African American Breast Cancer Survivors Research Articles

Abstract PO3-09-09: Interventions to improve adherence to oral endocrine therapy for prevention or treatment of breast cancer in African American women of low socioeconomic status

Abstract Introduction: Adherence to oral endocrine therapy (OET) for the prevention and treatment of hormone receptor-positive breast cancer (BC) is important as they reduce the risk of new or recurrent BC. OET adherence is greatly compromised in women of lower socioeconomic status (SES). We have recently reported that patients belonging to the African American race, with longer time on OET, and using OET in the prevention setting are more likely to be non-adherent to OET. Therefore, our study aims to design unique patient-centered interventions and pilot test their feasibility, acceptability, and effectiveness in improving OET adherence in African American women of low SES. Patients and Methods: This prospective study includes adult, African American women on OET for either the prevention or treatment of BC at Harris Health System in Houston, Texas, serving the underserved patient population with low SES. The first intervention is a motivational interviewing (MI) based telephone intervention consisting of an initial phone call followed by five monthly follow-up calls with an MI-trained pharmacy student. The second intervention is a theatre-based educational video with a script developed by a local African American playwright, featuring African American women. Three African American BC survivors with experience in taking OET consulted with the study team to convey their BC journey and explain challenges with taking OET. They provided feedback on the script and production of the educational video. Informed consent was obtained verbally via phone in the MI intervention and electronically for the educational video intervention. Individuals in both intervention groups were compensated with Walmart eGift cards. Pre- and post-intervention adherence was measured using the proportion of days covered (PDC) over 6-12 months and compared using a paired t-test. Participants also complete a survey at the end of the interventions to determine their acceptability. The survey responses were summarized descriptively. Results: For the MI intervention initiated in 20 patients, the median age and BMI of study participants was 61 years (range: 49-71) and 30.8 (range: 22.3-57.8) respectively. All participants identified their ethnicity as non-Hispanic or Latino. The majority of participants had hypertension (n=13, 65%) and/or hyperlipidemia (n=11, 55%) with depression (n=3, 15%) and diabetes (n=8, 40%) being less common. The most common stage of BC cancer was stage I (n=9, 45%), followed by stage II (n=4, 20%), stage 0 (n=3, 15%) and then stage III (n=2, 10%) and IV (n=2, 10%). Letrozole was the most common OET (n=13, 65%), followed by tamoxifen (n=3, 15%), anastrozole (n=2, 10%) and exemestane (n=2, 10%). Most participants were not on a CDK 4/6 inhibitor (n=18, 90%). The median number of years on therapy was 2.8 (0.6-4.5). The median pre-intervention PDC for OET was 0.7 (range: 0.2-0.9). The MI intervention is expected to be complete by October 2023 for all patients. For the educational video intervention, 7 out of the anticipated 25 participants have been enrolled in the intervention. All patients were taking OET for BC treatment and not prevention. Letrozole (n=3, 43%) and anastrozole (n=3, 43%) were the most utilized OET, followed by exemestane (n=1, 14%). While 5 participants (71%) in this intervention reported not missing any OET doses in the past week, 2 patients (29%) reported missing all 7 doses within the past week. After watching the educational video, most participants (n=6, 86%) reported that they strongly agreed to take their OET regularly. The recruitment of study participants for this intervention is ongoing. Conclusion: In this study, we report that MI and educational video interventions are feasible. The interventions and analysis of their effectiveness and acceptability are ongoing. Citation Format: Camille Johnson, Ann Adigwe, Nicole Ekezie, Bilqees Fatima, Zahra Majd, Keith Houk, Tejal Patel, Rob Shimko, Onyebuchi Ononogbu, Susan Abughosh, Meghana Trivedi. Interventions to improve adherence to oral endocrine therapy for prevention or treatment of breast cancer in African American women of low socioeconomic status [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-09-09.

Abstract B058: Positive changes in diet quality among African American breast cancer survivors from Moving Forward, a weight loss intervention program

Abstract Background: African American breast cancer survivors (AABCS) experience higher rates of all-cause mortality and recurrence risk compared to survivors of other races/ethnicities. Although disparities are multi-factorial, lifestyle is a key factor in cancer survivorship, comorbidity burden and quality of life. The American Cancer Society (ACS) and American Institute for Cancer Research (AICR) have set nutrition and physical activity guidelines for cancer survivors. This study examines the between and with-in group differences of diet quality and related outcomes among AABCS enrolled in Moving Forward (MF). Methods: MF was a 6-month, community-based, weight-loss intervention trial for AABCS. Participants were randomized to either an Interventionist-Guided (IG) or Self-Guided (SG) group. Both groups received educational materials to promote lifestyle changes. The IG group also received twice weekly group sessions with supervised exercise and group support. Participants completed surveys on diet quality (Block 2005 Food Frequency Questionnaires (FFQ)) and related outcomes, and fitness assessments at baseline, post-intervention and at a 12-month follow-up. Diet quality was scored using the Healthy Eating Index (HEI-2010) range 0-100, Alternative Healthy Eating Index (AHEI-2010) range 0-110, and ACS/AICR guidelines range 0-21 to measure adherence pre- and post-intervention. Results: 180 AABCS completed the FFQ at all 3 timepoints and were included in these analyses. Participants had a mean age of 57.6 ± 10.6, 40.2% were married/living with a partner, and had varied income and education levels. Participants were an average of 7.2 years from diagnosis (range 0.8-35.1 years), 99% had surgery, 78% had radiation and 74% had chemotherapy. At baseline, mean diet scores were 65.3 for HEI-2010, 56.7 for AHEI-2010, and 12.7 for ACS/AICR guidelines. Although results varied among the 3 diet indices, participants in the IG group saw significant improvements in fruit, vegetable, and whole grain consumption with decreased sugar, empty calorie, and trans fat consumption from baseline to 6 and 12 months. Both groups saw improvements in total scores for all 3 diet indices from baseline to 6 and 12 months. The SG group improved in limiting sugars and empty calories from baseline to follow-up timepoints. The IG group saw greater improvements in fruit and vegetable consumption compared to SG group in all 3 diet indices. Body Mass Index and physical activity were significantly improved in both groups but social support, self-efficacy, and perceived barriers to healthy eating were significantly improved in the IG group only. Conclusion: Overall diet quality scores were suboptimal at baseline showing a need for positive dietary change among AABCS, and a need for more evidence considering diet quality and social predictors of dietary intake in this community. Data from culturally tailored and community-based interventions like MF can be used to develop effective, sustainable strategies to improve diet quality and related outcomes in AABCS even after an intervention ends. Citation Format: Margaret Y. Tovar, Sparkle Springfield, Melinda Stolley. Positive changes in diet quality among African American breast cancer survivors from Moving Forward, a weight loss intervention program [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B058.

Abstract B100: Using a plant-based diet and exercise to improve outcomes in African American postmenopausal breast and endometrial cancer survivors

Abstract Background: Obese postmenopausal African American (AA) women with breast and endometrial cancer are at increased risk of recurrence. Obesity and aging have been associated with changes in the gut microbiota. Plant-based diets, such as soy isoflavone consumption may protect against breast and endometrial cancer. Methods: A mixed-methods, lifestyle intervention study was conducted to evaluate adoption of a whole-food plant-based diet, physical activity, and changes in risk for breast and endometrial cancer among obese, post-menopausal AA women. We examined acceptability and feasibility of adopting a whole-food, plant-based diet and the effect of the diet on reductions in weight, adiposity, inflammation, circulating estrogen, and gut microbiome profile. Results: In 5 focus group discussions, 20 AA women described their knowledge of breast and endometrial cancer risk factors, attitude toward a plant-based diet, experience with making lifestyle changes, and preferences for plant-based alternatives to traditional meat-based meals. This feedback was used to tailor the 4-weeks of plant-based produce boxes provided to the women. Women report being pleased with the food selections; document adherence to the meals and physical activity with food and exercise tracking. Gut microbiome analysis is underway. Conclusion: This study addresses knowledge gaps in breast and endometrial cancer risk and behavioral modifications affecting risk among an obese, post-menopausal AA female population. The long-term goal of this program of research will shed light on the mechanisms involved in the gut microbiome and the contributions of changes to these systems on declining health. Citation Format: Desiree A. Rivers, Regina Leonis, Zakirah A. Abdul-Hameed, Shaliesh A. Singh, Brian A. Rivers. Using a plant-based diet and exercise to improve outcomes in African American postmenopausal breast and endometrial cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B100.

Abstract A020: Examining the dietary patterns & quality of life among Latina breast and gynecologic cancer survivors in Avanzado Juntas

Abstract Purpose: Cancer survivor guidelines encourage plant-based eating patterns to improve diet quality. Studies examining diet and cancer survivorship among Latina/Hispanic cancer survivors (BGCS) are limited, and few intervention efforts have targeted this historically underserved community. Avanzado Juntas (AJ) was developed with and for Latina/Hispanic breast and gynecologic cancer (BGSC) survivors to promote weight loss, improve diet quality, and increase physical activity. These analyses describe pre and post-intervention dietary intake quality among AJ participants. Methods: The 16-week AJ intervention was adapted from the evidence-based Moving Forward intervention for African American breast cancer survivors leveraging focus group data and collaborating with our Community Advisory Board (previously presented). AJ was then pilot tested in a randomized trial with 35 Latina/Hispanic BGCS. To be eligible, women had to have a BMI > 25 kg/m2, be diagnosed with non-metastatic breast or gynecologic cancer, and have completed treatment (except hormonal). Participants completed surveys, ASA 24-hour diet recall (x2), and a physical assessment at baseline and post-intervention. Women were then randomized to an interventionist (IG) or self-guided (SG) arm. Both groups received a program workbook. The IG group also received in-person education/supervised exercise classes, cooking classes, and text messaging. Diet quality was scored using the Healthy Eating Index (HEI). Scores were compared within and between groups using the Wilcoxon rank sign test with a non-parametric analysis of differences. Notably, the AJ pilot began just as the COVID-19 pandemic began, paused, and then was restarted with safety measures in place. Results: Following the AJ intervention, the IG group reported increased greens and beans (p=.01), higher total protein (p=.008), and reduced added sugars (p=.04) consumption compared to the SG group. Within IG, significant improvements were observed for total vegetables (p=.03), greens and beans (p=.002), and refined grains (p=.03); total HEI Score approached significance (p=.07) . Conversely, in the SG group, significant increases in refined grains (p=.03) )and added sugar consumption (p=.04) was observed post-intervention. Conclusion: These differences suggest the efficacy of the guided intervention relative to the self-guided intervention. Results are of particular interest given the timing during the Pandemic and reflect the concerted effort of participants to purchase and prepare healthy foods. AJ is an example of how culturally relevant interventions and tools can promote diet quality improvements. Future efforts will examine adherence to cancer survivors guidelines and consider ways to integrate this type of programming within existing community resources. . Citation Format: Sandra I. Contreras, Marina Feffer, AnaKaren Manriquez Prado, Alexis Visotcky, Sailaja Kamaraju, Staci Young, Patricia Sheean, Melinda Stolley. Examining the dietary patterns & quality of life among Latina breast and gynecologic cancer survivors in Avanzado Juntas [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A020.

The Role of Spirituality on Physical Activity and Sleep Among African American Long-Term Breast Cancer Survivors.

African Americans with chronic conditions have reported the importance of spirituality in their lives. Aspects of spirituality have been shown to be related to physical activity (PA) and sleep, and PA and sleep affect quality of life (QOL). This study examined the association between spirituality, PA, and sleep in long-term African American breast cancer survivors. This cross-sectional study included 323 breast cancer survivors who previously participated in a case-only study. During 2015-2016, participants completed a questionnaire focused on survivorship that used validated measures for spirituality, PA, and sleep. Adjusted binary and multinomial logistic regression models estimated odds ratios (aORs) and 95% confidence intervals (CIs) for the associations of spirituality with total PA, meeting PA guidelines, sleep duration, and sleep medication. The mean age at diagnosis was 54.8 (SD = 9.89) years. The range of spirituality scores was 7-48 (median = 44). Among participants who had a score ≥ 44, 59% had high total PA, 61% met PA guidelines, 59% had high sleep duration, and 55% did not use sleep medication. Higher spirituality score was associated with higher total PA (aOR for ≥ 681 min/week: 1.90, 95% CI: 1.03-3.50), meeting PA guidelines (aOR: 1.78, 95% CI: 1.06-2.98), sleep duration > 7 h/night (aOR: 1.72, 95% CI 1.05-2.83), and lack of sleep medication use (aOR: 0.45, 95% CI: 0.24-0.84). In African American long-term breast cancer survivors, a higher spirituality score increased the likelihood of greater PA and high sleep duration. These results indicate that interventions surrounding spirituality may benefit the QOL of African American breast cancer survivors.

Examining experiences of African American patients with breast cancer in a multidisciplinary survivorship clinic.

e18621 Background: Breast cancer (BC) is the most commonly diagnosed cancer in women. More effective therapies have led to improved survival rates, yet, the survival benefit is not shared across all patient (pt) populations, with worse breast cancer outcomes among African American (AA) pts. The American College of Surgeons has mandated that accredited sites have a cancer survivorship program. At the Cardinal Bernardin Cancer Center (CBCC), there remain disparities in access and utilization of the survivorship clinic, especially by AA BC survivors. Of the 385 new BC analytic cases CBCC treated between March 1, 2020, and March 1, 2021, 72 of these were AA pts. Unfortunately, less than 10% of AA BC pts who received curative intent therapy attended the CBCC Survivorship Clinic. As part of the "Bringing Quality Care Training to Komen’s African American Health Equity Initiative" in collaboration with ASCO, CBCC remodeled its survivorship program into a multidisciplinary clinic staffed by medical oncology, oncologic psychology, genetic counselor, nutritionist and social worker in order to provide comprehensive care to pts following diagnosis and treatment. Methods: The CBCC team performed the following: construction of a process map outlining the current pathway for referring pts to the survivorship clinic; creation of a fishbone cause and effect diagram highlighting factors contributing to poor utilization of the clinic; implementation of faculty surveys to assess reasons for lack of referral to survivorship clinic; development of pt experience surveys; and identification of countermeasures. Tumor registry identified BC pts by stage, race, and ethnicity. Results: Review of the CBCC BC registry showed a low attrition rate among 72 AA pts, with only 1.4% (n = 1) of AA pts diagnosed at CBCC treated elsewhere. AA pts made up a disproportionate number of stage IV diagnoses comprising 40% (n = 8). Surveys demonstrated the following reasons for poor utilization of the survivorship clinic by faculty in order of descending importance: providers felt they were providing survivorship care to their pts; pts declined referral due to appointment fatigue; lack of understanding to make referral; no outcomes data to support survivorship clinics; pt misunderstanding the purpose; fear of losing the pt; pt financial burden. Pt surveys (n = 20) showed high pt satisfaction, with an average rating of 4.8 out of 5 for overall care. Conclusions: Lack of utilization of the cancer survivorship clinic among AA BC pts leads to inefficient application of resources, decreased survivorship care, reduced pt experience, and diminished opportunity for survivorship education and increased health literacy. Paths for the future include increased faculty and pt education, faculty engagement, designated scheduler for survivorship clinic, and increased promotional and marketing work.

African American Women Breast Cancer Survivors: Coping with the COVID-19 Pandemic.

African American women breast cancer survivors are among those with the greater burden of cancer. Breast cancer is the second leading cause of death among black women, and this death rate is 40% higher than that of white women. The COVID-19 pandemic increased the burden of morbidity and mortality among this population of cancer survivors. In this report, we explore the ways in which the COVID-19 pandemic was a source of stress for African American women breast cancer survivors and their subsequent responses to these stressors. This is a qualitative descriptive study with content analysis of data from the narratives of 18 African American breast cancer survivors. Participants were interviewed via phone and video conferencing platform and asked questions related to their experiences with the COVID-19 pandemic. The findings suggest stressors associated with (1) potential COVID-19 spreaders in their immediate environments; (2) closures and restricted access to social- and faith-based activities; (3) televised news broadcasts of COVID-19; and (4) disruptions to planned cancer prevention and control healthcare. Three categories emerged that captured the ways in which these women responded to stressors during the early phase of this pandemic: (1) seeking control in their social environments; (2) following the rules; and (3) seeking support from God, family, and friends. These findings can be used to better support breast cancer patients during the early phases of a pandemic.

Abstract P6-05-46: Project SOAR (Speaking Our African American Realities): A qualitative study of the Strong Black Woman schema in the breast cancer context

Abstract Background: Marked disparities exist for African American women, relative to non-Latina white women, in the five-year survival rate for breast cancer. Black women breast cancer survivors also demonstrate relative disadvantage in specific quality of life (QOL) domains, persisting through at least two years after diagnosis. Although Black women have higher QOL in the spiritual domain relative to white women, disparities include lower physical QOL, as well as more pronounced depressive symptoms, perceived stress, fear of dying, unmet supportive care needs, and financial distress, with younger Black women (< 50 years) particularly at risk. African American breast cancer survivors also report receiving too little information from their oncologists during diagnosis, treatment, and follow-up care. Sociodemographic and medical factors only partially explain the QOL disparities. The goal of Project SOAR (Speaking Our African American Realities), a community-academic partnership, is to interrogate the potential relevance of the Strong Black Woman (or Black Superwoman) schema in the breast cancer context. The schema involves historically grounded expectations to prioritize caregiving over self-care, suppress emotions, present an image of strength, decline support, and strive to achieve success without adequate resources. Method: Black women were recruited via relevant email listservs and flyers distributed at local breast cancer events to take part in a study “to understand the unique experiences of African American women and their views on the Strong Black Woman concept as it applies during their breast cancer experience.” Eligibility criteria were self-identification as being: 1) an African American woman (or a Black woman living in the United States); 2) diagnosed with breast cancer (any stage, any diagnosis duration); 3) at least 21 years old; and 4) able to communicate in English. Three Gatherings (i.e., culturally curated focus groups) were held as half-day experiences in intimate settings (e.g., private homes, a church) in three California cities (Sacramento, Oakland, Los Angeles). Gatherings provided an entirely Black women’s space to discuss the breast cancer experience and the relevance and consequences of the Strong Black Woman schema, break bread together, and engage in an inspiring activity. Reflexive thematic analysis was conducted on the Gatherings transcripts with a critical realist, contextualist approach. Results: All participants (N = 37; age range = 30-94 years; M = 59 years) had heard of the concept of the Strong Black Woman. Reflexive thematic analysis yielded six themes: 1) historical legacy of Strong Black Woman; 2) navigating intersecting Strong Black Woman identities; 3) everyday challenges encountered on the battlefield by Strong Black Women; 4) Strong Black Woman in action during the breast cancer journey; 5) the complexities of seeking and accepting support; and 6) the liberated Strong Black Woman. Participants linked both negative and positive consequences with the Strong Black Woman schema. Negative consequences included the oncologic team and others expecting them to be strong and not to need support, as well as expectations of themselves to suppress emotions and to continue caring for others to the neglect of caring for themselves. Positive consequences included engaging in self-advocacy in the oncologic context, having a sense of resilience, and redefining strength to include expressing emotions and accepting help from others. Conclusion: Qualitative analysis revealed the relevance of the Strong Black Woman schema in the breast cancer context, as well as its negative and positive consequences. Future research can assess whether oncologic professionals’ awareness of the schema is useful in ensuring they offer support and refer Black women diagnosed with breast cancer to culturally relevant supportive resources. Citation Format: Tammie Denyse, Kimberly J. Martin, Yrvane K. Pageot, Praise Owoyemi, Annette L. Stanton, Jacqueline H. Kim. Project SOAR (Speaking Our African American Realities): A qualitative study of the Strong Black Woman schema in the breast cancer context [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-46.

Abstract P111: Facilitators and Barriers to Physical Activity Among African American Long-Term Breast Cancer Survivors

Introduction: Breast cancer survivorship guidelines from the American Cancer Society (ACS) and American Society of Clinical Oncologists (ASCO) contain recommendations for health promotion, specifically obesity, nutrition, and physical activity. Breast cancer treatment is often cardiotoxic because of anthracycline- based drugs, radiation therapy, and use of monoclonal antibodies. Many African American (AA) BCS have preexisting conditions such as hypertension, obesity, and diabetes when diagnosed with breast cancer. Evidence suggests that breast cancer survivors (BCS) with sedentary lifestyles, obesity, and lack of physical activity have poorer outcomes among survivors. Research indicates AA BCS are less likely to be encouraged to lose weight or participate in physical activity by healthcare providers. Hypotheses: 1) Physical inactivity, smoking, and suboptimal dietary patterns adversely affect cardiovascular health and survival of AA female BCS; and 2) Socioeconomic, cultural, and environmental factors serve as barriers or facilitators to adopting heart healthy behaviors and health outcomes. Methods: The sample consisted of 14 participants in three focus groups. Because these women had been discharged from acute oncology care, they were recruited from the AA community in Greensboro and Durham, NC. The organizations included cancer survivor organizations, religious and community organizations, and by referral from participants. Focus groups were held in locations that provided privacy for participants to verbally express themselves and interact with others freely. Anthropometric and biomarker data were collected from each participant and are reported elsewhere. Results: Using thematic analysis, verbatim transcripts were analyzed using word processing software. We familiarized ourselves with the focus group data, and continued with coding, theme generation, review and naming. The overarching themes identified were eating habits, thoughts about exercise, thoughts about weight, physician advice, and the importance of regular exercise. Conclusions: In conclusion, because many BCS are at risk for late and long-term cardiac effects of cancer treatment therapies, it is advisable to promote cardiovascular health behaviors that connect other health recommendations as suggested by the American Heart Association’s Life’s Simple 7. Accordingly, it is necessary to assess socioeconomic, cultural, and environmental factors that may influence heart healthy behaviors and health outcomes before creating culturally relevant interventions.

Association of Cigarette Smoking and Alcohol Consumption With Subsequent Mortality Among Black Breast Cancer Survivors in New Jersey

There are limited data about how lifestyle factors are associated with breast cancer prognosis among Black or African American women because most of the evidence is based on studies of White breast cancer survivors. To examine the association of prediagnostic cigarette smoking and alcohol consumption with all-cause mortality and breast cancer-specific mortality in a cohort of Black breast cancer survivors. This population-based cohort study included 1926 Black or African American breast cancer survivors who received a diagnosis from June 6, 2005, to May 21, 2019, identified in 10 counties in New Jersey through rapid case ascertainment by the New Jersey State Cancer Registry. Statistical analysis was conducted from January 1, 2021, to August 1, 2022. Information on prediagnostic cigarette smoking, alcohol consumption, and additional covariates was collected during in-person interviews. The covariates examined included smoking status at the time of breast cancer diagnosis (currently smoking at the time of breast cancer diagnosis, formerly smoking, or never smoking), smoking duration (number of years smoking), smoking intensity (cigarettes smoked per day), number of pack-years of smoking, and regular alcohol consumption the year before diagnosis (categorized as nondrinkers, ≤3 drinks per week, or >3 drinks per week). Primary outcomes included breast cancer-specific mortality and all-cause mortality. Among the 1926 women in the study, the mean (SD) age at breast cancer diagnosis was 54.4 (10.8) years. During 13 464 person-years of follow-up (median follow-up, 6.7 years [range, 0.5-16.0 years]), there were 337 deaths, of which 187 (55.5%) were breast cancer related. Compared with never smokers, current smokers at the time of breast cancer diagnosis had a 52% increased risk for all-cause mortality (hazard ratio [HR], 1.52; 95% CI, 1.15-2.02), which was most pronounced for those with 10 or more pack-years of smoking (HR, 1.84; 95% CI, 1.34-2.53). Similar findings were observed for breast cancer-specific mortality (current smokers vs never smokers: HR, 1.27; 95% CI, 0.87-1.85), although they were not statistically significant. There was no statistically significant association between alcohol consumption and all-cause mortality (>3 drinks per week vs nondrinkers: HR, 1.05; 95% CI, 0.73-1.51) or breast cancer-specific mortality (>3 drinks per week vs nondrinkers: HR, 1.06; 95% CI, 0.67-1.67). This population-based cohort study of Black breast cancer survivors suggests that current smoking at the time of diagnosis was associated with an increased risk of all-cause mortality, particularly among women with greater pack-years of smoking.

"We're in this together": Perceived effects of breast cancer on African American survivors' marital relationships.

We examined married African American breast cancer survivors' perceptions of how cancer affected their marriage, social support from their spouses, and spouses' physical and mental health. We conducted a thematic analysis of semi-structured interviews with 15 married African American breast cancer survivors who had participated in a larger randomized controlled trial. Interviews were professionally transcribed and then independently coded by two coders. Themes emerged related to the challenges of maintaining mutually supportive relationships. There was variability in the perceived effects of cancer on relationships, as well as uncertainty about cancer's effects on their husbands' emotional and physical health and the adequacy of emotional and tangible support from their husbands. Participants described husbands' key role in promoting wives' positive body image, as well as the challenges of negotiating sexual activity. Participants were receptive to help from medical professionals in dealing with relationship issues. Findings show variability in couples' responses to cancer, with some patients and couples adapting well and others needing additional support. During treatment and at follow-up, oncology social workers can assess patients' and family members' social support needs, provide mental health services, and provide patient navigation to help patients and caregivers access health care and community resources.

Intersectionality Impacts Survivorship: Identity-Informed Recommendations to Improve the Quality of Life of African American Breast Cancer Survivors in Health Promotion Programming.

(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.

Patterns of Physical Activity and the Role of Obesity and Comorbidities Among Long-term African American Breast Cancer Survivors.

Physical activity (PA) has many health benefits for cancer survivors, but little research has examined patterns and correlates in African American women, who have a higher burden of comorbidities and obesity. We examined PA types and patterns overall and by obesity and comorbidities among long-term (> 5years) breast cancer survivors. This cross-sectional study included 323 women who were previous participants of a case-only study in three southeastern states. Women completed a survivorship-focused questionnaire using validated measures to collect data on cancer treatment, PA (recreational, household, transportation) and other lifestyle factors, and comorbidities. Logistic regression models estimated adjusted ORs and 95% CIs for total PA (all three types, categorized as tertiles) and meeting PA guidelines (> 150min/week of exercise). The mean age of women was 59.1years (range 27.9-79.5). The most frequent PA types (≥ 1/month) included routine household cleaning (92.9%), shopping (94.7%), walking slowly (42.1%), and walking briskly (40.6%). Less than 40% met PA guidelines. Women with more total comorbidities, arthritis, and obesity had lower levels of total PA (minutes/week) and/or recreational PA. In adjusted models, BMI ≥ 35kg/m2 was associated with reduced odds of total PA (OR = 0.33, 95% CI 0.12-0.88, highest tertile). Arthritis was associated with reduced odds of meeting PA guidelines (OR = 0.61, 95% CI 36-1.05). Close to 60% of African American breast cancer survivors did not meet PA guidelines based on recreational PA participation. Household PA was an important source of PA. Comorbidities and obesity were associated with both reduced total PA and not meeting PA guidelines.

Utilizing Social Media Advertisements and Participant Social Networks to Recruit African American Breast Cancer Survivors: Design and Rationale.

PurposeOur objective is to pilot an advertisement-driven sampling procedure among African American (AA) breast cancer survivors living in Maryland. These pilot study methods will inform a future population-based study of AA breast cancer survivors at high risk of poor outcomes due to biological differences and social inequities.MethodsThis cross-sectional study utilizes an innovative, social media-based advertisement campaign with an associated social media study page to recruit 100 AA breast cancer survivors. Participants are biologically female, aged 18 and older, identify as AA/Black, have a diagnosis of breast cancer, and reside in Maryland. A preset “Audience” was created via Meta (formerly Facebook) to automatically target potential interest in the online study via geolocation and public social media interests (estimated range = 101,000 women). Eligible participants complete an online survey including demographic and clinical characteristics, cancer screening, healthcare access, and utilization, COVID-19 impact, quality of doctor-patient communication, and preferences for future study participation.ResultsRecruitment began on 5 January 2022 and remains ongoing. As of 7 June 2002: 124 completed the screener, 110/124 (88.7%) consented passively, 24/110 (21.8%) started but did not complete survey, 86/110 (78.1%) completed the survey.ConclusionsResults from this study will inform a statewide multilevel prospective population-based study to improve health behaviors, disease management, and self-efficacy of chronic disease management among AA breast cancer survivors.

A randomized controlled trial of the effect of supervised exercise on functional outcomes in older African American and non-Hispanic White breast cancer survivors: Are there racial differences in the effects of exercise on functional outcomes?

The objective of this study was to test the hypothesis that exercise would be more effective than a support group plus Fitbit (SG+Fitbit) program in improving functional outcomes in older breast cancer survivors (BCSs) and that race would moderate the exercise effect on outcomes. Older African American (AA) and non-Hispanic White (NHW) BCSs were purposively recruited and enrolled into the 52-week randomized controlled trial. The interventions included 20 weeks of supervised moderate-intensity aerobic and resistance training followed by 32 weeks of unsupervised exercise called IMPROVE (n = 108) and a 20-week SG+Fitbit program followed by 32 weeks of unsupervised activity (n = 105). Study outcomes were assessed at 20 and 52 weeks. The primary outcome was the change in Short Physical Performance Battery (SPPB) scores 20 weeks from the baseline between arms. Secondary outcomes included change in the 6-Minute Walk Test (6MWT) in meters 20 weeks from the baseline between arms. General linear regression and multivariable logistic regression analyses were used. The mean age was 71.9 years (SD, 5.9 years), and 44% were AA. SPPB scores did not differ between arms (adjusted difference in mean change, 0.13; 95% CI, -0.28 to 0.55; P = .53). However, the exercise arm (vs the SG+Fitbit arm) improved on the 6MWT (21.6 m; 95% CI, 2.5-40.6 m; P = .03). Race moderated the exercise effect on the 6MWT (adjusted interaction effect, 43.3 m; 95% CI, 6.3-80.2 m; P = .02); this implied that the change in the adjusted mean for the 6MWT at 20 weeks from the baseline was 43.3 m higher in AA exercise participants versus NHW exercise participants. Combined aerobic and resistance exercise appears to improve physical performance in older BCSs, and the exercise effect might be moderated by race, with AAs appearing to derive larger benefits in comparison with NHWs. Larger studies are warranted to confirm the study findings.

Abstract P4-11-23: Project SOAR: The strong black woman schema in the breast cancer context

Abstract Breast cancer is a crucial problem for African American women, with marked disparities in five-year survival relative to non-Latina white women. Research also suggests that Black breast cancer survivors are disadvantaged in specific quality of life (QOL) domains (relative to non-Latina white women), persisting through two years or more. Although spiritual QOL appears more robust for Black women relative to white women, disparities include lower physical QOL, as well as more pronounced depressive symptoms, perceived stress, fear of dying, unmet supportive care needs, and financial distress, with younger Black women (< 50 years) particularly at risk. Additionally, African American breast cancer survivors report receiving a lack of information from their physicians during diagnosis, treatment, and follow-up care. Factors such as socioeconomic and medical characteristics only partially explain the QOL disparities. The goal of Project SOAR (Speaking Our African American Realities), a community-academic partnership, is to explore the potential relevance and influence of the Strong Black Woman schema (i.e., historically grounded expectations to prioritize caregiving over self-care, suppress emotions, present an image of strength, decline support, and strive to achieve success without adequate resources) in the breast cancer context. Three Gatherings (i.e., focus groups) were held in intimate settings (e.g., private homes) and provided an entirely Black women’s space to discuss the breast cancer experience. All participants (N = 37; age = 30-94 years) had heard of the concept of the Strong Black Woman, and the majority reported identifying with the scholarly definition of the Strong Black Woman, citing both negative and positive aspects of the schema in their breast cancer experience. Perceived negative consequences included differential treatment in the oncology setting, including a lack of empathy and expectations of Black breast cancer patients’ strength on the part of the oncologic team. Positive facets included a deep spiritual connection, a sense of resilience, and self-advocacy. Additionally, participants reported primarily approach-oriented attempts to cope with their experience (e.g., attempting self-advocacy in the oncologic setting), while also citing struggles in such coping efforts, such as feeling unheard in the medical system and a lack of belonging in the broader breast cancer community. Implications of the findings for the oncologic treatment team and enhancing the experience of Black women as breast cancer survivors will be addressed. Citation Format: Tammie Denyse, Kimberly J Martin, Yrvane K Pageot, K Denise deLuz, Jacqueline HJ Kim, Praise Owoyemi, Annette L Stanton. Project SOAR: The strong black woman schema in the breast cancer context [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-23.

Association between aspects of social support and health-related quality of life domains among African American and White breast cancer survivors.

Social support is associated with breast cancer survivors' health-related quality of life (HRQoL). More nuanced information is needed regarding aspects of social support associated with different HRQoL domains among diverse populations. We assessed the association between emotional/informational and tangible support and five HRQoL domains and evaluated race as an effect modifier. African American and White women (n = 545) diagnosed with hormone-receptor-positive breast cancer completed a survey that assessed sociodemographic, clinical, and psychosocial factors. We assessed bivariate relationships between emotional/informational and tangible support along with overall HRQoL and each HRQoL domain.We tested interactions between race and emotional/informational and tangible social support using linear regression. The sample included African American (29%) and White (71%) breast cancer survivors. Emotional/informational social support had a statistically significant positive association with emotional well-being (β = .08, p = 0.005), social well-being (β = 0.36, p < 0.001), functional well-being (β = .22, p < .001), breast cancer concerns (β = .16, p = 0.002), and overall HRQoL (β = .83, p < .001). Similarly, tangible social support had a statistically significant positive association with emotional well-being (β = .14, p = 0.004), social well-being (β = .51, p < .001), functional well-being (β = .39, p < .001), and overall HRQoL (β = 1.27, p < .001). The interactions between race and social support were not statistically significant (p > 0.05). Results underscore the importance of the different social support types among breast cancer survivors, regardless of survivors' race. Population-based interventions can be standardized and disseminated to provide guidance on how to increase emotional/information and tangible support for all breast cancer survivors by caregivers, health providers, and communities.

Recommendations for breast cancer education for African American women below screening age.

Although statistically unlikely, early-onset breast cancer tends to be more aggressive and leads to greater mortality than breast cancer among women of screening age. Young African American women are disproportionately impacted by early-onset breast cancer compared to women of other races. Given the racial disparities and because young women are typically not the primary audience for breast cancer educational messaging, there is a need to identify recommendations for age-appropriate breast cancer education for African American women below mammogram eligibility. Through N = 30 key informant interviews with young African American breast cancer survivors, family members of young survivors, community organization leaders and healthcare providers, we identified breast cancer educational message content and communication channels relevant for these women. Participants recommended that message content should emphasize the need to address family cancer history and self-advocacy in healthcare encounters in addition to concerns about loss of womanhood, financial costs and opportunity costs associated with preventive healthcare visits. Breast cancer messages for this audience should consider the influences of earlier life stage, culture and race. Recommended communication channels highlighted use of social media and videos. Findings will inform future age-appropriate educational messaging aimed at eliminating early-onset breast cancer disparities disproportionately impacting young African American women.

Psychosocial protective interventions associated with a better quality of life and psychological wellbeing for African American/Black female breast cancer survivors: an integrative review.

This integrative review provides an overview of current psychosocial interventions and qualitative studies exploring African American Breast Cancer Survivors (AABCS)' psychosocial wellbeing. We conducted a search of five databases: PubMed, Academic Search Ultimate, CINAHL, PsycINFO, and Web of Science. Peer-reviewed articles written in English and published from 2011 to May 26, 2021 were included. We critically appraised intervention studies and qualitative studies using established frameworks. Of the 633 unique studies identified, seven interventions and twenty-one qualitative studies were included. Analysis of the interventions revealed the importance of alleviating structural barriers and facilitating peer support for AABCS. Analysis of the qualitative studies revealed seven themes: (1) spirituality/religion, (2) social support, (3) cultural perceptions of BC, (4) lack of representation, (5) negative impacts of treatment, (6) healthcare system experience, and (7) barriers to psychosocial care. This review highlights the dearth of psychosocial interventions created specifically for AABCS. The qualitative literature in this review elucidates the unique psychosocial challenges that AABCS experience, providing rich data to inform the creation of future culturally competent interventions in this population. This review found spirituality and social support to be protective factors for AABCS' psychosocial wellbeing. Further research using rigorous methodologies is needed to further evaluate how to most effectively alleviate structural barriers that AABCS face in obtaining long-term support.

Patterns of Fitbit Use and Activity Levels Among African American Breast Cancer Survivors During an eHealth Weight Loss Randomized Controlled Trial.

This study examined adherence with a physical activity tracker and patterns of activity among different subgroups of African American/Black breast cancer survivors (AABCS). Secondary analysis of weight loss trial that used an activity tracker (FitBit) with or without a commercial eHealth program (SparkPeople) over 12 months. AABCS (N = 44) in New Jersey. Adherence with tracker use, steps per day, and active minutes per week were compared by demographic and clinical characteristics using nonparametric statistics. Median adherence was over 6 days per week throughout the 12-months. Adherence was significantly correlated with steps and active minutes (p < 0.015). Groups with lower adherence included: those with 5 or more conditions (p = 0.039), had higher number of household members (p = 0.008), and younger than 60 years (p = 0.044). Median number of steps per day remained consistently around 7000 throughout 12 months. Factors associated with lower activity included: age > 60; retirement; higher number of household members, comorbidity, or baseline BMI; and those in the SparkPeople + Fitbit group. Self-monitoring, goal setting, and self-efficacy were significantly correlated with activity levels (p < 0.05). Use of a physical activity tracker may help increase activity levels in AABCS. Certain subgroups, e.g. those older than age 60 years, retired, with BMI over 40, higher number of comorbidities or more household members, may require additional interventions.