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Aumaitre A, Gagnayre R, Foucaut AM. Determinants and Factors of Physical Activity After Oncology Treatments (DEFACTO) in Metropolitan France: Protocol of a Mixed Methods Study and Intervention. JMIR Res Protoc 2024; 13:e52274. [PMID: 38753415 PMCID: PMC11140280 DOI: 10.2196/52274] [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: 08/29/2023] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND While the scientific community widely recognizes the benefits of physical activity (PA) in oncology supportive care, cancer survivors who have undergone chemo- or radio-immunotherapy treatments struggle to meet PA recommendations. This underscores the importance of identifying factors influencing active lifestyle adoption and maintenance and proposing a multilevel model (micro-, meso-, and macrolevel) to better understand facilitators and barriers. Currently, no socioecological model explains an active lifestyle in the posttreatment phase of breast, colorectal, prostate, and lung cancers. OBJECTIVE The objective is to identify factors influencing an active lifestyle in cancer survivorship and assess the feasibility of an individualized program targeting an active lifestyle. The objectives will be addressed in 3 stages. Stage 1 aims to elucidate factors associated with the active lifestyle of cancer survivors. Stage 2 involves developing an explanatory model based on previously identified factors to create a tailored health education program for an active lifestyle after oncology treatments. Stage 3 aims to evaluate the feasibility and potential effects of this personalized health education program after its national implementation. METHODS First, the exploration of factors influencing PA (stage 1) will be based on a mixed methods approach, using an explanatory sequential design and multilevel analysis. The quantitative phase involves completing a questionnaire from a socioecological perspective. Subsequently, a subset of respondents will engage in semistructured interviews to aid in interpreting the quantitative results. This phase aims to construct a model of the factors influencing an active lifestyle and develop an individualized 12-week program based on our earlier findings (stage 2). In stage 3, we will implement our multicenter, multimodal program for 150 physically inactive and sedentary cancer survivors across metropolitan France. Program feasibility will be evaluated. Measured PA level by connected device and multidimensional variables such as declared PA and sedentary behaviors, PA readiness, motivation, PA preferences, PA knowledge and skills, and barriers and facilitators will be assessed before and during the program and 52 weeks afterward. RESULTS The institutional review board approved the mixed methods study (phase 1) in April 2020, and the intervention (phase 3) was approved in March 2022. Recruitment and data collection commenced in April 2022, with intervention implementation concluded in May 2023. Data collection and full analysis are expected to be finalized by July 2024. CONCLUSIONS The Determinants and Factors of Physical Activity After Oncology Treatments (DEFACTO) study seeks to enhance our understanding, within our socioecological model, of factors influencing an active lifestyle among cancer survivors and to assess whether a tailored intervention based on this model can support an active lifestyle. TRIAL REGISTRATION ClinicalTrials.gov NCT05354882; https://www.clinicaltrials.gov/study/NCT05354882. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52274.
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Affiliation(s)
- Albane Aumaitre
- Health Educations and Promotion Laboratory, LEPS, UR 3412, Sorbonne Paris North University, Villetaneuse, France
| | - Rémi Gagnayre
- Health Educations and Promotion Laboratory, LEPS, UR 3412, Sorbonne Paris North University, Villetaneuse, France
| | - Aude-Marie Foucaut
- Health Educations and Promotion Laboratory, LEPS, UR 3412, Sorbonne Paris North University, Villetaneuse, France
- Sports Science Department, Sorbonne Paris North University, Bobigny, France
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Edmonds MC, Bickell NA, Gallagher EJ, LeRoith D, Lin JJ. Racial differences in weight perception among Black and White women diagnosed with breast cancer. J Cancer Surviv 2024; 18:531-540. [PMID: 36169797 PMCID: PMC10166002 DOI: 10.1007/s11764-022-01255-3] [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: 05/09/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Black women are more likely than White women to have obesity, and obesity is associated with worse breast cancer prognosis. Weight perception, however, has not been studied as a potential mediator of obesity disparities in women with breast cancer. In this study, we sought to describe racial differences and the association of lifestyle factors with weight perception. METHODS In this cross-sectional study design, Black and White women with a new primary breast cancer were surveyed about socio-demographics, weight perception, diet, and exercise habits. Height and weight were measured at enrollment. We classified women with a BMI ≥ 25 kg/m2 or waist circumference ≥ 88 cm who reported that they were "about the right weight" as under-perceivers. Chi-square and t tests were used to assess study variables (e.g., race, physical activity) associated with under-perception of weight. Logistic regression models were fit to evaluate for racial differences in under-perception while controlling for other covariates. RESULTS Of 1,197 women with newly diagnosed breast cancer, the average age was 58 years, and 909 (75.9%) were White. Nine hundred eighteen (77%) had stage I cancer, 1,035 (87%) had estrogen receptor positive cancer, and 795 (66%) were privately insured at time of diagnosis. Seven hundred eighty-nine (66%) women had abdominal obesity (waist circumference ≥ 88 cm), while 366 (31%) women had a BMI ≥ 25 kg/m2. Overall, 24% of women were under-perceivers. Compared to White women, Black women with WC ≥ 88 cm more frequently under-perceived their weight (24% vs. 14% p < 0.0001) were more obese with BMI > 30 kg/m2 (51% vs. 23%, p < 0.0001) and had lower physical activity (22% vs. 77%, p < 0.0001). After controlling for age, education, and stage, Black women remained more likely to under-perceive their weight relative to White women for those with BMI ≥ 25 kg/m2 (OR: 2.64; 95% CI: 1.4-4.6) or waist circumference ≥ 88 cm (OR: 2.89; 95% CI: 1.8-4.5). With respect to lifestyle factors, among women with BMI ≥ 25 kg/m2, those who met physical activity guidelines were less likely to under-perceive their weight compared to those who did not meet physical activity guidelines (OR: 0.37; 95% CI: 0.2-0.6), regardless of race. CONCLUSIONS We found racial differences in weight perception and identified social determinants and lifestyle factors such as lower education and physical inactivity that influenced under-perception of weight among newly diagnosed breast cancer patients. IMPLICATIONS FOR CANCER SURVIVORS Since obesity is associated with worse breast cancer outcomes, identifying optimal modifiable factors to intervene upon to support weight management among breast cancer survivors is clinically important. Breast cancer patients' perceptions about their weight provide insight that may inform lifestyle behavior interventions to reduce obesity during survivorship care.
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Affiliation(s)
- Megan C Edmonds
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Nina A Bickell
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emily J Gallagher
- Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Derek LeRoith
- Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jenny J Lin
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Semenza D, Silver I, Stansfield R, Boen C. Concentrated disadvantage and functional disability: a longitudinal neighbourhood analysis in 100 US cities. J Epidemiol Community Health 2023; 77:676-682. [PMID: 37451845 DOI: 10.1136/jech-2023-220487] [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: 02/21/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Socioeconomic disadvantage related to poverty, unemployment and social disinvestment contributes to significant disparities in community health in the USA. Yet, there remains limited ecological research on the relationship between neighbourhood disadvantage and functional disability. Much of the work in this area has focused on elderly populations without attention to variation across age and sex groups. METHODS Using a longitudinal dataset of almost 16 000 neighbourhoods, we examine the relationship between neighbourhood disadvantage and functional disability. Leveraging a series of cross-lagged panel models, we account for reciprocal dynamics and a range of pertinent covariates while assessing differences across age- and sex-specific groups. RESULTS Accounting for reciprocal effects, we found that the association between concentrated disadvantage and functional disability varies across age and sex groups. Concentrated disadvantage is most consistently associated with increased functional disability among boys (5-17 years), young men (18-34 years) and middle-aged men (35-64 years). Similar associations are found among girls (5-17 years) and middle-aged women (35-64 years). CONCLUSION Local neighbourhood economic conditions are significantly associated with functional disability among relatively young populations of males and females. Exposure to neighbourhood disadvantage and deprivation may accelerate disablement processes and shift the age curve of disability risk.
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Affiliation(s)
- Daniel Semenza
- Sociology, Anthropology, and Criminal Justice, Rutgers University, Camden, New Jersey, USA
- Urban-Global Public Health, Rutgers University, Piscataway, New Jersey, USA
| | - Ian Silver
- Center for Courts and Corrections Research, Research Triangle Institute, Research Triangle Park, North Carolina, USA
| | - Richard Stansfield
- Sociology, Anthropology, and Criminal Justice, Rutgers University, Camden, New Jersey, USA
| | - Courtney Boen
- Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Barriers and facilitators to the engagement of physical activity among Black and African American cancer survivors during and after treatments. Support Care Cancer 2023; 31:136. [PMID: 36700992 PMCID: PMC9877498 DOI: 10.1007/s00520-023-07601-0] [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: 10/24/2022] [Accepted: 01/18/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE To identify physical activity (PA) barriers and facilitators among Black and African American (Black/AA) cancer survivors that should be considered in future PA intervention development for this population. METHODS A community advisory board (CAB) of Black/AA cancer survivors and patient advocates guided in-depth qualitative interviews (n = 19) that were completed via telephone using a semi-structured interview guide. Interviews were transcribed verbatim, and data were analyzed using directed content analysis to detail a report of PA barriers and facilitators during and after cancer treatment. The CAB reviewed and interpreted these barriers and facilitators to identify the final results. RESULTS Survivors (n = 19) of nine different types of cancer completed interviews. PA barriers during cancer treatments included physical and psychological suffering. PA barriers after cancer treatments included social and environmental constraints (e.g., lack of access needed for PA, safety concerns, and competing priorities). PA facilitators both during and after cancer treatments included family support, faith, and support from other survivors. PA facilitators during treatment also included feeling better after doing PA, setting realistic and flexible goals, and gaining a sense of control of one's health by striving for PA goals. CONCLUSIONS To increase PA among Black/AA cancer survivors, PA interventions are needed that address structural barriers, include the role of faith, leverage family support, highlight the psychological benefits of PA, and use goal setting.
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Bandera EV, Alfano CM, Qin B, Kang DW, Friel CP, Dieli-Conwright CM. Harnessing Nutrition and Physical Activity for Breast Cancer Prevention and Control to Reduce Racial/Ethnic Cancer Health Disparities. Am Soc Clin Oncol Educ Book 2021; 41:1-17. [PMID: 33989021 DOI: 10.1200/edbk_321315] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There are well-known racial/ethnic disparities in the prevalence of obesity and physical inactivity, as well as breast cancer risk and survival. However, most of the current scientific evidence that serves as a foundation for nutrition and physical activity guidelines is based on studies conducted in predominantly non-Hispanic White populations. Similarly, exercise, diet, or lifestyle intervention trials for breast cancer prevention and survivorship are scarce in racial/ethnic minority populations. We review the current evidence for racial/ethnic disparities in obesity and breast cancer risk and survival (we are focusing on obesity, because this is considered an ASCO priority, and studies conducted in the United States), discuss the evolution of nutrition/physical activity guidelines for cancer prevention and control, and provide an overview of lifestyle interventions, including barriers and facilitators in implementation and dissemination science among minority populations underrepresented in research. There is a critical need to include racially/ethnically diverse populations in cancer prevention and control research or to specifically target minority populations in which disparities are known to exist to achieve much needed health equity.
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Affiliation(s)
- Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Catherine M Alfano
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, New York, NY.,Northwell Health Cancer Institute, New York, NY.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Bo Qin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Dong-Woo Kang
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Ciarán P Friel
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, New York, NY
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Namin S, Zhou Y, Neuner J, Beyer K. The role of residential history in cancer research: A scoping review. Soc Sci Med 2021; 270:113657. [PMID: 33388619 DOI: 10.1016/j.socscimed.2020.113657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/18/2020] [Accepted: 12/22/2020] [Indexed: 11/29/2022]
Abstract
The role of residential history in cancer prevention, diagnosis, treatment, and survivorship is garnering increasing attention in cancer research. To our knowledge, there is no comprehensive synthesis of the current state of knowledge in the field. We reviewed the extant literature on this topic and conducted a scoping analysis to examine two main research questions: (a) To what degree, and how, have researchers accounted for residential history/mobility in cancer research? and (b) What are the gaps in the literature based on a knowledge synthesis using scoping review and concept mapping? To answer these questions, this scoping analysis focuses on how researchers compile, analyze and discuss residential history/mobility in studies on cancer. The study is focused on peer-reviewed articles from 6 different datasets (PubMed, Cinahl, Scopus, Web of Science and JSTOR, ERIC) from 1990 to August 2020. The review captured 1951 results in total, which was scoped to 281 relevant peer-reviewed journal articles. First, we examined these articles based on cancer continuum, cancer type and the main theme. Second, we identified 21 main themes and an additional 16 sub-themes in the pool of the selected articles. We utilized concept mapping to provide a conceptual framework and to highlight the underlying socioecological assumptions and paradigms. Results show that cancer research incorporating residential histories is primarily focused on incidence and estimating cumulative exposure, with little consideration across the cancer continuum. Additionally, our review suggests that although the social environment plays an important role across the cancer continuum, a small number of articles were focused on such factors and this area remains relatively unexplored. Additionally, the expansion of interdisciplinary research on residential mobility before and after cancer diagnosis will enhance understanding of the role of environmental and socioeconomic characteristics and exposures on cancer continuum.
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Affiliation(s)
- S Namin
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Y Zhou
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Neuner
- General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - K Beyer
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA
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Kwarteng JL, Beyer KMM, Banerjee A, Stolley MR. Facilitators of behavior change and weight loss in an intervention for African American Breast Cancer Survivors. Cancer Causes Control 2020; 31:737-747. [PMID: 32415529 PMCID: PMC11196002 DOI: 10.1007/s10552-020-01315-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 05/05/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this study was to examine facilitators of behavior change and weight loss among African-American women who participated in the Moving Forward Efficacy trial. METHODS Linear mixed models were used to examine the role of self-efficacy, social support, and perceived access to healthy eating, exercise, and neighborhood safety on weight, physical activity, and diet. We also examined the mediation of self-efficacy, social support, and perceived access to healthy eating, exercise, and neighborhood safety on weight loss, physical activity, and diet using the Freedman Schatzkin statistic. RESULTS We found no evidence to suggest mediation, but some direct associations of self-efficacy, certain types of social support and perceived access to exercise on weight loss, and behavior change. CONCLUSION We determined that self-efficacy, social support, and perceived access to exercise played a role in weight loss, increased MVPA, and better diet. The role of self-efficacy and perceived access to exercise were more consistent than social support.
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Affiliation(s)
- J L Kwarteng
- Division of Community Health, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - K M M Beyer
- Division of Epidemiology, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - A Banerjee
- Division of Biostatistics, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - M R Stolley
- Division of Hematology and Oncology, Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Reported Barriers Impeding Adherence to a Physical Exercise Program in Patients With Breast Cancer: A Systematic Review. REHABILITATION ONCOLOGY 2020. [DOI: 10.1097/01.reo.0000000000000220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Moore JX, Akinyemiju T, Bartolucci A, Wang HE, Waterbor J, Griffin R. A Prospective Study of Community Mediators on the Risk of Sepsis After Cancer. J Intensive Care Med 2019; 35:1546-1555. [PMID: 31684782 DOI: 10.1177/0885066619881122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Few studies have examined whether community factors mediate the relationship between patients surviving cancer and future development of sepsis. We determined the influence of community characteristics upon risk of sepsis after cancer, and whether there are differences by race. METHODS We performed a prospective analysis using data from the REasons for Geographic and Racial Differences in Stroke cohort years 2003 to 2012 complemented with county-level community characteristics from the American Community Survey and County Health Rankings. We categorized those with a self-reported prior cancer diagnosis as "cancer survivors" and those without a history of cancer as "no cancer history." We defined sepsis as hospitalization for a serious infection with ≥2 systemic inflammatory response syndrome criteria. We examined the mediation effect of community characteristics on the association between cancer survivorship and sepsis incidence using Cox proportional hazards models adjusted for age, sex, race, and total number of comorbidities. We repeated analysis stratified by race. RESULTS There were 28 840 eligible participants, of which 2860 (9.92%) were cancer survivors, and 25 289 (90.08%) were no cancer history participants. The only observed community-level mediation effects were from income (% mediated 0.07%; natural indirect effect [NIE] on hazard scale] = 1.001, 95% confidence interval [95% CI]: 1.000-1.005) and prevalence of adult smoking (% mediated = 0.21%; NIE = 1.002, 95% CI: 1.000-1.004). We observed similar effects when stratified by race. CONCLUSION Cancer survivors are at increased risk of sepsis; however, this association is weakly mediated by community poverty and smoking prevalence.
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Affiliation(s)
- Justin Xavier Moore
- Division of Epidemiology, Department of Population Health Sciences, 160343Augusta University, Augusta, GA, USA
- Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, St Louis, MO, USA
| | - Tomi Akinyemiju
- Department of Population Health Sciences, 3065Duke University School of Medicine, Durham, NC, USA
| | - Alfred Bartolucci
- Department of Biostatistics, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Henry E Wang
- Department of Emergency Medicine, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - John Waterbor
- Department of Epidemiology, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Russell Griffin
- Department of Epidemiology, 9968University of Alabama at Birmingham, Birmingham, AL, USA
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Paxton RJ, Zhang L, Wei C, Price D, Zhang F, Courneya KS, Kakadiaris IA. An exploratory decision tree analysis to predict physical activity compliance rates in breast cancer survivors. ETHNICITY & HEALTH 2019; 24:754-766. [PMID: 28922931 PMCID: PMC6581628 DOI: 10.1080/13557858.2017.1378805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Background: The study of physical activity in cancer survivors has been limited to one cause, one effect relationships. In this exploratory study, we used recursive partitioning to examine multiple correlates that influence physical activity compliance rates in cancer survivors. Methods: African American breast cancer survivors (N = 267, Mean age = 54 years) participated in an online survey that examined correlates of physical activity. Recursive partitioning (RP) was used to examine complex and nonlinear associations between sociodemographic, medical, cancer-related, theoretical, and quality of life indicators. Results: Recursive partitioning revealed five distinct groups. Compliance with physical activity guidelines was highest (82% met guidelines) among survivors who reported higher mean action planning scores (P < 0.001) and lower mean barriers to physical activity (P = 0.035). Compliance with physical activity guidelines was lowest (9% met guidelines) among survivors who reported lower mean action and coping (P = 0.002) planning scores. Similarly, lower mean action planning scores and poor advanced lower functioning (P = 0.034), even in the context of higher coping planning scores, resulted in low physical activity compliance rates (13% met guidelines). Subsequent analyses revealed that body mass index (P = 0.019) and number of comorbidities (P = 0.003) were lowest in those with the highest compliance rates. Conclusion: Our findings support the notion that multiple factors determine physical activity compliance rates in African American breast cancer survivors. Interventions that encourage action and coping planning and reduce barriers in the context of addressing function limitations may increase physical activity compliance rates.
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Affiliation(s)
- Raheem J Paxton
- a Department of Community Medicine and Population Health, The University of Alabama , Tuscaloosa , AL , USA
| | - Lingfeng Zhang
- b Computational Biomedicine Lab, Department of Computer Science, University of Houston , Houston , TX , USA
| | | | - Daniel Price
- d Honors College, University of Houston , Houston , TX , USA
| | - Fan Zhang
- e The University of North Texas Health Science Center , Fort Worth , TX , USA
| | - Kerry S Courneya
- f Department of Physical Education and Recreation, The University of Alberta , Edmonton , AB , Canada
| | - Ioannis A Kakadiaris
- b Computational Biomedicine Lab, Department of Computer Science, University of Houston , Houston , TX , USA
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Saini G, Ogden A, McCullough LE, Torres M, Rida P, Aneja R. Disadvantaged neighborhoods and racial disparity in breast cancer outcomes: the biological link. Cancer Causes Control 2019; 30:677-686. [PMID: 31111277 PMCID: PMC7043809 DOI: 10.1007/s10552-019-01180-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 05/09/2019] [Indexed: 02/07/2023]
Abstract
Neighborhoods encompass complex environments comprised of unique economic, physical, and social characteristics that have a profound impact on the residing individual's health and, collectively, on the community's wellbeing. Neighborhood disadvantage (ND) is one of several factors that prominently contributes to racial breast cancer (BC) health disparities in American women. African American (AA) women develop more aggressive breast cancer features, such as triple-negative receptor status and more advanced histologic grade and tumor stage, and suffer worse clinical outcomes than European American (EA) women. While the adverse effects of neighborhood disadvantage on health, including increased risk of cancer and decreased longevity, have recently come into focus, the specific molecular mechanisms by which neighborhood disadvantage increases BC risk and worsens BC outcomes (survivorship, recurrence, mortality) are not fully elucidated. This review illuminates the probable biological links between neighborhood disadvantage and predominantly BC risk, with an emphasis on stress reactivity and inflammation, epigenetics and telomere length in response to adverse neighborhood conditions.
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Affiliation(s)
- Geetanjali Saini
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA
| | - Angela Ogden
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA
| | - Lauren E McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Mylin Torres
- Department of Radiation Oncology, Glenn Family Breast Center, Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Padmashree Rida
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA
| | - Ritu Aneja
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA.
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Tabaczynski A, Strom DA, Wong JN, McAuley E, Larsen K, Faulkner GE, Courneya KS, Trinh L. Demographic, medical, social-cognitive, and environmental correlates of meeting independent and combined physical activity guidelines in kidney cancer survivors. Support Care Cancer 2019; 28:43-54. [PMID: 30980259 DOI: 10.1007/s00520-019-04752-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/15/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE Guidelines for cancer survivors recommend both aerobic physical activity (PA) and strength training (ST). Few kidney cancer survivors (KCS) are meeting single-activity or combined guidelines; therefore, examining factors influencing PA participation is warranted. The purpose of this study is to examine demographic, medical, social-cognitive, and environmental correlates of meeting independent (i.e., aerobic-only, strength training (ST)-only) and combined guidelines (i.e., aerobic and ST) in KCS. METHODS KCS (N = 651) completed self-reported measures of PA and demographic, medical, social-cognitive, and perceived environmental factors. Built environment was assessed using the geographic information systems (GIS). Multinomial logistic regressions were conducted to determine the correlates of meeting the combined versus independent guidelines. RESULTS Compared with meeting neither guideline, meeting aerobic-only guidelines was associated with higher intentions (p < .01) and planning (p < .01); meeting ST-only guidelines was associated with higher intentions (p = .02) and planning (p < .01), lower perceived behavioral control (PBC) (p = .03), healthy weight (p = .01), and older age (p < .01); and meeting the combined guidelines were associated with higher intentions (p < .01), planning (p = .02), higher instrumental attitudes (p < .01), higher education (p = .04), better health (p < .01), and localized cancer (p = .05). Additionally, compared with neither guideline, meeting aerobic-only (p < .01) and combined (p < .01) guidelines was significantly associated with access to workout attire. Compared with neither guideline, meeting aerobic-only guidelines was associated with proximity to retail (p = .02). CONCLUSION PA participation correlates may vary based on the modality of interest. Interventions may differ depending on the modality promoted and whether KCS are already meeting single-modality guidelines.
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Affiliation(s)
- Allyson Tabaczynski
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada
| | - Dominick A Strom
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 South Goodwin Avenue, Urbana, IL, 61801, USA
| | - Jaime N Wong
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 South Goodwin Avenue, Urbana, IL, 61801, USA
| | - Edward McAuley
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 South Goodwin Avenue, Urbana, IL, 61801, USA
| | - Kristian Larsen
- CAREX Canada, Faculty of Health Sciences, Simon Fraser University, 105-515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada.,Department of Geography and Planning, University of Toronto, 100 St. George Street, Toronto, ON, M5S 2W6, Canada
| | - Guy E Faulkner
- School of Kinesiology, University of British Columbia, 2259 Lower Mall, Vancouver, British Columbia, V6T 1Z4, Canada
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 113 University Hall, Edmonton, Alberta, T6G 2H9, Canada
| | - Linda Trinh
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada.
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Paxton RJ, Garner W, Dean LT, Logan G, Allen-Watts K. Health Behaviors and Lifestyle Interventions in African American Breast Cancer Survivors: A Review. Front Oncol 2019; 9:3. [PMID: 30723698 PMCID: PMC6349825 DOI: 10.3389/fonc.2019.00003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 01/02/2019] [Indexed: 11/13/2022] Open
Abstract
Background: African American breast cancer survivors have a higher incidence of estrogen receptor negative and basal-like (e.g., triple negative) tumors, placing them at greater risk for poorer survival when compared to women of other racial and ethnic groups. While access to equitable care, late disease stage at diagnosis, tumor biology, and sociodemographic characteristics contribute to health disparities, poor lifestyle characteristics (i.e., inactivity, obesity, and poor diet) contribute equally to these disparities. Lifestyle interventions hold promise in shielding African American survivors from second cancers, comorbidities, and premature mortality, but they are often underrepresented in studies promoting positive behaviors. This review examined the available literature to document health behaviors and lifestyle intervention (i.e., obesity, physical activity, and sedentary behavior) studies in African American breast cancer survivors. Methods: We used PubMed, Academic Search Premier, and Scopus to identify cross-sectional and intervention studies examining the lifestyle behaviors of African American breast cancer survivors. Identified intervention studies were assessed for risk of bias. Other articles were identified and described to provide context for the review. Results: Our systematic review identified 226 relevant articles. The cross-sectional articles indicated poor adherence to physical activity and dietary intake and high rates of overweight and obesity. The 16 identified intervention studies indicated reasonable to modest study adherence rates (>70%), significant reductions in weight (range -1.9 to -3.6%), sedentary behavior (-18%), and dietary fat intake (range -13 to -33%) and improvements in fruit and vegetable intake (range +25 to +55%) and physical activity (range +13 to +544%). The risk of bias for most studies were rated as high (44%) or moderate (44%). Conclusions: The available literature suggests that African American breast cancer survivors adhere to interventions of various modalities and are capable of making modest to significant changes. Future studies should consider examining (a) mediators and moderators of lifestyle behaviors and interventions, (b) biological outcomes, and (c) determinants of enhanced survival in this population.
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Affiliation(s)
- Raheem J Paxton
- Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL, United States
| | - William Garner
- Department of Life and Health Sciences, University of North Texas at Dallas, Dallas, TX, United States
| | - Lorraine T Dean
- Department of Epidemiology, John Hopkins School of Public Health, Baltimore, MD, United States
| | - Georgiana Logan
- Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL, United States
| | - Kristen Allen-Watts
- Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL, United States
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Determinants of changes in physical activity from pre-diagnosis to post-diagnosis in a cohort of prostate cancer survivors. Support Care Cancer 2018; 27:2819-2828. [DOI: 10.1007/s00520-018-4578-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 11/27/2018] [Indexed: 12/30/2022]
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Predicting Physical Activity Behavior in African American Females: UsingMulti Theory Model. J Res Health Sci 2018. [PMCID: PMC7204419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Despite physical activity having several benefits, a considerable number of Americans donot engage in sufficient exercise. Among the high-risk groups are African American women. A recenttheory, multi theory model (MTM) for health behavior change can be used to develop effectiveinterventions. The objective of this research was to test MTM in its ability to predict physical activitybehavior in African American women. Study design: A cross-sectional study. Methods: African American women aged 18 yr and older were recruited at various locations (primarilychurches) of Jackson, a large city in Central Mississippi instead of southern Mississippi to participate inthis cross-sectional study in 2016. The valid and reliable survey was administered to a G*Power calculatedquota sample of 156 women either in person or via a Qualtrics link sent through an e-mail. Results: The regression analysis revealed that 32.7% of the variance in initiating physical activity behaviorwas predicted by participatory dialogue, behavioral confidence, and changes in physical environment.Sustenance of physical activity behavior was predicted up to 38.8% by emotional transformation andchanges in social environment. Conclusions: MTM appears to be a robust theory in its application for changing physical activity behaviorin African American women. This theory must be reified and empirically tested with this population.
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Smith SA, Ansa BE, Yoo W, Whitehead MS, Coughlin SS. Determinants of adherence to physical activity guidelines among overweight and obese African American breast cancer survivors: implications for an intervention approach. ETHNICITY & HEALTH 2018; 23:194-206. [PMID: 27838922 PMCID: PMC5429994 DOI: 10.1080/13557858.2016.1256376] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Public health agencies encourage breast cancer survivors (BCSs) to follow their physical activity guidelines (PAGs). However, adherence to these guidelines is low. African American (AA) BCSs are more often overweight or obese and less likely than women of other races to report adherence to physical activity recommendations. This study examined socioeconomic, clinical, and psychosocial correlates with meeting PAGs. DESIGN AA women diagnosed and treated for breast cancer and participating in a breast cancer support group (N = 193) completed a lifestyle assessment tool capturing demographic characteristics; breast cancer diagnosis and treatment history; health-related quality of life; weight history, including body mass index and post-diagnosis weight gain; and physical activity. Logistic regressions were used to determine if these covariates were associated with meeting [>8.3 metabolic equivalent task (MET) hr/wk]; partially meeting (4.15-8.3 MET hr/wk); or not meeting (<4.15 MET hr/wk) PAGs. RESULTS Only 54% of AA BCSs reported meeting current PAGs. Participants reporting weight gain of ≤5 lbs post-diagnosis, and those who received surgical treatment for breast cancer were more likely to complete at least 8.3 MET hr/wk. Better physical functioning and lesser pain intensity were associated with meeting PAGs. CONCLUSION Several factors influence physical activity behaviors and are likely to be important in developing effective interventions to assist AA survivors manage their weight. It is essential that providers and breast cancer support groups that assist survivors to remain physically active and to manage their weight should be aware of these factors. These findings may help generate hypotheses for future research to undergird efforts to increase physical activity among African American BCSs.
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Affiliation(s)
- Selina A. Smith
- Institute of Public & Preventive Health, Augusta University, Augusta, GA, USA
- Department of Family Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Benjamin E. Ansa
- Institute of Public & Preventive Health, Augusta University, Augusta, GA, USA
| | - Wonsuk Yoo
- Institute of Public & Preventive Health, Augusta University, Augusta, GA, USA
- Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Mary S. Whitehead
- Florida Resources for Empowering Sustainable Health, Miami, FL, USA
- SISTAAH Talk Breast Cancer Support Group, Miami, FL, USA
| | - Steven S. Coughlin
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA, USA
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Cho D, Park CL. Barriers to physical activity and healthy diet among breast cancer survivors: A multilevel perspective. Eur J Cancer Care (Engl) 2017; 27. [PMID: 28940854 DOI: 10.1111/ecc.12772] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2017] [Indexed: 12/17/2022]
Abstract
Cancer survivors engage in suboptimal levels of health behaviours and report many barriers to health behaviours, but we lack a solid understanding of the different levels of barriers and how they relate to enacted health behaviours. To address these issues, we conducted mixed-method research in 97 breast cancer survivors. Participants' barriers to physical activity (PA) and healthy diet, asked as an open-ended question, were coded as individual-level, social-level, and organisational/environmental-level for each health behaviour. Moderate-to-vigorous PA and fruit and vegetable (F&V) intake were assessed. Most participants perceived at least one PA (72.7%) and diet (64.9%) individual-level barrier (e.g. physical symptoms/injury); only 15.2% (PA) and 15.6% (diet) reported at least one social-level barrier (e.g. family obligations). About 28.8% (PA) and 29.9% (diet) perceived at least one organisational/environmental-level barrier (e.g. job demand, cost of F&V). Survivors perceiving individual-level dietary barriers consumed less F&V (-.65 servings/day) than those not perceiving dietary barriers at this level. Survivors perceiving social-level dietary barriers reported marginally lower F&V intake (-.65 servings/day) than their counterparts. Those perceiving organisational/environmental-level PA barriers reported marginally fewer minutes (-44.30/week) of moderate-to-vigorous PA than their counterparts. Barriers at multiple levels should be addressed to improve health behaviours among breast cancer survivors.
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Affiliation(s)
- D Cho
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - C L Park
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
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Abstract
BACKGROUND Limited data exist on the benefits of, barriers to, and potential strategies to break up time spent sitting in cancer survivors. Such data will be meaningful given the consequences of prolonged sitting. OBJECTIVES The aim of this study was to conduct a mixed-method research study consisting of semistructured telephone interviews to identify recurrent themes associated with prolonged sitting in cancer survivors. METHODS African American breast cancer survivors (N = 31) were recruited from a local tumor registry. Telephone interviews were conducted and group consensus processes were used to identify recurrent themes. The a priori categories were benefits, barriers, and potential strategies to breaking up prolonged periods of sitting. RESULTS Recurrent themes contributing most to prolonged sitting were leisure time interest (45%: eg, watching television and reading) and health challenges (27%: eg, pain and fatigue). Most (66%) women perceived improved health as benefits to breaking up time spent sitting. Nonetheless, many (41%) survivors reported health (eg, pain and fatigue) as the biggest challenge to interrupt time spent sitting. Engaging in light intensity activities (eg, staying active, keep moving) was the most commonly reported strategy for breaking up prolonged sitting. CONCLUSIONS African American breast cancer survivors identified the benefits and barriers to breaking up time spent sitting as well as potential strategies to interrupt time-spent sitting. IMPLICATIONS FOR PRACTICE Clinicians are integral in promoting breaks from prolonged sitting throughout the initial phases of the cancer continuum. Successful studies will begin with early intervention in the clinical setting, with increasing intensity as survivors transition to the recovery phase.
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Maxwell-Smith C, Zeps N, Hagger MS, Platell C, Hardcastle SJ. Barriers to physical activity participation in colorectal cancer survivors at high risk of cardiovascular disease. Psychooncology 2016; 26:808-814. [PMID: 27478009 DOI: 10.1002/pon.4234] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 07/22/2016] [Accepted: 07/26/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lifestyle factors including inadequate physical activity may contribute to increased risk of developing cardiovascular disease in colorectal cancer survivors. Identification of the barriers to physical activity is important for forming an evidence base of factors to target in future physical activity programs aimed at improving cardiovascular health in this population. METHODS Colorectal cancer survivors (N = 24) from St. John of God Subiaco Hospital participated in semi-structured interviews about their current physical activity behaviors and perceived barriers to physical activity. RESULTS Inductive thematic analysis of interviews revealed 5 overarching themes relating to barriers to physical activity: psychological barriers, environmental barriers, knowledge of guidelines, lack of practitioner support, and energy/age barriers. CONCLUSIONS Novel findings revealed participants' dependence on practitioner support, including a reliance on practitioners to recommend lifestyle change. Survivors also revealed that regular checkups to monitor cardiovascular risk replaced the need for healthy lifestyle changes. IMPLICATIONS With survivors holding the advice of clinicians in high regard, an opportunity exists for clinicians to facilitate lifestyle change. Health care professionals such as nurses can implement motivational strategies and provide additional health information during follow-up visits, to ensure long-term adherence. Individuals who reported psychological, motivational, and environmental barriers may benefit from interventions to improve self-regulation, planning, and problem-solving skills.
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Affiliation(s)
- Chloe Maxwell-Smith
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Nik Zeps
- Department of Oncology, St. John of God Hospital, Perth, Western Australia, Australia
| | - Martin S Hagger
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Cameron Platell
- Department of Oncology, St. John of God Hospital, Perth, Western Australia, Australia
| | - Sarah J Hardcastle
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
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Dean LT, Brown J, Coursey M, Schmitz KH. Great expectations: racial differences in outcome expectations for a weight lifting intervention among black and white breast cancer survivors with or without lymphedema. Psychooncology 2016; 25:1064-70. [PMID: 27192633 DOI: 10.1002/pon.4175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 02/26/2016] [Accepted: 05/11/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Black breast cancer survivors are less likely to engage in physical activity than are White survivors. This is unfortunate because physical activity may be especially beneficial given Black breast cancer survivors' higher rates of obesity and adverse treatment effects related to obesity, such as breast cancer-related lymphedema (BCRL). The analysis explored outcome expectations for a weight lifting intervention by sedentary Black or White female breast cancer survivors and assessed the role of BCRL on outcome expectations for exercise. METHODS Chi-squared tests compared mean outcome expectation values for Black and White breast cancer survivors who completed baseline surveys for the Physical Activity and Lymphedema trial (n = 281). With race as the independent variable, multivariable analysis compared results for women without BCRL with those with BCRL, separately. RESULTS Across the entire sample, Black survivors (n = 90) had significantly higher (p < 0.05) outcome expectations than White survivors (n = 191) for improvements in sleep, appearance, mental health, affect, energy, and eating habits, with small to moderate effect sizes. When stratified by BCRL status, differences by race were robust only among those with BCRL. CONCLUSIONS Black cancer survivors had greater expectations than White cancer survivors for how a weight lifting intervention would improve their physical and mental states; these differences were most apparent among women with BCRL. Improving outcomes in Black breast cancer survivors rests on the development of interventions that are appropriately tailored to address the expectations of this population and account for differences in persistent adverse effects of cancer such as BCRL. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Justin Brown
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Morgan Coursey
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kathryn H Schmitz
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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