; 170 (38%) reported symptoms of anxiety or depression. In multivariable analyses, mastectomy with radiation (vs breast conserving surgery) and Asian, Black, or American Indian or Alaska Native race (vs White race) were associated with lower QOL (mastectomy with radiation: coefficient: -5.5; 95% CI, -10.1 to -0.9; Asian, Black, or American Indian or Alaska Native race: coefficient: -7.3; 95% CI, -13.2, -1.4). CONCLUSIONS AND RELEVANCE In this study, the addition of bevacizumab to chemotherapy was not negatively associated with QOL at 18 months. A substantial proportion of participants reported problems related to pain or discomfort and anxiety or depression, demonstrating persistent consequences for physical and psychosocial well-being in this heavily treated population. Many problems reported are amenable to intervention, underscoring the need for timely referral to supportive resources, especially for women of color and those who have more extensive local therapy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00433511.
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Affiliation(s)
| | - Anne O’Neill
- Dana-Farber Cancer Institute, Boston, Massachusetts
- ECOG-ACRIN Biostatistics Center, Boston, Massachusetts
| | | | | | - Chau T. Dang
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - George W. Sledge
- Indiana University, Indianapolis
- Stanford University, Stanford, California
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14
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Nolan TS, Ivankova N, Carson TL, Spaulding AM, Dunovan S, Davies S, Enah C, Meneses K. Life after breast cancer: 'Being' a young African American survivor. ETHNICITY & HEALTH 2022; 27:247-274. [PMID: 31642349 DOI: 10.1080/13557858.2019.1682524] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/23/2019] [Indexed: 06/10/2023]
Abstract
Objective: In the United States, 26,534 young women (≤45 years) were diagnosed with breast cancer in 2017. Young African American (AA) women have higher incidence and mortality rates than Whites and Hispanics. Yet, few published studies describe survivorship (life after breast cancer diagnosis) experiences among this group. Here, we explore the lived experience of young AA breast cancer survivorship (via quality of life [QOL]).Design: This phenomenological study was framed by the QOL Applied to Breast Cancer model. Fifteen young AA survivors from the Southern U. S. participated in two semi-structured interviews. Methods of transcendental phenomenology were used for data collection and analysis.Results: Five themes emerged from participants' (mean age = 35 years; survivorship = 4 years) descriptions of survivorship experience: (1) actively managing spiritual self, (2) actively managing physical self, (3) actively managing psychological self, (4) actively managing social self, and (5) seeking survivorship knowledge. Participants perceived survivorship as a labile 'new normal' and 'ongoing struggle,' in which spirituality and survivorship knowledge were key to restructuring their lives.Conclusions: Survivorship among young AA survivors was more fluid and complex than the QOL model explained. Findings describe young AA breast cancer survivorship and indicate areas of potential strengths and distress. Healthcare providers and ancillary staff must exercise cultural competence to assess and anticipate young AA survivors' needs and concerns. Implementing targeted survivorship interventions, accounting for cultural contexts (e.g. high spirituality) and need for age-specific survivorship information, may improve QOL among young AA survivors.
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Affiliation(s)
- Timiya S Nolan
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Nataliya Ivankova
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tiffany L Carson
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Shanon Dunovan
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Susan Davies
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Comfort Enah
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karen Meneses
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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15
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Dixit N, Sarkar U, Trejo E, Couey P, Rivadeneira NA, Ciccarelli B, Burke N. Catalyzing Navigation for Breast Cancer Survivorship (CaNBCS) in Safety-Net Settings: A Mixed Methods Study. Cancer Control 2021; 28:10732748211038734. [PMID: 34657452 PMCID: PMC8521758 DOI: 10.1177/10732748211038734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose The current number of breast cancer survivors (BCS) in the United States is approximately 3.8 million, and this number is further expected to increase with improvement in treatments. Survivorship care plans (SCPs) are patient-centered tools that are designed to meet cancer survivors' informational needs about their treatment history, recommended health care, and health maintenance. However, the data on SCP benefits remain uncertain, especially in low-income and racial and ethnic minority cancer survivors. Patient navigation is an effective intervention to improve patient adherence and experience of interdisciplinary breast cancer treatment. Objectives This study sought to understand the role of lay patient navigators (LPN) in survivorship care planning for BCS in safety-net settings. Methods This study is a mixed methods pilot randomized clinical trial to understand the role of patient navigation in cancer survivorship care planning in a public hospital. We invited BCS who had completed active breast cancer treatment within 5 years. LPNs discussed survivorship care planning and survivorship care-related issues with BCS in the intervention arm over a 6-month intervention period and accompanied patients to their primary care appointment. LPNs also encouraged survivors to discuss health care issues with oncology and primary care providers. The primary objective was to assess BCS’ health-related quality of life (HRQOL). The secondary objectives were self-efficacy and implementation. We assessed implementation with 45–60-min semi-structured interviews with 15 BCS recruited from the intervention arm and 60-min focus groups with the oncologists and separately with LPNs. Results We enrolled 40 patients, 20 randomized to usual care and 20 randomized to LPN navigation. We did not find a statistically significant difference between the two arms in HRQOL. There was also no difference in self-efficacy between the two arms. Qualitative analysis identified implementation barriers to intervention that may have contributed to less effective intervention. Implications for Cancer Survivors Future survivorship care planning interventions need to consider: Cancer survivors’ needs and preferences, the need for dedicated resources, and the role of electronic health records in survivorship care plan delivery.
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Affiliation(s)
- Niharika Dixit
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Urmimala Sarkar
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA.,Center for Vulnerable Populations, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Evelin Trejo
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Paul Couey
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Natalie A Rivadeneira
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA.,Center for Vulnerable Populations, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Barbara Ciccarelli
- Cancer Navigation Program, San Francisco Department of Public Health, San Francisco, California, USA
| | - Nancy Burke
- School of Social Sciences, Humanities, and Arts, University of California Merced, Merced, California, USA
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16
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Madison AA, Peng J, Shrout MR, Renna ME, Alfano CM, Povoski SP, Lipari AM, Agnese DM, Carson WE, Malarkey WB, Kiecolt-Glaser JK. Distress Trajectories in Black and White Breast Cancer Survivors: From Diagnosis to Survivorship. Psychoneuroendocrinology 2021; 131:105288. [PMID: 34090140 PMCID: PMC8405565 DOI: 10.1016/j.psyneuen.2021.105288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Black breast cancer survivors have greater morbidity and mortality than White survivors. However, evidence comparing Black survivors' psychological symptoms with their White counterparts has been mixed. Prior studies have not compared Black and White survivor's distress-related symptom trajectories from pre- to post-treatment - the goal of the current study. METHODS At three annual visits from shortly after diagnosis to 6 and 18 months post-treatment, 195 women (n = 163 White; n = 32 Black) reported their cancer-related distress (intrusive thoughts and avoidance), perceived stress, anxiety and depressive symptoms, fatigue, and pain. RESULTS Adjusting for age, educational attainment, income, treatment type, stage at diagnosis, and physical comorbidities, Black and White breast cancer survivors had different trajectories of cancer-related distress (p = .004), intrusive thoughts about cancer diagnosis and treatment (p = .002), perceived stress (p = .04), emotional fatigue (p = .01), and vigor (p = .02). Specifically, among White women, these distress-related symptoms improved from diagnosis to 6 months post-treatment (ps < 0.0001) and then remained stable between 6 and 18 months post-treatment, whereas Black women had persistently elevated distress - even 18 months after finishing treatment. Additionally, Black women reported more avoidance of cancer-related thoughts and emotions across visits (p = .047). Race was unrelated to the trajectories of anxiety and depressive symptoms, other fatigue subscales, or pain levels (ps > 0.08). CONCLUSION Longitudinal assessment of the same breast cancer survivors from diagnosis to early survivorship revealed that Black and White survivors had divergent trajectories of psychological distress symptoms that were not reliably evident at a single timepoint. Overall, White women reported less psychological distress from pre- to post-treatment, but Black women's distress remained high from diagnosis to 18 months post-treatment. If left untreated, Black women's high distress levels may contribute to their poorer health throughout survivorship.
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Affiliation(s)
- Annelise A. Madison
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine,Department of Psychology, The Ohio State University,Corresponding author: Annelise Madison, M.A., Institute for Behavioral Medicine Research, The Ohio State University, 460 Medical Center Drive, Columbus, OH 43210,
| | - Juan Peng
- Center for Biostatistics, The Ohio State University
| | - M. Rosie Shrout
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine
| | - Megan E. Renna
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine,Comprehensive Cancer Center, The Ohio State University
| | | | | | | | | | | | - William B. Malarkey
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine,Department of Internal Medicine, The Ohio State University College of Medicine
| | - Janice K. Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine,Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine
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17
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Independent and Joint Impacts of Acid-Producing Diets and Depression on Physical Health among Breast Cancer Survivors. Nutrients 2021; 13:nu13072422. [PMID: 34371931 PMCID: PMC8308757 DOI: 10.3390/nu13072422] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 12/14/2022] Open
Abstract
The purpose of this study was to examine the independent and joint associations of acid-producing diets and depressive symptoms with physical health among breast cancer survivors. We studied a cohort of 2944 early stage breast cancer survivors who provided dietary, physical health, demographic, and lifestyle information at baseline, year 1, and year 4. We assessed the intakes of acid-producing diets via two commonly used dietary acid load scores: potential renal acid load (PRAL) and net endogenous acid production (NEAP). Physical health was measured using the Rand 36-Item Short Form Health Survey (SF-36), consisting of physical functioning, role limitation due to physical function, bodily pain, general health, and overall physical health subscales. Increased dietary acid load and depression were each independently and significantly associated with reduced physical health subscales and overall physical health. Further, dietary acid load and depression were jointly associated with worse physical health. For instance, depressed women with dietary acid load higher than median reported 2.75 times the risk (odds ratio = 2.75; 95% confidence interval: 2.18–3.47) of reduced physical function and 3.10 times the risk of poor physical health (odds ratio = 3.10; 95% confidence interval: 2.53–3.80) compared to non-depressed women with dietary acid load lower than median. Our results highlight the need of controlling acid-producing diets and the access of mental care for breast cancer survivors.
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18
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Jackson I, Rowan P, Padhye N, Hwang LY, Vernon SW. Racial/ethnic differences in health-related quality of life among female breast cancer survivors: cross-sectional findings from the Medical Expenditure Panel Survey. Public Health 2021; 196:74-81. [PMID: 34161858 DOI: 10.1016/j.puhe.2021.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/25/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Breast cancer survivors have reported worse health-related quality of life (HRQoL) outcomes on some subscales when compared with members of the general population. However, the increased attention to breast cancer survivorship should have improved the HRQoL of these survivors. Our aim was to examine whether physical and mental component scores (PCS-12 and MCS-12) using the Short Form (SF-12) questionnaire were different for racial/ethnic minorities, specifically for Black and Hispanic women relative to White women. Furthermore, we stratified the data by age group to evaluate these racial/ethnic differences in HRQoL of breast cancer survivors. STUDY DESIGN Cross-sectional study. METHODS Pooled cross-sectional analyses using data from the Medical Expenditure Panel Survey between 2008 and 2016 were conducted. Pooled ordinary least squares (OLS) regression was used to examine the racial/ethnic differences in PCS-12 and MCS-12 scores of breast cancer survivors. Furthermore, stratified analyses by age group were conducted to evaluate racial/ethnic differences in HRQoL by the age of breast cancer survivors. RESULTS After adjusting for confounders, there was no association between race/ethnicity and PCS-12 scores. However, Hispanic breast cancer survivors had statistically significantly lower MCS-12 scores (by 1.9 points [95% confidence interval {CI}: -3.53 to -0.37]) when compared with White breast cancer survivors. For PCS-12, after stratifying by age, the adjusted analyses showed no significant differences in PCS-12 scores when White female breast cancer survivors were compared with the other racial/ethnic categories. On the other hand, Black female survivors aged <50 years had 4.3 points (95% CI: 0.46-8.13) higher MCS-12 scores when compared with their White counterparts, while Hispanic breast cancer survivors aged <50 years had 3.1 points (95% CI: -0.40-6.69) higher MCS-12 scores relative to White women. Furthermore, among female breast cancer survivors aged ≥50 years, Hispanic women had 3.2 points (95% CI: -4.98 to -1.40) lower MCS-12 scores than White women. CONCLUSION Our study generated findings showing the racial/ethnic differences in HRQoL of breast cancer survivors and presented results stratified by age group. These findings provide the much-needed rationale for targeted and racial/ethnic-specific HRQoL improvement strategies among breast cancer survivors.
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Affiliation(s)
- I Jackson
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas-Houston School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - P Rowan
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas-Houston School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA; Division of Management, Policy, and Community Health, The University of Texas-Houston School of Public Health, Houston, TX, USA
| | - N Padhye
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - L Y Hwang
- Department of Epidemiology, Human Genetics and Environmental Sciences, Center for Infectious Diseases, University of Texas-Houston School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - S W Vernon
- University of Texas School of Public Health, Center for Health Promotion and Prevention Research, Division of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
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19
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Hu X, Chehal PK, Kaplan C, Krukowski RA, Lan RH, Stepanski E, Schwartzberg L, Vidal G, Graetz I. Characterization of Clinical Symptoms by Race Among Women With Early-Stage, Hormone Receptor-Positive Breast Cancer Before Starting Chemotherapy. JAMA Netw Open 2021; 4:e2112076. [PMID: 34061200 PMCID: PMC8170541 DOI: 10.1001/jamanetworkopen.2021.12076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Race disparities persist in breast cancer mortality rates. One factor associated with these disparities may be differences in symptom burden, which may reduce chemotherapy tolerance and increase early treatment discontinuation. OBJECTIVES To compare symptom burden by race among women with early-stage breast cancer before starting chemotherapy and quantify symptom differences explained by baseline characteristics. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional analysis of symptom burden differences by race among Black and White women with a diagnosis of stage I to III, hormone receptor-positive breast cancer who had a symptom report collected before chemotherapy initiation in a large cancer center in the southern region of the US from January 1, 2007, through December 31, 2015. Analyses were conducted from November 1, 2019, to March 31, 2021. Blinder-Oaxaca decomposition was used, adjusting for baseline sociodemographic and clinical characteristics. MAIN OUTCOMES AND MEASURES Four symptom composite scores with a mean (SD) of 50 (10) were reported before starting chemotherapy (baseline) and were derived from symptom items: general physical symptoms (11 items), treatment adverse effects (8 items), acute distress (4 items), and despair (7 items). Patients rated the severity of each symptom they experienced in the past week on a scale of 0 to 10 (where 0 indicates not a problem and 10 indicates as bad as possible). RESULTS A total of 1338 women (mean [SD] age, 54.6 [11.6] years; 420 Black women [31.4%] and 918 White women [68.6%]) were included in the study. Before starting chemotherapy, Black women reported a statistically significantly higher (ie, worse) symptom composite score than White women for adverse effects (44.5 vs 43.8) but a lower acute distress score (48.5 vs 51.0). Decomposition analyses showed that Black patients' characteristics were associated with higher symptom burden across all 4 scores. However, these differences were offset by relatively greater, statistically significant, unexplained physical, distress, and despair symptom reporting by White patients. CONCLUSIONS AND RELEVANCE In this study, before starting chemotherapy, Black patients with early-stage breast cancer reported significantly higher burden for symptoms that may be exacerbated with chemotherapy and lower distress symptoms compared with White patients. Future studies should explore how symptoms change before and after treatment and differ by racial/ethnic groups and how they are associated with treatment adherence and mortality disparities.
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Affiliation(s)
- Xin Hu
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Puneet K. Chehal
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Cameron Kaplan
- Gehr Family Center for Health Systems Science and Innovation, Keck School of Medicine of University of Southern California, Los Angeles
| | | | - Roy H. Lan
- College of Medicine, University of Tennessee Health Science Center, Memphis
| | | | - Lee Schwartzberg
- West Cancer Center and Research Institute, Germantown, Tennessee
| | - Gregory Vidal
- West Cancer Center and Research Institute, Germantown, Tennessee
- Division of Hematology and Oncology, University of Tennessee Health Science Center, Memphis
| | - Ilana Graetz
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Trends in health-related quality of life of female breast cancer survivors using the Medical Expenditure Panel Survey (MEPS), 2008-2016. Qual Life Res 2021; 30:3547-3558. [PMID: 34052940 DOI: 10.1007/s11136-021-02895-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE In recent years, breast cancer detection and treatment have advanced. As a result, increased attention to breast cancer survivorship should have improved their health-related quality of life (HRQoL). Our aim was to examine the trends in the HRQoL of female breast cancer survivors between 2008 and 2016, to determine whether or not the increased focus on survivorship has translated into improved HRQoL. Furthermore, stratified analyses were conducted by race/ethnicity and age group and these were compared to a similar group of women without a breast cancer history. METHODS Repeated cross-sectional analyses using the Medical Expenditure Panel Survey between 2008 and 2016 were conducted. Pooled ordinary least squares (OLS) regression was used to examine the trends in physical component scores (PCS-12) and mental component scores (MCS-12) among breast cancer survivors and a similar population of women without a breast cancer history. Analyses stratified by race/ethnicity and age group were also conducted. RESULTS Among breast cancer survivors, after adjusting for confounders, there was no change in PCS-12 scores over time, but the MCS-12 scores increased by 0.27 points (95% CI 0.09-0.45). Those without a history of breast cancer had mean PCS-12 scores that were 0.13 points greater each year (95% CI 0.02-0.24) while their mean MCS-12 scores were 0.10 (95% CI 0.00-0.21) points greater each year. After stratifying by race/ethnicity, Hispanic breast cancer survivors had a small increase in PCS-12 (β: 0.65; 95% CI 0.01-1.29), and MCS-12 scores (β: 0.70; 95% CI 0.06-1.33) over time. Similar small effects were found when stratified by age group, both among breast cancer survivors and those without a history of breast cancer. The younger age group (< 50 years) reported poorer MCS-12 than the older population (age 50 years and above). CONCLUSION Our study generated findings showing the trends in the HRQoL of breast cancer survivors and compared these to a similar population of women without a history of breast cancer. This paper highlights the importance of focusing on the mental health of young breast cancer survivors to improve their prospects at a good quality of life post-breast cancer diagnosis and treatment.
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Sánchez-Díaz CT, Strayhorn S, Tejeda S, Vijayasiri G, Rauscher GH, Molina Y. What mediates the racial/ethnic disparity in psychosocial stress among breast cancer patients? Cancer Causes Control 2021; 32:357-367. [PMID: 33559770 PMCID: PMC7946668 DOI: 10.1007/s10552-021-01392-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 01/05/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Prior studies have observed greater levels of psychosocial stress (PSS) among non-Hispanic (nH) African American and Hispanic women when compared to nH White patients after a breast cancer diagnosis. We aimed to determine the independent and interdependent roles of socioeconomic position (SEP) and unmet support in the racial disparity in PSS among breast cancer patients. METHODS Participants were recruited from the Breast Cancer Care in Chicago study (n = 989). For all recently diagnosed breast cancer patients, aged 25-79, income, education, and tract-level disadvantage and affluence were summed to create a standardized socioeconomic position (SEP) score. Three measures of PSS related to loneliness, perceived stress, and psychological consequences of a breast cancer diagnosis were defined based on previously validated scales. Five domains of unmet social support needs (emotional, spiritual, informational, financial, and practical) were defined from interviews. We conducted path models in MPlus to estimate the extent to which PSS disparities were mediated by SEP and unmet social support needs. RESULTS Black and Hispanic patients reported greater PSS compared to white patients and greater unmet social support needs (p = 0.001 for all domains). Virtually all of the disparity in PSS could be explained by SEP. A substantial portion of the mediating influence of SEP was further transmitted by unmet financial and practical needs among Black patients and by unmet emotional needs for Hispanic patients. CONCLUSIONS SEP appeared to be a root cause of the racial/ethnic disparities in PSS within our sample. Our findings further suggest that different interventions may be necessary to alleviate the burden of SEP for nH AA (i.e., more financial support) and Hispanic patients (i.e., more emotional support).
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Affiliation(s)
- C T Sánchez-Díaz
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL, 60612, USA.
| | - S Strayhorn
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, USA
| | - S Tejeda
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, USA
| | - G Vijayasiri
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, USA
| | - G H Rauscher
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL, 60612, USA
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, USA
| | - Y Molina
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, USA
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22
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Thompson T, Pérez M, Yan Y, Kreuter MW, Margenthaler JA, Colditz GA, Jeffe DB. Randomized controlled trial of a breast cancer Survivor Stories intervention for African American women. Soc Sci Med 2021; 270:113663. [PMID: 33454539 DOI: 10.1016/j.socscimed.2020.113663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/08/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
RATIONALE Video-based interventions hold promise for improving quality of life (QoL) among African American breast cancer patients. OBJECTIVE An interactive, cancer-communication intervention using African American breast cancer survivors' narratives was tested in a randomized controlled trial to determine whether viewing survivor stories improved newly diagnosed African American breast cancer patients' QoL. METHOD Participants were 228 African American women with non-metastatic breast cancer interviewed five times over two years; 120 controls received standard medical care, and 108 intervention-arm participants also received a tablet-computer with survivor stories three times in 12 months. Growth curve models were used to analyze differences between arms in change in eight RAND 36-Item Health Survey subscales, depressive symptoms, and concerns about recurrence. Additional models explored the effects of intervention usage and other intervention-related variables on QoL among patients in the intervention arm. RESULTS Models showed no effect of study arm on QoL, depressive symptoms, or concerns about recurrence. Longer use of the intervention was associated with an increase in concerns about recurrence and decline in three QoL subscales: emotional wellbeing, energy/fatigue, and role limitations due to physical health. CONCLUSION Although no significant impact of the intervention on QoL was observed when comparing the two study arms, in the intervention arm longer intervention use was associated with declines in three QoL subscales and increased concerns about recurrence. Women with improving QoL may have interacted with the tablet less because they felt less in need of information; it is also possible that encouraging patients to compare themselves to survivors who had already recovered from breast cancer led some patients to report lower QoL. Future work is warranted to examine whether adding different stories to this cancer-communication intervention or using stories in conjunction with additional health promotion strategies (e.g., patient navigation) might improve QoL for African American breast cancer patients.
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Affiliation(s)
- Tess Thompson
- Brown School of Social Work, Washington University in St. Louis, USA.
| | - Maria Pérez
- Washington University School of Medicine, USA
| | - Yan Yan
- Washington University School of Medicine, USA
| | - Matthew W Kreuter
- Brown School of Social Work, Washington University in St. Louis, USA
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Pre-diagnostic allostatic load and health-related quality of life in a cohort of Black breast cancer survivors. Breast Cancer Res Treat 2020; 184:901-914. [PMID: 32914357 DOI: 10.1007/s10549-020-05901-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 08/29/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To determine the association of pre-diagnostic allostatic load (AL) with health-related quality of life (HRQOL) among Black women with breast cancer. METHODS In a sample of 409 Black women with non-metastatic breast cancer enrolled in the Women's Circle of Health Follow-Up Study (WCHFS), two pre-diagnostic AL measures were estimated using medical records data from up to 12 months prior to breast cancer diagnosis: AL-lipid/metabolic profile-based measure and AL-inflammatory profile-based measure. HRQOL was assessed approximately 24 months post diagnosis, using the Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B) instrument, including 5 subscale scores [presented by physical well-being (PWB), social & family well-being (SFWB), emotional well-being (EWB), functional well-being (FWB), and breast cancer-specific scale (BCS)] and 3 derived total scores [presented by trial outcome index (TOI), Functional Assessment of Cancer Therapy-General (FACT-G) and FACT-B]. We used multivariable logistic regression models, using dichotomized AL scores (lower AL: 0-3 points, higher AL: 4-8 points), to assess the associations between the two pre-diagnostic AL measures and HRQOL. RESULTS Higher pre-diagnostic AL was associated with poorer FWB and lower FACT-G, but these associations were statistically significant for the AL-inflammatory profile-based measure (FWB: OR 1.63, 95% CI 1.04, 2.56; FACT-G: OR 1.62, 95% CI 1.04, 2.54), but not the AL-lipid/metabolic profile-based measure (FWB: OR 1.45, 95% CI 0.81, 2.59; FACT-G: OR 1.33, 95% CI 0.75, 2.37). CONCLUSION These findings suggest that higher AL, particularly when measured using the inflammatory profile-based measure, was associated with poorer HRQOL, namely FWB and FACT-G, among Black breast cancer survivors.
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24
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Schootman M, Perez M, Schootman JC, Fu Q, McVay A, Margenthaler J, Colditz GA, Kreuter MW, Jeffe DB. Influence of built environment on quality of life changes in African-American patients with non-metastatic breast cancer. Health Place 2020; 63:102333. [PMID: 32543424 PMCID: PMC7676919 DOI: 10.1016/j.healthplace.2020.102333] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/10/2020] [Accepted: 03/30/2020] [Indexed: 12/15/2022]
Abstract
Research links the built environment to health outcomes, but little is known about how this affects quality of life (QOL) of African American breast cancer patients, especially those residing in disadvantaged neighborhoods. Using latent trajectory models, we examined whether the built environment using Google Street View was associated with changes in QOL over a 2-year follow-up in 228 newly diagnosed African American breast cancer patients. We measured QOL using the RAND 36-Item Health Survey subscales. After adjusting for covariates, improvement in emotional well-being and pain over time was greater for women living on streets with low-quality (vs. high-quality) sidewalks.
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Affiliation(s)
- M Schootman
- SSM Health, Department of Clinical Analytics and Insights, Center for Clinical Excellence, 10101 Woodfield Lane, St. Louis, MO, 63132, USA.
| | - M Perez
- Washington University in St Louis, School of Medicine, Department of Medicine, St. Louis, MO, 63110, USA
| | - J C Schootman
- Saint Louis University, College for Public Health and Social Justice, Department of Epidemiology and Biostatistics, St. Louis, MO, 63103, USA
| | - Q Fu
- Saint Louis University, College for Public Health and Social Justice, Department of Epidemiology and Biostatistics, St. Louis, MO, 63103, USA
| | - A McVay
- Saint Louis University, College for Public Health and Social Justice, Department of Epidemiology and Biostatistics, St. Louis, MO, 63103, USA
| | - J Margenthaler
- Washington University in St. Louis, School of Medicine, Department of Surgery, St. Louis, MO, 63110, USA
| | - G A Colditz
- Washington University in St. Louis, School of Medicine, Department of Surgery, St. Louis, MO, 63110, USA
| | - M W Kreuter
- Washington University in St. Louis, The Brown School, Health Communication Research Laboratory, St. Louis, MO, 63130, USA
| | - D B Jeffe
- Washington University in St Louis, School of Medicine, Department of Medicine, St. Louis, MO, 63110, USA
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Senft N, Abrams J, Katz A, Barnes C, Charbonneau DH, Beebe-Dimmer JL, Zhang K, Eaton T, Heath E, Thompson HS. eHealth Activity among African American and White Cancer Survivors: A New Application of Theory. HEALTH COMMUNICATION 2020; 35:350-355. [PMID: 32013612 PMCID: PMC7006632 DOI: 10.1080/10410236.2018.1563031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
eHealth is a promising resource for cancer survivors and may contribute to reducing racial disparities in cancer survivorship. This research applies the Unified Theory of Acceptance and Use of Technology (UTAUT) to examine eHealth activity among African American (AfAm) and White cancer survivors. In a population-based sample of AfAm and White survivors (n = 300), a Poisson regression tested whether UTAUT constructs (facilitating conditions, social influence, perceived ease of use, perceived usefulness) and beliefs about security/trustworthiness of eHealth were associated with the number of eHealth activities respondents had used. To test whether the effects varied across racial groups, interactions between each of these five facets and survivor race were included in the model. The model adjusted for demographic characteristics, cancer history, and internet access and use. Across racial groups, facilitating conditions (IRR = 1.44, 95%CI [1.17, 1.77]) and perceived usefulness (IRR = 1.16, 95%CI [1.08, 1.24]) were associated with increased eHealth activity. A marginally significant interaction between race and perceived ease of use (IRR = 1.17, 95%CI [0.99, 1.39]) indicated this perception was associated with decreased eHealth activity for White but not AfAm survivors. A significant interaction between race and perceived security/trustworthiness (IRR = 1.16, 95%CI [1.02, 1.32]) indicated this perception was associated with increased eHealth activity for AfAm but not White survivors. Social influence was not associated with eHealth use for either group (IRR = 1.07, 95%CI [0.98, 1.16]). Interventions targeting attitudes about eHealth may encourage its adoption and use. Furthermore, eHealth tools intended for use among AfAm cancer survivors should ensure they are secure and emphasize trustworthiness to intended users.
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Affiliation(s)
- Nicole Senft
- Department of Oncology, Wayne State University/Karmanos Cancer Institute
| | - Judith Abrams
- Department of Oncology, Wayne State University/Karmanos Cancer Institute
| | - Anne Katz
- Department of Oncology, Wayne State University/Karmanos Cancer Institute
| | - Charity Barnes
- Department of Oncology, Wayne State University/Karmanos Cancer Institute
| | | | | | - Ke Zhang
- School of Education, Wayne State University
| | - Tara Eaton
- Center for Outcomes Research and Evaluation, Atrium Health
| | - Elisabeth Heath
- Department of Oncology, Wayne State University/Karmanos Cancer Institute
| | - Hayley S. Thompson
- Department of Oncology, Wayne State University/Karmanos Cancer Institute
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Lee SJC, Jetelina KK, Marks E, Shaw E, Oeffinger K, Cohen D, Santini NO, Cox JV, Balasubramanian BA. Care coordination for complex cancer survivors in an integrated safety-net system: a study protocol. BMC Cancer 2018; 18:1204. [PMID: 30514267 PMCID: PMC6278055 DOI: 10.1186/s12885-018-5118-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/20/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The growing numbers of cancer survivors challenge delivery of high-quality survivorship care by healthcare systems. Innovative ways to improve care coordination for patients with cancer and multiple chronic conditions ("complex cancer survivors") are needed to achieve better care outcomes, improve patient experience of care, and lower cost. Our study, Project CONNECT, will adapt and implement three evidence-based care coordination strategies, shown to be effective for primary care conditions, among complex cancer survivors. Specifically, the purpose of this study is to: 1) Implement a system-level EHR-driven intervention for 500 complex cancer survivors at Parkland; 2) Test effectiveness of the strategies on system- and patient-level outcomes measured before and after implementation; and 3) Elucidate system and patient factors that facilitate or hinder implementation and result in differences in experiences of care coordination between complex patients with and without cancer. METHODS Project CONNECT is a quasi-experimental implementation study among 500 breast and colorectal cancer survivors with at least one of the following chronic conditions: diabetes, hypertension, chronic lung disease, chronic kidney disease, or heart disease. We will implement three evidence-based care coordination strategies in a large, county integrated safety-net health system: 1) an EHR-driven registry to facilitate patient transitions between primary and oncology care; 2) co-locating a nurse practitioner trained in care coordination within a complex care team; 3) and enhancing teamwork through coaching. Segmented regression analysis will evaluate change in system-level (i.e. composite care quality score) and patient-level outcomes (i.e. self-reported care coordination). To evaluate implementation, we will merge quantitative findings with structured observations and physician and patient interviews. DISCUSSION This study will result in an evaluation toolkit identifying key model elements, barriers, and facilitators that can be used to guide care coordination interventions in other safety-net settings. Because Parkland is a vanguard of safety-net healthcare nationally, findings will be widely applicable as other safety-nets move toward increased integration, enhanced EHR capability, and experience with growing patient diversity. Our proposal recognizes the complexity of interventions and scaffolds evidence-based strategies together to meet the needs of complex patients, systems of care, and service integration. TRIAL REGISTRATION ClinicalTrials.gov, NCT02943265 . Registered 24 October 2016.
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Affiliation(s)
- Simon J. Craddock Lee
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, E5.506, Dallas, TX 75390-9066 USA
- Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Road, Dallas, TX 75235 USA
| | - Katelyn K. Jetelina
- Department of Epidemiology, University of Texas Health Science Center, School of Public Health, 6011 Harry Hines Blvd, V8.112, Dallas, TX 75235 USA
| | - Emily Marks
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, E5.506, Dallas, TX 75390-9066 USA
| | - Eric Shaw
- Department of Community Medicine, Mercer University, 1250 E. 66th St, Savannah, GA 31404 USA
| | - Kevin Oeffinger
- Department of Medicine, Division of Medical Oncology, Duke Cancer Institute and Duke University Medical Center, 20 Duke Medicine Cir, Durham, NC 27710 USA
| | - Deborah Cohen
- Department of Family Medicine, Oregon Health and Science Center, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098 USA
| | - Noel O. Santini
- Parkland Health and Hospital System, 5201 Harry Hines Blvd, Dallas, TX 75235 USA
| | - John V. Cox
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, E5.506, Dallas, TX 75390-9066 USA
- Parkland Health and Hospital System, 5201 Harry Hines Blvd, Dallas, TX 75235 USA
| | - Bijal A. Balasubramanian
- Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Road, Dallas, TX 75235 USA
- Department of Epidemiology, University of Texas Health Science Center, School of Public Health, 6011 Harry Hines Blvd, V8.112, Dallas, TX 75235 USA
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Keeping us all whole: Acknowledging the agency of African American breast cancer survivors and their systems of social support. Support Care Cancer 2018; 27:2625-2632. [PMID: 30470890 DOI: 10.1007/s00520-018-4538-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 11/04/2018] [Indexed: 10/27/2022]
Abstract
While all cancer patients face a bewildering array of treatments, side effects, and emotions, several researchers have shown that African American women with breast cancer experience greater stress and burdens because of unmet supportive needs associated with psychological distress, financial distress, and lower physical/functional well-being. Social support has been shown to improve health outcomes for African American breast cancer patients. The purpose of this paper is to understand the meaning of social support among African American women diagnosed with breast cancer. A total of 47 African American women with breast cancer participated in the in-depth qualitative interviews. Key findings indicate that social support was received in the context of the stability of the extended family network. Moreover, social support was received in the context of distributing the social support received among many members in their personal networks and that social support was only received on patient's own terms. The findings of this paper provide an understanding to the inter-relational and cultural meanings of receiving support by diverse cancer patients. In addition, the findings of this paper have implications for health care professionals working with African American breast cancer patients in understanding how social support can be received.
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Robertson-Jones TA, Tissue MM, Connolly M, Gallups SF, Bender CM, Rosenzweig MQ. Exploring Racial Differences in Patient Centeredness of Care (PCC) During Breast Cancer (BC) Chemotherapy Clinical Visits. J Racial Ethn Health Disparities 2018; 6:94-100. [PMID: 29971577 DOI: 10.1007/s40615-018-0503-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/10/2018] [Accepted: 05/17/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The communication patterns between clinician and patient, described as the patient centeredness of care (PCC), may be a critically important etiology of breast cancer (BC) racial disparity. The purpose of this prospective, comparative pilot study was to qualitatively explore and code for PCC during the clinical visit of women undergoing BC chemotherapy and compare by race. METHODS Age-matched Black and White women were recruited. Audio recordings of clinical visits conducted prior to any cycle (except first) chemotherapy infusion were obtained and transcribed. Transcripts were blindly reviewed by three independent coders assigning PCC scores, ranging from 1 to 5, with lower scores indicating better PCC. Consensus was reached among reviewers via discussion. RESULTS Dyads consisted of five Black (mean age 47) and five White (mean age 45) women undergoing BC chemotherapy. Twenty-four recordings were analyzed, 13 White and 11 Black. For all 22 PCC items, the mean scores were worse for Black women with significant differences (compared by chi-square analysis) noted for 6/22 items (27%). CONCLUSIONS Qualitatively exploring clinician and patient communication patterns during the chemotherapy clinical visits informs the understanding of racial differences for symptom assessment, reporting, and management. These pilot findings inform future research exploring racial disparity in cancer treatment dose intensity.
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Affiliation(s)
- Tinnikkar Angel Robertson-Jones
- Hampton University School of Nursing, E. Tyler St. & Emancipation Drive, William Freeman Hall, Room 110, Hampton, VA, 23668, USA
| | - Madison M Tissue
- University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15261, USA
| | - Mary Connolly
- University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15261, USA
| | - Sarah Frazier Gallups
- University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15261, USA
| | - Catherine M Bender
- University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15261, USA
| | - Margaret Quinn Rosenzweig
- University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15261, USA. .,Acute and Tertiary Care Department, University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15216, USA.
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Coughlin SS, Williams V, Moore N, Bowen D, Anglin J, Mansur N, Leo GD. The Augusta, Georgia Breast Cancer Survivor Study. JOURNAL OF CANCER TREATMENT & DIAGNOSIS 2018; 2:10-15. [PMID: 30320304 PMCID: PMC6183059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Several studies have provided important information about health conditions and other challenges faced by women diagnosed with breast cancer and how they can improve their quality of life and reduce their risk of cancer recurrence. Although African American and Hispanic breast cancer patients have a poorer survival than their white counterparts, few studies have compared the experiences of African American, Hispanic, and non-Hispanic white breast cancer survivors. OBJECTIVES To facilitate collaborative studies on breast cancer survivorship in a multicultural population, including future intervention research on nutrition, and physical activity, and clinical substudies. METHODS This cohort study consists of a postal survey of up to 1,000 women with a history of a breast cancer diagnosis who reside in Augusta-Richmond County, Georgia, USA, and a repeat survey in 4 to 5 years to obtain longitudinal data. The follow-up survey in 4 to 5 years will allow for longitudinal changes in health to be assessed. CONCLUSION The survey will provide a comprehensive picture of the health of breast cancer survivors, across the lifespan, in a large Southern city. A broad range of health issues will be addressed including physical activity, diet, nutrition, personal and family history of cancer, quality-of-life, psychosocial concerns, and beliefs about cancer recurrence risk reduction through lifestyle changes. Through its longitudinal design, the study will also provide important information about changes in physical and mental health as breast cancer survivors advance in age.
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Affiliation(s)
- Steven S Coughlin
- Department of Clinical and Digital Health Sciences, Augusta University, Augusta, GA
- Research Service, Charlie Norwood Veterans Administration Medical Center, Augusta, GA
| | | | - Nicole Moore
- Department of Clinical and Digital Health Sciences, Augusta University, Augusta, GA
| | - Deborah Bowen
- University of Washington School of Medicine, Seattle, WA
| | - Judith Anglin
- Department of Clinical and Digital Health Sciences, Augusta University, Augusta, GA
| | - Nadine Mansur
- Department of Clinical and Digital Health Sciences, Augusta University, Augusta, GA
| | - Gianluca De Leo
- Department of Clinical and Digital Health Sciences, Augusta University, Augusta, GA
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Claridy MD, Ansa B, Damus F, Alema-Mensah E, Smith SA. Health-related quality of life of African-American female breast cancer survivors, survivors of other cancers, and those without cancer. Qual Life Res 2018; 27:2067-2075. [PMID: 29704078 DOI: 10.1007/s11136-018-1862-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of this study was to compare differences in health-related quality of life (HRQOL) between African-American female breast cancer survivors, African-American female survivors of other cancers, and African-American women with no history of cancer. METHODS Using data from the 2010 National Health Interview Survey (NHIS), the HRQOL of African-American women aged 35 years or older was compared by cancer status. Physical and mental health items from the Patient-Reported Outcomes Measurement Information System (PROMIS) global health scale were used to assess differences in HRQOL. RESULTS For summary physical and mental health measures, no significant differences were found between breast cancer survivors and women with no history of cancer; survivors of other cancers reported poorer physical and mental health than did women with no history of cancer. Similar differences were found at the item level. When we examined the two African-American female cancer survivor groups, we found that cancer survivors whose cancer was being treated reported substantially poorer physical health and mental health than did those whose cancer was not being treated. Survivors who had private insurance and were cancer free reported better physical and mental health than did those who did not have private insurance and those who were not cancer free. Breast cancer survivors reported slightly better physical and mental health than did survivors of other cancers. CONCLUSIONS Our findings highlight the need for public health agencies to adopt practices to improve the mental and physical health of African-American female survivors of cancer.
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Affiliation(s)
- Mechelle D Claridy
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA, 30310-1495, USA.
| | - Benjamin Ansa
- Department of Family Medicine, Medical College of Georgia, Augusta University, 1120 15th Street, Augusta, GA, USA
| | - Francesca Damus
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA, 30310-1495, USA
| | - Ernest Alema-Mensah
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA, 30310-1495, USA
| | - Selina A Smith
- Department of Family Medicine, Medical College of Georgia, Augusta University, 1120 15th Street, Augusta, GA, USA
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Activities, function, and health-related quality of life (HRQOL) of older adults with cancer. J Geriatr Oncol 2017; 8:249-254. [PMID: 28285980 DOI: 10.1016/j.jgo.2017.02.009] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/15/2017] [Accepted: 02/24/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study aims to (1) describe the activities, function, and health-related quality of life (HRQOL) of a large sample of older adults (age ≥65) with cancer, (2) identify the associations with demographics, cancer type, comorbid conditions, and ability to participate in activities and functional status. MATERIALS AND METHODS The Health Registry/Cancer Survivorship Cohort is an institutional database designed to aid cancer survivorship research. The registry includes three measures of patient-reported HRQOL: FACT-G and PROMIS® Global measures for physical and mental health. Other measures included in the registry are cancer type, date from diagnosis, number of comorbid conditions and specific conditions and their limitations in daily activity, and self-reported daily activity/function. RESULTS Our sample consists of 768 older adults with cancer, mean age 72years, 60% female, and 90% White. Mean scores for HRQOL: FACT-G (85, range: 25-108), PROMIS-physical (48, range: 16-67) and, PROMIS-mental (51, range: 21-67). In multivariable models, Black race, one or more comorbid conditions, and Gastrointestinal cancer (p<.05), and patient- reported decreased levels of activities/function were all independently associated with poor HRQOL (p<.0001). CONCLUSIONS Older Black adults with cancer, those that have high comorbidity burden, with gastrointestinal cancers and those that report decreased ability to participate in daily activities/function reported poorer HRQOL. As geriatric oncology moves towards trying to identify who may need supportive services, this study demonstrated that a one question patient-reported level of activities and functional ability were independently associated with physical, mental, and cancer-specific HRQOL.
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Yee MK, Sereika SM, Bender CM, Brufsky AM, Connolly MC, Rosenzweig MQ. Symptom incidence, distress, cancer-related distress, and adherence to chemotherapy among African American women with breast cancer. Cancer 2017; 123:2061-2069. [PMID: 28199006 DOI: 10.1002/cncr.30575] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/20/2016] [Accepted: 01/03/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND There is a persistent racial survival disparity between African American (AA) and white women with breast cancer. There is evidence that symptom incidence, associated distress, and overall cancer-related distress may be unexplored, important contributing factors. The purpose of the current study was to: 1) describe and compare the number of chemotherapy-related symptoms and associated distress among AA women with breast cancer over the course of chemotherapy at 3 time points (at baseline before initiating chemotherapy, midpoint, and at the completion of chemotherapy); and 2) to describe the relationship between the number of chemotherapy-related symptoms and overall cancer distress compared with the ability to receive at least 85% of the prescribed chemotherapy within the prescribed timeframe. METHODS Descriptive, comparative, and correlational analyses of symptom incidence, symptom distress, cancer-related distress, and prescribed chemotherapy dose received among a cohort of AA women receiving chemotherapy for breast cancer were performed. RESULTS AA women (121 women) experienced worsening symptoms from baseline to midpoint in chemotherapy and then stabilized for the duration of therapy. The inability to receive 85% of the prescribed chemotherapy within a prescribed time point was found to be significantly correlated with midpoint symptom distress. CONCLUSIONS The main findings of the current study were that AA women experience a deterioration in symptom distress over the course of chemotherapy from baseline (before chemotherapy) to the midpoint, which was found to be associated with less adherence to chemotherapy overall. Thus, the incidence and management of physical and emotional symptoms, as measured through a multidimensional symptom measurement tool, may be contributing to breast cancer dose disparity and should be explored further. Cancer 2017;123:2061-2069. © 2017 American Cancer Society.
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Affiliation(s)
- Melissa K Yee
- Department of Medical Oncology at Dana-Farber/Brigham and Women's Cancer Center in clinical affiliation with South Shore Hospital, Harvard University, Cambridge, Massachusetts
| | - Susan M Sereika
- Department of Epidemiology, School of Nursing and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Adam M Brufsky
- Department of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mary C Connolly
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Margaret Q Rosenzweig
- Acute and Tertiary Care Department, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
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A Precision Medicine Approach to Improve Cancer Rehabilitation’s Impact and Integration with Cancer Care and Optimize Patient Wellness. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2017. [DOI: 10.1007/s40141-017-0145-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Tao W, Luo X, Cui B, Liang D, Wang C, Duan Y, Li X, Zhou S, Zhao M, Li Y, He Y, Wang S, Kelley KW, Jiang P, Liu Q. Practice of traditional Chinese medicine for psycho-behavioral intervention improves quality of life in cancer patients: A systematic review and meta-analysis. Oncotarget 2016; 6:39725-39. [PMID: 26498685 PMCID: PMC4741858 DOI: 10.18632/oncotarget.5388] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/02/2015] [Indexed: 11/30/2022] Open
Abstract
Background Cancer patients suffer from diverse symptoms, including depression, anxiety, pain, and fatigue and lower quality of life (QoL) during disease progression. This study aimed to evaluate the benefits of Traditional Chinese Medicine psycho-behavioral interventions (TCM PBIs) on improving QoL by meta-analysis. Methods Electronic literature databases (PubMed, CNKI, VIP, and Wanfang) were searched for randomized, controlled trials conducted in China. The primary intervention was TCM PBIs. The main outcome was health-related QoL (HR QoL) post-treatment. We applied standard meta analytic techniques to analyze data from papers that reached acceptable criteria. Results The six TCM PBIs analyzed were acupuncture, Chinese massage, Traditional Chinese Medicine five elements musical intervention (TCM FEMI), Traditional Chinese Medicine dietary supplement (TCM DS), Qigong and Tai Chi. Although both TCM PBIs and non-TCM PBIs reduced functional impairments in cancer patients and led to pain relief, depression remission, reduced time to flatulence following surgery and sleep improvement, TCM PBIs showed more beneficial effects as assessed by reducing both fatigue and gastrointestinal distress. In particular, acupuncture relieved fatigue, reduced diarrhea and decreased time to flatulence after surgery in cancer patients, while therapeutic Chinese massage reduced time to flatulence and time to peristaltic sound. Conclusion These findings demonstrate the efficacy of TCM PBIs in improving QoL in cancer patients and establish that TCM PBIs represent beneficial adjunctive therapies for cancer patients.
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Affiliation(s)
- Weiwei Tao
- Institute of Cancer Stem Cell, Cancer Center, Dalian Medical University, Dalian, China.,Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong, China.,College of Nursing, Dalian Medical University, Dalian, China
| | - Xi Luo
- Institute of Cancer Stem Cell, Cancer Center, Dalian Medical University, Dalian, China.,Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong, China
| | - Bai Cui
- Institute of Cancer Stem Cell, Cancer Center, Dalian Medical University, Dalian, China.,Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong, China
| | - Dapeng Liang
- Institute of Cancer Stem Cell, Cancer Center, Dalian Medical University, Dalian, China.,Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong, China
| | - Chunli Wang
- Institute of Cancer Stem Cell, Cancer Center, Dalian Medical University, Dalian, China.,Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong, China
| | - Yangyang Duan
- Department of Radiology, Second Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Xiaofen Li
- School of Public Health, Dalian Medical University, Dalian, China
| | - Shiyu Zhou
- Department of Psychology, Dalian Medical University, Dalian, China
| | - Mingjie Zhao
- Dalian Medical University Magazine, Dalian, China
| | - Yi Li
- School of Art, Dalian Medical University, Dalian, China
| | - Yumin He
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shaowu Wang
- Department of Radiology, Second Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Keith W Kelley
- Integrative Immunology and Behavior Program, Department of Animal Sciences, College of ACES, Urbana, IL, USA.,Department of Pathology, College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Ping Jiang
- Graduate School, Dalian Medical University, Dalian, China
| | - Quentin Liu
- Institute of Cancer Stem Cell, Cancer Center, Dalian Medical University, Dalian, China.,Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong, China
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Barsevick AM, Leader A, Bradley PK, Avery T, Dean LT, DiCarlo M, Hegarty SE. Post-treatment problems of African American breast cancer survivors. Support Care Cancer 2016; 24:4979-4986. [PMID: 27543161 DOI: 10.1007/s00520-016-3359-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 07/18/2016] [Indexed: 01/04/2023]
Abstract
PURPOSE African American breast cancer survivors (AABCS) have a lower survival rate across all disease stages (79 %) compared with White survivors (92 %) and often have more aggressive forms of breast cancer requiring multimodality treatment, so they could experience a larger burden of post-treatment quality of life (QOL) problems. This paper reports a comprehensive assessment of the number, severity, and domains of problems faced by AABCS within 5 years after treatment completion and identifies subgroups at risk for these problems. METHODS A population-based random sample was obtained from the Pennsylvania Cancer Registry of African American females over 18 years of age who completed primary treatment for breast cancer in the past 5 years. A mailed survey was used to document survivorship problems. RESULTS Two hundred ninety-seven AABCS completed the survey. The median number of survivor problems reported was 15. Exploratory factor analysis of the problem scale revealed four domains: emotional problems, physical problems, lack of resources, and sexuality problems. Across problem domains, younger age, more comorbid conditions, and greater medical mistrust were risk factors for more severe problems. CONCLUSIONS The results demonstrated that AABCS experienced significant problem burden in the early years after diagnosis and treatment. In addition to emotional and physical problem domains that were documented in previous research, two problem domains unique to AABCS included lack of resources and sexuality concerns. At risk groups should be targeted for intervention. The study results reported in this manuscript will inform future research to address problems of AABCS as they make the transition from cancer patient to cancer survivor.
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Affiliation(s)
- Andrea M Barsevick
- Thomas Jefferson University, 834 Chestnut Street, Philadelphia, PA, 19107, USA.
| | - Amy Leader
- Thomas Jefferson University, 834 Chestnut Street, Philadelphia, PA, 19107, USA
| | | | | | | | - Melissa DiCarlo
- Thomas Jefferson University, 834 Chestnut Street, Philadelphia, PA, 19107, USA
| | - Sarah E Hegarty
- Thomas Jefferson University, 834 Chestnut Street, Philadelphia, PA, 19107, USA
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Flores AM, Nelson J, Sowles L, Bienenstock K, Blot WJ. Physical impairments and physical therapy services for minority and low-income breast cancer survivors. SPRINGERPLUS 2016; 5:1227. [PMID: 27536511 PMCID: PMC4971004 DOI: 10.1186/s40064-016-2455-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 05/27/2016] [Indexed: 12/27/2022]
Abstract
Purpose We describe impairments after breast cancer and its treatment for African American (AA), non-Hispanic white and low-income breast cancer survivors (BCS) and whether physical therapy (PT) was utilized to address these impairments. Methods BCS from the Southern Community Cohort Study (SCCS) were surveyed about self-reported BC treatment-related impairments (shoulder impairment, muscle weakness, pain, fatigue, skin numbness, abnormal posture) and referral to PT for impairments. We compared impairments by race, income and PT utilization. We used a cross-sectional design. Results Among 528 BCS interviewed (266 whites; 262 AA), mean age 64, those with low incomes were more likely to report muscle weakness, pain and postural abnormalities, and a greater total number of impairments than those with higher incomes. Racial differences were few. PT utilization tended to be low, with AAs more likely than whites to utilize PT if they had shoulder impairment or pain, whereas no monotonic trends across income levels were seen in PT utilization. Conclusions Low-income level was associated with greater prevalence of BC-related physical impairments, but not higher PT utilization. There appears to be a possible under-utilization of PT, particularly for those with low incomes.
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Affiliation(s)
- Ann Marie Flores
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Center for Cancer Survivorship Studies (CCSL), Northeastern University, Boston, MA USA
| | - Jason Nelson
- Biostatistics Research Center, Institute for Clinical Research and Health Policy Studies, Tufts University Medical Center, Boston, MA USA
| | - Lee Sowles
- Office of Health Equity, Maine Center for Disease Control and Prevention, Augusta, ME USA
| | - Karen Bienenstock
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Center for Cancer Survivorship Studies (CCSL), Northeastern University, Boston, MA USA
| | - William J Blot
- International Epidemiology Institute, Rockville, MD USA ; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN USA
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Patel-Kerai G, Harcourt D, Rumsey N, Naqvi H, White P. The psychosocial experiences of breast cancer amongst Black, South Asian and White survivors: do differences exist between ethnic groups? Psychooncology 2016; 26:515-522. [PMID: 27252032 DOI: 10.1002/pon.4187] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 03/20/2016] [Accepted: 05/27/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Geeta Patel-Kerai
- Centre for Appearance Research; University of the West of England; Bristol UK
| | - Diana Harcourt
- Centre for Appearance Research; University of the West of England; Bristol UK
| | - Nichola Rumsey
- Centre for Appearance Research; University of the West of England; Bristol UK
| | | | - Paul White
- Department of Engineering Design and Mathematics; University of the West of England; Bristol UK
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Rebholz WN, Cash E, Zimmaro LA, Bayley-Veloso R, Phillips K, Siwik C, Chagpar AB, Dhabhar FS, Spiegel D, Bell BS, Sephton SE. Distress and quality of life in an ethnically diverse sample awaiting breast cancer surgery. J Health Psychol 2016; 23:1438-1451. [PMID: 27466289 DOI: 10.1177/1359105316659916] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Poor breast cancer-related quality of life is associated with flattened cortisol rhythms and inflammation in breast cancer survivors and women with advanced disease. We explored the associations of cancer-specific distress (Impact of Events Scale), mood (Profile of Mood States), activity/sleep (wake after sleep onset, 24-hour autocorrelation coefficient) and cortisol (diurnal slope) circadian rhythms, and inflammation (interleukin-6) with quality of life (Functional Assessment of Cancer Therapy-Breast) among patients awaiting breast cancer surgery ( N = 57). Models were adjusted for differences in age and cancer stage. Distress and mood disturbance were significantly correlated with lower quality of life. Ethnic differences in the relationship between distress and mood disturbance with global quality of life and subscales of quality of life were observed. Actigraphic measures showed that in comparison with non-Hispanic patients, African Americans had significantly poorer activity/sleep (wake after sleep onset, 24-hour autocorrelation coefficient). Circadian disruption and inflammation were not associated with quality of life. Physiological dysregulation and associated comorbidities may take time to develop over the course of disease and treatment.
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Clarkin K, Kim M, Hubbi B, Salvador M, Lassiter T, Halperin W. Breast Pain and the Perception of Associated Risk. Breast J 2016; 22:480-1. [DOI: 10.1111/tbj.12615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Kim Clarkin
- Department of Radiology; New York Presbyterian- Columbia University Medical Center; New York New York
- Department of Radiology; Rutgers, New Jersey Medical School; Newark New Jersey
| | - Marianne Kim
- Department of Radiology; Yale University School of Medicine; New Haven Connecticut
- Department of Radiology; Rutgers, New Jersey Medical School; Newark New Jersey
| | - Basil Hubbi
- Department of Radiology; Rutgers, New Jersey Medical School; Newark New Jersey
| | - Magdalena Salvador
- Department of Radiology; Rutgers, New Jersey Medical School; Newark New Jersey
| | - Teri Lassiter
- School of Public Health; Rutgers University; Newark New Jersey
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Weaver KE, Leach CR, Leng X, Danhauer SC, Klepin HD, Vaughan L, Naughton M, Chlebowski RT, Vitolins MZ, Paskett E. Physical Functioning among Women 80 Years of Age and Older With and Without a Cancer History. J Gerontol A Biol Sci Med Sci 2016; 71 Suppl 1:S23-30. [PMID: 26858321 DOI: 10.1093/gerona/glv073] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Females 80 years and older comprise 22% of the total U.S. survivor population, yet the impact of cancer on the physical well-being of women is this age group has not been well characterized. METHODS We compared women, 80 years of age and older in the Women's Health Initiative extension 2, who did (n = 2,270) and did not (n = 20,272) have an adjudicated history of cancer during Women's Health Initiative enrollment; analyses focused on women >2-years postcancer diagnosis. The physical functioning subscale of the RAND-36 was the primary outcome. Demographic, health-status, and psychosocial covariates were drawn from Women's Health Initiative assessments. Analysis of covariance was used to examine the effect of cancer history on physical function, with and without adjustment for covariates. RESULTS In adjusted models, women with a history of cancer reported significantly lower mean physical functioning (56.6, standard error [SE] 0.4) than those without a cancer history (58.0, SE 0.1), p = .002. In these models, younger current age, lower body mass index, increased physical activity, higher self-rated health, increased reported happiness, and the absence of noncancer comorbid conditions were all associated with higher physical functioning in both women with and without a history of cancer. CONCLUSIONS Women older than 80 years of age with a cancer history have only a moderately lower level of physical function than comparably aged women without a cancer history. Factors associated with higher levels of physical functioning were similar in both groups.
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Affiliation(s)
- Kathryn E Weaver
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Winston-Salem, North Carolina.
| | - Corinne R Leach
- The American Cancer Society, Behavioral Research Center Atlanta, GA
| | - Xiaoyan Leng
- Wake Forest School of Medicine, Department of Biostatistical Sciences Winston-Salem, North Carolina
| | - Suzanne C Danhauer
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Winston-Salem, North Carolina. Wake Forest School of Medicine, Department of Internal Medicine, Section on Hematology and Oncology Winston-Salem, North Carolina
| | - Heidi D Klepin
- Wake Forest School of Medicine, Department of Internal Medicine, Section on Hematology and Oncology Winston-Salem, North Carolina
| | - Leslie Vaughan
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Winston-Salem, North Carolina
| | - Michelle Naughton
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Winston-Salem, North Carolina
| | - Rowan T Chlebowski
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center Torrance, California
| | - Mara Z Vitolins
- Wake Forest School of Medicine, Department of Epidemiology and Prevention Winston-Salem, North Carolina
| | - Electra Paskett
- The Ohio State University, Department of Internal Medicine, College of Medicine Columbus, Ohio
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Diggins AD, Hearn LE, Lechner SC, Annane D, Antoni MH, Whitehead NE. Physical activity in Black breast cancer survivors: implications for quality of life and mood at baseline and 6-month follow-up. Psychooncology 2016; 26:822-828. [PMID: 26923090 DOI: 10.1002/pon.4095] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 12/02/2015] [Accepted: 01/18/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND The present study sought to examine the influence of physical activity on quality of life and negative mood in a sample of Black breast cancer survivors to determine if physical activity (dichotomized) predicted mean differences in negative mood and quality of life in this population. METHODS Study participants include 114 women diagnosed with breast cancer (any stage of disease, any type of breast cancer) recruited to participate in an adaptive cognitive-behavioral stress management intervention. The mean body mass index of the sample at baseline was 31.39 (standard deviation = 7.17). RESULTS A multivariate analysis of covariance (MANCOVA) was conducted to determine if baseline physical activity predicted mean differences in negative mood and quality of life at baseline and at follow ups while controlling for relevant covariates. A one-way MANCOVA revealed a significant multivariate effect by physical activity group for the combined dependent variables at Time 2 (post 10-week intervention), p = .039. The second one-way MANCOVA revealed a significant multivariate effect at Time 3 (6 months after Time 2), p = .034. Specifically, Black breast cancer survivors who engaged in physical activity experienced significantly lower negative mood and higher social/family well-being at Time 2 and higher spiritual and functional well-being at Times 2 and 3. CONCLUSIONS Results show that baseline physical activity served protective functions for breast cancer survivors over time. Developing culturally relevant physical activity interventions specifically for Black breast cancer survivors may prove vital to improving quality of life and mood in this population. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Allyson D Diggins
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Lauren E Hearn
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Suzanne C Lechner
- Department of Psychiatry and Behavioral Sciences, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Debra Annane
- Department of Psychiatry and Behavioral Sciences, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Michael H Antoni
- Department of Psychiatry and Behavioral Sciences, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL, USA.,Department of Psychology, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Nicole Ennis Whitehead
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
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Jones SMW, LaCroix AZ, Li W, Zaslavsky O, Wassertheil-Smoller S, Weitlauf J, Brenes GA, Nassir R, Ockene JK, Caire-Juvera G, Danhauer SC. Depression and quality of life before and after breast cancer diagnosis in older women from the Women's Health Initiative. J Cancer Surviv 2015; 9:620-9. [PMID: 25708515 PMCID: PMC4547920 DOI: 10.1007/s11764-015-0438-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 02/06/2015] [Indexed: 01/06/2023]
Abstract
PURPOSE Distress and reduced quality of life (QOL) are common among people with cancer. No study has compared these variables after breast cancer diagnosis to pre-cancer diagnosis levels. METHODS Data on women with breast cancer 50 years of age or older (n = 6949) were analyzed from the Women's Health Initiative (1993-2013). Health-related QOL (physical function, mental health) was measured using Rand-36. Depressive symptoms were measured with the six-item Center for Epidemiologic Studies Depression scale. Assessments occurred before and after the cancer diagnosis. Hierarchical linear modeling compared pre-cancer QOL and depressive symptoms to levels post-diagnosis and tested whether pre-cancer physical activity, stressful life events, sleep disturbance, and pain predicted post-diagnosis outcomes. RESULTS Compared with pre-cancer levels, depressive symptoms increased (20.0% increase at 0-6 months, 12.9% increase at 6-12 months), while physical function (-3.882 points at 0-6 months, -3.545 at 6-12 months) and mental health decreased (-2.899 points at 0-6 months, -1.672 at 6-12 months) in the first year after diagnosis (all p < .01). Depressive symptoms returned to pre-cancer levels after 10 years, but QOL remained significantly lower. At more than 10 years post-diagnosis, physical function was 2.379 points lower than pre-cancer levels (p < 0.01) while mental health was 1.922 points lower (p < 0.01). All pre-cancer predictors were associated with all outcomes. Pain predicted uniquely greater decreases in physical function post-diagnosis. CONCLUSIONS Depressive symptoms increased and QOL decreased following breast cancer diagnosis compared with pre-cancer levels, particularly in the first year. IMPLICATIONS FOR CANCER SURVIVORS QOL may remain lower for years after breast cancer diagnosis, although decreases are small.
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Affiliation(s)
- Salene M W Jones
- Group Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA.
| | | | - Wenjun Li
- University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | | | | | - Julie Weitlauf
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | | | - Rami Nassir
- University of California, Davis, Davis, CA, 95616, USA
| | - Judith K Ockene
- University of Massachusetts Medical School, Worcester, MA, 01655, USA
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Jeffe DB, Pérez M, Cole EF, Liu Y, Schootman M. The Effects of Surgery Type and Chemotherapy on Early-Stage Breast Cancer Patients' Quality of Life Over 2-Year Follow-up. Ann Surg Oncol 2015; 23:735-43. [PMID: 26511265 DOI: 10.1245/s10434-015-4926-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND We examined the effects of surgery type and adjuvant chemotherapy on change in early-stage breast cancer patients' quality of life (QOL) over time. METHODS A cohort of 549 patients (33.5% ductal carcinoma in situ, 66.5% stages I/IIA) were interviewed a mean 6.1 weeks (Time1), and 6.2 (Time2), 12.3 (Time3), and 24.4 (Time4) months following definitive breast-conserving surgery (BCS) or mastectomy. QOL was measured using the total Functional Assessment of Cancer Therapy-Breast (FACT-B). Adjusting for demographic, psychosocial, and clinical variables, multiple linear regression models estimated the associations between QOL and each of surgery type, chemotherapy, and their 2-way interaction at each interview. Adjusted generalized estimating equation (GEE) models tested Time1-Time4 change in QOL. RESULTS At Time2, chemotherapy (P < .001) and BCS (P < .001) were independently associated with worse QOL in adjusted linear regression, and the adverse effect of chemotherapy was prominent among patients who received BCS compared with those who received mastectomy (P interaction = .031). In the GEE model, QOL significantly improved over time among patients who received BCS (P trend = .047), mastectomy (P trend = .024), and chemotherapy (P trend < .001), but not among patients who did not receive chemotherapy (P trend = .720). All patients completed adjuvant chemotherapy and radiation by Time3. Regardless of surgery type, patients receiving chemotherapy reported lower QOL following surgery, and QOL improved after completion of adjuvant treatment. CONCLUSIONS Chemotherapy had a short-term negative impact on QOL after definitive surgical treatment regardless of surgery type. QOL rebounded after completion of adjuvant treatment.
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Affiliation(s)
- Donna B Jeffe
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA. .,Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA.
| | - Maria Pérez
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Emily F Cole
- Department of Internal Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Ying Liu
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Mario Schootman
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
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Dean LT, DeMichele A, LeBlanc M, Stephens-Shields A, Li SQ, Colameco C, Coursey M, Mao JJ. Black breast cancer survivors experience greater upper extremity disability. Breast Cancer Res Treat 2015; 154:117-25. [PMID: 26420404 DOI: 10.1007/s10549-015-3580-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/19/2015] [Indexed: 01/06/2023]
Abstract
Over one-third of breast cancer survivors experience upper extremity disability. Black women present with factors associated with greater upper extremity disability, including: increased body mass index (BMI), more advanced disease stage at diagnosis, and varying treatment type compared with Whites. No prior research has evaluated the relationship between race and upper extremity disability using validated tools and controlling for these factors. Data were drawn from a survey study among 610 women with stage I-III hormone receptor positive breast cancer. The disabilities of the arm, shoulder and hand (QuickDASH) is an 11-item self-administered questionnaire that has been validated for breast cancer survivors to assess global upper extremity function over the past 7 days. Linear regression and mediation analysis estimated the relationships between race, BMI and QuickDASH score, adjusting for demographics and treatment types. Black women (n = 98) had 7.3 points higher average QuickDASH scores than White (n = 512) women (p < 0.001). After adjusting for BMI, age, education, cancer treatment, months since diagnosis, and aromatase inhibitor status, Black women had an average 4-point (95 % confidence interval 0.18-8.01) higher QuickDASH score (p = 0.04) than White women. Mediation analysis suggested that BMI attenuated the association between race and disability by 40 %. Even several years post-treatment, Black breast cancer survivors had greater upper extremity disability, which was partially mediated by higher BMIs. Close monitoring of high BMI Black women may be an important step in reducing disparities in cancer survivorship. More research is needed on the relationship between race, BMI, and upper extremity disability.
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Affiliation(s)
- Lorraine T Dean
- School of Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 909 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA.
| | - Angela DeMichele
- School of Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 909 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - Mously LeBlanc
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA.,Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, USA
| | - Alisa Stephens-Shields
- School of Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 909 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA
| | - Susan Q Li
- Family Medicine and Community Health at the Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, USA
| | - Chris Colameco
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - Morgan Coursey
- School of Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 909 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA
| | - Jun J Mao
- School of Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 909 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA.,Family Medicine and Community Health at the Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, USA
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Pakiz B, Ganz PA, Sedjo RL, Flatt SW, Demark-Wahnefried W, Liu J, Wolin KY, Rock CL. Correlates of quality of life in overweight or obese breast cancer survivors at enrollment into a weight loss trial. Psychooncology 2015; 25:142-9. [PMID: 25920528 DOI: 10.1002/pon.3820] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 02/18/2015] [Accepted: 03/18/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this analysis was to examine the correlates of the physical and psychosocial domains of quality of life (QOL) in a cohort of breast cancer survivors participating in a weight loss intervention trial. METHODS Correlates of QOL and psychosocial functioning were examined in 692 overweight or obese breast cancer survivors at entry into a weight loss trial. QOL was explored with three measures: Short-form 36 (SF-36), Impact of Cancer scale (IOC), and the Breast Cancer Prevention Trial (BCPT) symptom scales. Available data included information on weight and physical activity, as well as demographic and medical characteristics. Multivariate analyses were used to identify associations adjusted for other characteristics. RESULTS In multivariate analysis, younger age was associated with higher negative impact scores (p < 0.0001). Hispanic, African-American, and Asian women had higher positive IOC impact scores compared with White non-Hispanic women (p < 0.01). Increased number of comorbidities was associated with lower physical and mental QOL scores (p < 0.01). Body mass index was not independently associated with QOL measures. Physical activity was directly associated with physical and mental QOL and IOC positive impact, and inversely related to IOC negative impact and Breast Cancer Prevention Trial symptom scales. CONCLUSIONS Quality-of-life measures in breast cancer survivors are differentially associated with demographic and other characteristics. When adjusted for these characteristics, degree of adiposity among overweight or obese women does not appear to be independently associated with QOL. Among overweight or obese breast cancer survivors, higher level of physical activity is associated with higher QOL across various scales and dimensions.
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Affiliation(s)
- Bilgé Pakiz
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Patricia A Ganz
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA.,UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Rebecca L Sedjo
- Department of Community and Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Shirley W Flatt
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | | | - Jingxia Liu
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Kathleen Y Wolin
- Coeus Health LLC, Chicago, IL, USA.,Scale Down LLC, Atlanta, GA, USA.,Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Cheryl L Rock
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, USA
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Treatment-related risk factors for arm lymphedema among long-term breast cancer survivors. J Cancer Surviv 2015; 9:422-30. [PMID: 25913877 DOI: 10.1007/s11764-014-0416-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 11/19/2014] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Treatment-related factors may increase the risk for arm lymphedema, which may occur after surgery or even many years after initial treatment for breast cancer. The association between treatment-related risk factors and development of arm lymphedema was examined for women who participated in the long-term quality of life (LTQOL) study, a 12-15-year follow-up of a breast cancer case-control study of Hispanic and non-Hispanic white women. METHODS Among 199 cases, 43 women (15 Hispanic, 28 non-Hispanic white) reported physician-diagnosed lymphedema during follow-up. Multivariable logistic regression analysis was used to calculate the odds ratios (OR) and 95% confidence intervals (CI) for the association of risk factors with lymphedema, adjusting for relevant covariates. RESULTS Tamoxifen had a non-significant, positive association with lymphedema (OR = 2.07, 95% CI 0.94-4.55, p =0.07). There were no significant associations with type of surgery, radiation, or chemotherapy. Risk was increased specifically in overweight and obese women (body mass index (BMI) > =25 kg/m(2)) treated with tamoxifen (OR = 2.62, 95% CI 0.99-6.93, p = 0.05). CONCLUSIONS This study suggests that breast cancer survivors with a BMI >25 who report the use of tamoxifen therapy may be at increased risk for arm lymphedema. IMPLICATIONS FOR CANCER SURVIVORS Larger case-control studies and clinical trials should investigate the long-term association of tamoxifen treatment with arm lymphedema especially in overweight and obese women. Lymphedema risk may be another indication to consider a weight reduction program in breast cancer survivors.
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Davis CM, Myers HF, Nyamathi AM, Lewis M, Brecht ML. The Meaning of Survivorship as Defined by African American Breast Cancer Survivors. J Transcult Nurs 2014; 27:277-85. [DOI: 10.1177/1043659614561678] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: While there is an abundance of cancer survivorship research among various racial/ethnic groups, there is a paucity of research on survivors of African descent. To date, the meaning of survivorship has not been reported exclusively among African American breast cancer survivors (AABCS). Purpose: The purpose was to describe and understand the meaning of survivorship among community-dwelling AABCS, mostly recruited from breast cancer support groups. Method: Using a qualitative descriptive approach, an open-ended questionnaire explored the meaning of survivorship among 155 AABCS. An analysis of the content was performed. Results: Among AABCS, survivorship meant having a strong spiritual base, thriving, being resilient, and being altruistic. The survivors self-identified with and embraced the term survivor.Conclusions: These results provide an important understanding of the perspectives and meaning of survivorship among AABCS and may assist in developing cancer survivorship care plans that are relevant, responsive, patient centered, and culturally appropriate.
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Maly RC, Liu Y, Liang LJ, Ganz PA. Quality of life over 5 years after a breast cancer diagnosis among low-income women: effects of race/ethnicity and patient-physician communication. Cancer 2014; 121:916-26. [PMID: 25411008 DOI: 10.1002/cncr.29150] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 09/29/2014] [Accepted: 10/10/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND The current study was performed to identify risk factors for a lower quality of life (QOL) among low-income women with breast cancer (BC), with an emphasis on the impact of patient-physician communication. In addition, ethnic/racial group differences in QOL changes over time were examined. METHODS A longitudinal study was conducted among 921 low-income women with BC. Patients were interviewed at 6 months, 18 months, 36 months, and 60 months after their diagnosis of BC. Mixed-effect regression models were performed to investigate predictors for and time effects on QOL. The main outcomes included the Medical Outcomes Study Health Survey Short Form-36 Mental Component Summary scale (SF-36 MCS), Medical Outcomes Study Health Survey Short Form-36 Physical Component Summary scale (SF-36 PCS), and the Ladder of Life scale. Chief independent variables included physician information-giving and patient self-efficacy in interacting with physicians. RESULTS There were no significant changes noted over time in QOL except with regard to physical functioning, with survivors reporting a significant decrease over time (P<.0001). Mean SF-36 MCS and SF-36 PCS scores were lower than national general population norms at all time points. Both patient self-efficacy in interacting with physicians and physician information-giving were found to be positively associated with the SF-36 MCS (P = .03 and P = .02, respectively) and Ladder of Life (P = .01 and P = .03, respectively) scales. Latinas who were less acculturated reported higher SF-36 MCS and SF-36 PCS scores (P<.0001 and P = .01, respectively) and better global QOL (P<.0001) than white women. CONCLUSIONS Low-income women with BC experienced poor physical and mental health. The results of the current study suggest that QOL among low-income women with BC would be enhanced by interventions aimed at empowering patients in communicating with physicians and increasing the amount of information provided by physicians.
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Affiliation(s)
- Rose C Maly
- Department of Family Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
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Seliktar N, Polek C, Brooks A, Hardie T. Cognition in breast cancer survivors: hormones versus depression. Psychooncology 2014; 24:402-7. [PMID: 25044780 DOI: 10.1002/pon.3602] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 05/12/2014] [Accepted: 05/19/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND OBJECTIVE Breast cancer survivors receiving hormone treatment and/or endorsing histories of receiving chemotherapy report changes in their cognitive capacity, which is often not supported by formal testing. To address these conflicting reports, this study examined survivors' applied cognitive capacity and its association with hormone treatment, depression, and selected demographics. METHODS A descriptive, correlational, cross-sectional survey design was employed. There were 357 women who completed a survey comprised of 69 questions. The survey included both investigator-developed questions and instruments from the PROMIS(®) system. RESULTS There were significant main effects for hormone therapy, race, and depression. Depression explained the largest portion of variance of the perceived decreases in cognitive function among breast cancer survivors. CONCLUSIONS Survivor complaints of changes in cognitive function may be a predictor for evaluating the presence of mood disorders and less a function of hormone therapy or chemotherapy history.
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Affiliation(s)
- Naomi Seliktar
- Interdisciplinary Research Unit, Drexel University, Philadelphia, PA, USA
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50
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Minority Breast Cancer Survivors: The Association between Race/Ethnicity, Objective Sleep Disturbances, and Physical and Psychological Symptoms. Nurs Res Pract 2014; 2014:858403. [PMID: 25101174 PMCID: PMC4101933 DOI: 10.1155/2014/858403] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 05/26/2014] [Accepted: 06/09/2014] [Indexed: 12/30/2022] Open
Abstract
Background. Limited research has been conducted on the moderating effect of race/ethnicity on objective sleep disturbances in breast cancer survivors (BCSs). Objective. To explore racial/ethnic differences in objective sleep disturbances among BCSs and their relationship with self-reported symptoms. Intervention/Methods. Sleep disturbance and symptoms were measured using actigraphy for 72 hours and self-reported questionnaires, respectively, among 79 BCSs. Analysis of covariance, Pearson's correlation, and multivariate regression were used to analyze data. Results. Sixty (75.9%) participants listed their ethnicity as white, non-Hispanic and 19 (24.1%) as minority. Total sleep time was 395.9 minutes for white BCSs compared to 330.4 minutes for minority BCSs. Significant correlations were seen between sleep onset latency (SOL) and depression, SOL and fatigue, and sleep efficiency (SE) and fatigue among minority BCSs. Among white BCSs, significant correlations were seen between SE and pain and wake after sleep onset (WASO) and pain. The association between depression and SOL and fatigue and SOL appeared to be stronger in minority BCSs than white BCSs. Conclusions. Results indicate that white BCSs slept longer than minority BCSs, and race/ethnicity modified the effect of depression and fatigue on SOL, respectively. Implications for Practice. As part of survivorship care, race/ethnicity should be included as an essential component of comprehensive symptom assessments.
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