Understanding the barriers and facilitators of colorectal cancer screening among low income immigrant hispanics

Colorectal cancer (CRC) screening rates are low among Hispanics; thus understanding screening barriers and facilitators is essential. A survey, based on blended health promotion theories, was conducted with low income, mostly immigrant, Hispanics at community based organizations and health clinics in New York City. Correlates of undergoing colonoscopy screening were examined. Four hundred men (28%) and women were interviewed. Older age, longer US residence, having a regular health care provider and provider recommendation predicted colonoscopy receipt (P values <0.01). Greater fear and worry concerning colonoscopy and fewer perceived screening benefits were associated with reduced screening likelihood (P values <0.05). In a multivariate model, colonoscopy receipt was negatively associated with Medicaid and positively associated with English preference, physician recommendation for and encouragement of screening and less fear. Interventions that educate physicians and patients regarding colonoscopy screening guidelines, increase physicians' screening referrals, and reduce patients' fear are needed.

Global meaning and psychological adjustment among survivors of bone marrow transplant

The purpose of the present study was to examine global meaning (i.e. the belief that life has purpose and coherence) and psychological adjustment in survivors of bone marrow transplantation (BMT). Eighty-five survivors of BMT participated in a telephone interview. Regression analyses demonstrated that after controlling for physical functioning, stressor severity, and gender, global meaning was inversely related to global psychological distress and BMT-related psychological distress (i.e. posttraumatic stress disorder-like symptoms related to the cancer treatment). Global meaning was also positively related to mental health aspects of quality of life (e.g. emotional functioning and social functioning). These findings suggest that global meaning may be an important factor in the psychological adjustment of BMT survivors.

Predictors of relapse in bipolar disorder: A review

INTRODUCTION

Bipolar disorder is the sixth leading cause of disability in the United States. Moreover, repeated episodes and non-responsiveness to treatment continue to present a significant problem, and little is known about the factors that may precipitate relapse. This article reviews the available literature on predictors of bipolar relapse.

METHODS

We conducted a literature search on Medline from 1996 to March 2006, using the keywords "relapse," "recurrence," "compliance," "adherence," "life events," "kindling," and "predictors" combined with the term "bipolar disorder(s)." References from the resulting articles also supplemented the initial search. Thirty-eight articles were included in the analysis.

RESULTS

Predictors of episodes include stressful life events, increased number of previous episodes, decreased interval between episodes, and persistence of affective symptoms and episodes. Factors associated with longer survival times include psychotherapy, social support, and medication adherence.

CONCLUSIONS

Our review suggests several reliable predictors of bipolar episodes. Knowledge of these factors has significant clinical implications and could aid in treatment and prevention strategies. However, further research is clearly needed to address the limitations of the existing research and to increase our understanding of predictors of relapse, with the intent of improving quality of life and preventing episodes in patients with bipolar disorder.

An examination of distress, sleep, and fatigue in metastatic breast cancer patients

OBJECTIVE

Few studies have used rapid screening instruments to document the prevalence of distress among metastatic breast cancer patients. This study used the one-item Distress Thermometer (DT) to assess distress in this population. Anxiety and depressive symptoms, sleep problems, fatigue, and mental health service use were assessed for patients who met the cutoff on the DT for probable distress (score ≥4).

METHODS

A total of 173 metastatic breast cancer patients rated their distress on the DT. Respondents who met study eligibility criteria (n = 90), including a score ≥4 on the DT, completed a telephone survey 1 week later that assessed anxiety, depressive symptoms, sleep problems, and fatigue. Associations of study outcomes with demographic and medical characteristics were computed.

RESULTS

Sixty percent of the 173 patients met the cutoff for probable distress on the DT. Meeting this cutoff was not associated with age, ethnicity, time since diagnosis, or medical treatments. The majority (61%) of respondents who were classified as distressed on the DT reported clinically significant anxiety or depressive symptoms 1 week later. On average, these patients also showed significant fatigue and sleep disturbance, with 70% reporting decrements in sleep quality. Only 29% of patients with significant anxiety or depressive symptoms accessed mental health services.

CONCLUSIONS

Results point to a high prevalence of distress, sleep problems, and fatigue across demographic and medical subgroups of metastatic breast cancer patients. A rapid one-item screening tool may be used to identify patients with a potential need for psychosocial assessment and intervention.

Maternal Perspectives on Children’s Health-Related Quality of Life During the First Year After Pediatric Hematopoietic Stem Cell Transplant

OBJECTIVE

To assess the longitudinal health-related quality of life (HRQL) of children receiving hematopoietic stem cell transplantation (HSCT).

METHODS

Mothers (N = 160) of HSCT recipients aged 5-20 at six US transplant centers completed the Child Health Ratings Inventories (CHRIs), the Disease Impairment Inventory (DSII)-HSCT module, and the Short Form (SF)-36 at baseline, 3, 6, and 12 months.

RESULTS

HRQL domain scores at baseline varied by recipient age and program site. Longitudinal data over the first year post-HSCT revealed lowest functioning at baseline and 3 months, with largest improvement in functioning between the 3 and 6-months assessments and continued improvement from 6 to 12 months. Recipients of unrelated donor transplants had steepest declines in functioning at 3 months and great HSCT-specific issues at 3 and 6 months. Among children who survived the first year, functioning at 12 months was similar across transplant types and surpassed baseline scores. Children who did not survive the first year exhibited deterioration in HRQL in the months before death and trajectories were strikingly different than for survivors.

CONCLUSIONS

This study offers the first glimpse of the 12-month trajectory of HRQL following pediatric HSCT from mothers' perspectives. This study also highlights the importance of and approaches to addressing missing data in longitudinal research.

Assessment of the Short Acculturation Scale for Hispanics (SASH) among low-income, immigrant Hispanics

The present analysis sought to determine the usefulness and validity of the Short Acculturation Scale for Hispanics (SASH) in assessment of acculturation among Hispanics participating in a colorectal cancer screening study. Primary data was collected from 2008 to 2009 through surveys in East Harlem community-based sites and health clinics among Hispanics. Bivariate correlations and independent samples t tests assessed SASH correlation with acculturation proxies and relationships between proxies, SASH, and sociodemographics. SASH was highly correlated with commonly used acculturation proxies; inter-scale correlations and alpha scores were high. Sociodemographics associated with proxy variables were associated with SASH. In conclusion, SASH is useful and valid for assessing acculturation among Hispanics; however, a shortened version or acculturation proxy variables could also be utilized.

Self-efficacy for coping with cancer in a multiethnic sample of breast cancer patients: associations with barriers to pain management and distress

OBJECTIVES

This study examined the interrelations of self-efficacy for coping with cancer, perceived barriers to pain management, distress, and pain outcomes in a multiethnic sample of breast cancer patients. The extent to which ethnicity (Black, Latina, or White), language (English or Spanish), and level of education and income predicted these variables was also assessed.

METHODS

Participants were breast cancer patients with persistent pain (N=87) who were recruited from oncology clinics in New York City. Patients completed an assessment battery that included measures of self-efficacy for coping with cancer, barriers to pain management, distress, and pain outcomes.

RESULTS

Greater self-efficacy for coping with cancer was associated with older age, less time since diagnosis, and less distress. In addition, less self-efficacy for seeking and understanding medical information, Spanish language preference, and greater distress predicted greater barriers to pain management. Average pain severity was higher among Spanish-speaking individuals and those with lower incomes.

DISCUSSION

Findings point to the potential importance of self-efficacy for seeking and understanding medical information and perceived barriers to pain management in understanding the psychologic well-being of breast cancer patients with pain, especially those who are Spanish-speaking.

Effectiveness of partner social support predicts enduring psychological distress after hematopoietic stem cell transplantation

OBJECTIVE

Hematopoietic stem cell transplant (HSCT) survivors who are 1 to 3 years posttransplant are challenged by the need to resume valued social roles and activities--a task that may be complicated by enduring transplant-related psychological distress common in this patient population. The present study investigated whether transplant survivors who receive adequate social support from their spouse or intimate partner experience lower distress.

METHOD

Effects of receiving a greater quantity of partner support (a common approach to studying enacted support) were compared with effects of receiving more effective partner support (i.e., support that more closely matches their needs in terms of its quantity and quality). Men and women (N = 230) who were 1 to 3 years posttransplant completed measures of partner support quantity (Manne & Schnoll, 2001), partner social support effectiveness (Rini & Dunkel Schetter, 2010), and psychological distress (Brief Symptom Inventory; Derogatis & Spencer, 1982). Potential medical and sociodemographic confounds were controlled in analyses.

RESULTS

As hypothesized, survivors reported less distress when they received more effective partner support (p < .001). Quantity of partner support was not associated with distress (p = .23). An interaction revealed that when partner support was effective, the quantity of support survivors received was not associated with their distress (p = .90); however, when partner support was ineffective, receiving a greater quantity of partner support was associated with substantially elevated distress (p = .002).

CONCLUSIONS

Findings suggest that clinical approaches to addressing or preventing enduring distress after HSCT should target features of partner support related to its appraised effectiveness.

Randomised trial of expressive writing for distressed metastatic breast cancer patients

Women with metastatic breast cancer and significant psychological distress (N = 87) were assigned randomly to engage in four home-based sessions of expressive writing or neutral writing. Women in the expressive writing group wrote about their deepest thoughts and feelings regarding their cancer, whereas women in the neutral writing group wrote about their daily activities in a factual manner. No statistically significant group differences in existential and psychological well-being, fatigue and sleep quality were found at 8-weeks post-writing. However, the expressive writing group reported significantly greater use of mental health services during the study than the neutral writing group (55% vs. 26%, respectively; p < 0.05). Findings suggest that expressive writing may improve the uptake of mental health services among distressed cancer patients, but is not broadly effective as a psychotherapeutic intervention.

Pre-bereavement meaning and post-bereavement distress in mothers of children who underwent haematopoietic stem cell transplantation

OBJECTIVES

The purpose of this study was to explore the association of meaning-making with psychological adjustment to bereavement among mothers of children who had undergone haematopoietic stem cell transplantation (HSCT).

DESIGN

A prospective research design was used. Regression analyses were conducted to determine the relations between pre-bereavement variables (distress, searching for meaning, and finding meaning) and distress post-bereavement.

METHODS

Thirty-five mothers of children who had undergone HSCT were interviewed at the time of their child's HSCT and 3 months post-bereavement.

RESULTS

Mothers who reported searching for meaning at HSCT reported greater post-bereavement distress, and mothers who reported finding meaning at HSCT reported less post-bereavement distress. Distress at HSCT and the number of days between the time of death and the post-bereavement time point were also found to be significant predictors of post-bereavement distress.

CONCLUSIONS

This study provides partial support for the role of meaning in adjustment to loss.

Coping and the course of mother's depressive symptoms during and after pediatric bone marrow transplantation

OBJECTIVE

To evaluate the role of maternal coping strategies in depressive symptoms experienced by mothers of children undergoing bone marrow transplantation (BMT).

METHOD

A total of 207 mothers completed measures of coping and depressive symptoms at the time of the child's BMT, 3 and 6 months post-BMT. The sample was collected between 1998 and 2002. The acceptance rate was 73%. The contribution of demographic, illness and treatment parameters, and mothers' concerns about the child were also evaluated. Growth curve modeling was used to evaluate the role of coping in the course of depressive symptoms. Both main effects and interactions of coping strategies with time of assessment were evaluated.

RESULTS

Acceptance and humor were associated with reductions in maternal depressive symptoms, and planning and alcohol/substance use were associated with increases in maternal depressive symptoms. Positive reframing, use of emotional support, and use of religion were associated with the course of depressive symptoms, but the magnitude of associations differed depending on the use of the coping strategies at the time of transplantation. Mothers' fears about the child also predicted depressive symptoms.

CONCLUSIONS

Acceptance and humor may be targets for behavioral interventions to reduce mothers' depressive symptoms during and after pediatric BMT hospitalization.

Psychological distress among healthy women with family histories of breast cancer: effects of recent life events

The experience of breast cancer in a close family member can be a major life stressor for many women as evidenced by various psychosocial and biological indicators. However, existing studies have found considerable variability in the levels of psychological distress among women with family histories of breast cancer (FHBC). Based on cognitive processing models, we examined moderating effects of recent life events on the impact of having a family member with breast cancer and psychological distress. Specifically, we hypothesized that negative recent life events would be associated with greater psychological distress and that positive recent life events would be associated with less psychological distress, and these patterns will be more prominent among women with FHBC than women without FHBC. Women with (FHBC+, N = 59) and women without (FHBC-, N = 94) FHBC completed measures of recent life events, cancer-specific distress (intrusion and avoidance) and general distress. Results indicated that among FHBC+ women, negative life events were associated with higher levels of breast cancer-specific intrusion and positive life events were associated with lower levels of breast cancer-specific avoidance. These results support the application of cognitive processing models for understanding variability in women's psychological adjustment to their FHBC. Psychological interventions designed to facilitate coping with negative life events and to increase the occurrence of positive events may be warranted.

An examination of the psychosocial factors influencing colorectal cancer patients' communication of colorectal cancer patient risk with their siblings

This study examined psychosocial factors influencing colorectal cancer (CRC) patients' communication with their first-degree relatives regarding their CRC risk. Among a sample of CRC patients who were members of a colon registry in New York (n = 127), 60% reported discussing CRC risk with their siblings. These discussions were related to the CRC patients' age of diagnosis, such that those diagnosed before age 45 years were more likely to communicate with their siblings about CRC risk. Despite advances made in CRC prevention, compliance with screening recommendations among individuals who may be at familial risk for the disease is low. Perhaps this underrepresentation reflects how CRC patients communicate with their first-degree relatives about their potential risk for the disease. This study examined the psychosocial factors influencing whether CRC patients communicate with their siblings about CRC risk. The sample included CRC patients with siblings who enrolled in a colon disease registry at a NYC metropolitan hospital. Participants completed questionnaires regarding their current psychosocial functioning, perceived risk of sibling's development of CRC, and communication of CRC risk with their siblings. Patients were predominantly Caucasian, with a mean age of 60.4 years. Of the 127 patients, 60% engaged in discussions with their siblings regarding their CRC risk. Patients diagnosed with CRC before the age of 45 years were more likely to discuss the risk of CRC with their siblings (P < 0.01). These data suggest that CRC patients may serve as an effective vehicle to promote CRC screening and support the need for health care providers to not only educate patients of the familial risk of CRC, but to also encourage these patients to communicate this information with their siblings.

Sociodemographic correlates of stage of adoption for colorectal cancer screening in African Americans

OBJECTIVES

African Americans have the highest incidence and mortality rates from colorectal cancer in the United States. Endoscopic screening, while effective in reducing both, is greatly underutilized. This research sought to understand sociodemographic factors related to stage of readiness for endoscopic screening.

DESIGN

One hundred fifty nine African American women (76.1%) and men (mean age = 57.0 years) who were non-adherent to endoscopic screening guidelines were recruited and asked to complete semi-structured interviews.

SETTING

Participants were all being seen for a non-acute primary care medical visit at one of two urban hospitals. The theoretical framework that informed this study was the Trans-theoretical Model (TTM) and the emphasis on Stage of Change or intention for undergoing endoscopic screening.

MAIN OUTCOME AND MEASURES

Based on their stage of readiness to undergo screening, 67 (42%) were categorized as precontemplative (Has no plans to have a colonoscopy) while 92 were categoriezed as being in a contemplative or preparation stage. Using chi-square and Student t-tests, differences were examined between the two groups.

RESULTS

No sociodemographic variables distinguished the two groups. However, people in the contemplative/preparation group were more likely to: have a regularly seen healthcare professional (63.7% vs 36.3%; P = .005), have had a previous recommendation for screening (65.7% vs 34.3%; P = .003); had heard of a colonoscopy (63.6% vs 36.4%; P = .000) and have been told by a healthcare professional that they needed a colonoscopy (73.1% vs 26.9%; P = .000).

CONCLUSIONS

This study helps us to better understand the relevance of sociodemographic characteristics that may be associated with completing endoscopic colorectal cancer screening. In addition, we confirm that physician recommendation and individual awareness of the procedure are significant factors in readiness to get screened.

Abstract B68: Assessing screening disparities for CRC by race across states

Background: Recent research suggests that there are geographic “hotspots” in the United States which have higher colorectal cancer (CRC) mortality rates [1]. These regions are characterized by high poverty, wherein individuals with lower socioeconomic status are less likely to undergo CRC screening tests, leading to a later stage of diagnosis and increased risk of mortality [1]. Additionally, significant racial disparities have been identified regarding CRC screening rates, although not always consistent, with the lowest rates amongst Blacks [2]. Furthermore, Hispanics over age 50 (the recommended age to begin screening at risk individuals) are less likely to have had a recent CRC screening than non-Hispanic Whites (29.9 vs. 44.3%) [3]. This study aims to identify geographic and racial disparities for CRC screening rates within the U.S. so that future interventions can be targeted according to geographic location and population demographics.

Method: Analysis was conducted using available data published through the Behavioral Risk Factor Surveillance System (BRFSS) on the Centers for Disease Control and Prevention (CDC) website. The data were published on the “BRFSS: Table of Colorectal Cancer Screening,” and were open and available to the public [4]. While we recognize that these data were already published, we have analyzed it in a novel way, allowing us to formulate new research. Visual maps showing the ratios of screening rates for both fecal occult blood tests (FOBT) and colonoscopies were generated using SAS software. Additional maps were also created to display the overall screening rates for both screening tests according to race by state. Based on previous literature, states with screening data were grouped into five geographic regions: Northeast, Southeast, Midwest, West, and Southwest [5]. After data were weighted by population for each state, average screening rates were found for each race by test type and region. Ratios of Black to White and Hispanic to White screening rates for each test by region were also calculated in order to better understand the current disparities between the races by geographic location.

Results: The lowest overall screening rates were found within the Hispanic population in the Southwest (10% for FOBT, 47% colonoscopy). The highest rates were within the White population in the Southeast (17% FOBT, 70% colonoscopy). The largest racial disparities were found between Hispanics and Whites in the West (ratio of 0.72 FOBT, 0.68 colonoscopy) and Southwest (ratio of 0.75 FOBT, 0.69 colonoscopy). Overall, Blacks had higher rates of FOBT screenings than Whites, with the largest disparity found in the Southwest (ratio of 1.57); colonoscopy rates were generally lower than Whites, with the largest disparity found in the Midwest (ratio of .91). Screening rates were most similar between Blacks and Whites in the Northeast (ratio of 1.20 FOBT, 0.98 colonoscopy).

Conclusion: Future interventions should be targeted at increasing CRC screening rates for Hispanics, particularly in the West and Southwest regions of the U.S. Four of the states in these regions (New Mexico, Alaska, Texas, and Oklahoma) rank in the top ten states with the highest poverty levels [6]. Six states in these regions (Texas, Nevada, Arizona, Wyoming, New Mexico, and Alaska) are also in the top ten for the greatest percentage of the population without health insurance [7]. Due to these high poverty levels and subsequent lack of health insurance, individuals experience more obstacles to accessing benefits of healthcare such as CRC screening.

Citation Format: Rachel Cooper, Noah Cohen, Elizabeth Schofield, Tatiana Starr, Chris Nelson, Lina Jandorf, Katherine Duhamel. Assessing screening disparities for CRC by race across states. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B68.