African American Breast Cancer Survivors Research Articles

Factors Associated With Body Mass Index Among African American Breast Cancer Survivors

Weight gain after diagnosis and treatment is common among breast cancer survivors (BCSs). Little information exists regarding associations between body mass index (BMI) and lifestyle factors and health-related quality of life (HR-QoL) among African American (AA) BCSs. The present study sought to determine associations between BMI, dietary intake, and physical activity as lifestyle modification strategies and HR-QoL among AA BCSs. For this cross-sectional study, a lifestyle assessment tool was administered to 195 AA BCSs. Possible predictor variables included socio-demographic and medical characteristics, dietary intake and physical activity patterns, and physical health. The outcome variable was BMI. Many BCSs (63%) had BMIs ≥25 Kg/M2 and presented with stage I cancer (41%) at diagnosis. Among those presenting with late-stage cancer (IIIA, IIIB, IV), 76% were overweight or obese (p=0.0008). Eighty-four percent reported excellent-to-good physical health (p=0.0499) and were less likely to have higher BMIs compared to those reporting fair-to-poor physical health (OR=0.616 [CI=0.192-1.978]). Responders with graduate level education were more likely to have healthy body weights than those attaining high school or less educational levels (OR=2.379 [CI=0.617-9.166]). Most AA BCSs surveyed were overweight or obese, did not engage in recommended physical activity levels and failed to consume diets linked to breast cancer prevention. Interventions are needed to promote weight loss, improve dietary intake, and enhance physical activity among AA BCSs.

Abstract A13: African American breast cancer survivors in the digital age

Abstract The information needs of breast cancer survivors are varied and complex. How African American breast cancer survivors (AABCS) access cancer-related information and the extent to which they find the information helpful is not well understood. We conducted a statewide survey with 297 female AABCS and led 8 in-depth focus groups with 60 female AABCS to understand where AABCS look for health information and their preferred format of materials. We were also interested in the extent to which AABCS used social media services to look for information or to bolster their supportive networks. The average age of those who completed the survey was 57.5 years, and almost all (95%) received surgical treatment for their breast cancer; 77% received radiotherapy and 53% chemotherapy. Almost all (95%) reported at least one co-morbid health condition such as hypertension or diabetes; 22% reported five or more co-morbid conditions. The majority of AABCS (85%) reported using informational books or brochures, followed by in-person talks or lectures by experts (56%). AABCS also found these two formats to be the most helpful. Not surprisingly, most AABCS preferred to receive information in written form (59%) or in-person (60%). Although most of the AABCS in our sample (70%) had access to the Internet in their home and many (61%) were on Facebook, the majority (63%) reported that they are not members of social networking sites such as Twitter or Google Plus, and few (<10%) reported using these platforms for sharing their cancer-related experiences, connecting to other survivors, or accessing health-related information. The discussions of AABCSs in the focus groups echo these findings with stories of difficulty finding information tailored to their needs and frustration that too many resources are only available online. The results from this mixed-methods study suggest that while many organizations have moved their cancer information online, there are segments of the population, such as AABCS, who continue to rely on and prefer print materials and in-person formats to manage their health care needs. Organizations should aim to increase AABCS' familiarity and ease of accessing online health information, as many AABCS have access to the Internet yet do not perceive online materials or social networking services to be as helpful for addressing their needs. Citation Format: Amy Leader, Melissa DiCarlo, Patricia Bradley, Sarah Hagerty, Andrea Barsevick. African American breast cancer survivors in the digital age. [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 A13.

Abstract C24: An integrative review of psychosocial concerns among young African American breast cancer survivors

Abstract Background: African American women are more likely to be diagnosed with breast cancer at an early age, more likely to experience morbidity after treatment, and disparities in survivorship. While psychosocial well-being is well known among breast cancer survivors, data are few regarding minorities such as African Americans, particularly those who are young. Objective: This integrative review examines psychosocial concerns in survivorship among young African American breast cancer survivors (YAABCS) using a holistic quality of life framework. Methods: Pubmed, CINHAL, and Scopus were searched for articles exploring psychological or social well-being in YAABCS. Results: The search yielded 264 articles. Thirty-six articles were retrieved and reviewed for relevance. Of these, 14 articles were selected based on inclusion/exclusion criteria. Themes of YAABCS psychosocial concerns were sexuality, mood, social support, and spirituality. Conclusions: The review demonstrated need for further research in YAABCS quality of life to adapt a more fitting quality of life model and to develop culturally-appropriate survivorship interventions. Implications for Practice: Clinicians, researchers, and YAABCS must partner to increase knowledge of the multidimensional survivorship of YAABCS. With knowledge, we may be able to decrease health disparities among YAABCS. The project was funded by an American Cancer Society Doctoral Degree in Nursing Scholarship, Jonas Nurse Leadership Scholarship, and Gladys F. Colvin Doctoral fellowship. Additional support received from a Komen Graduate Training in Disparities Research Award. Citation Format: Timiya S. Nolan, Jennifer Frank, Silvia Gisiger-Camata, Karen Meneses. An integrative review of psychosocial concerns among young African American breast cancer survivors. [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 C24.

Abstract C06: Examining reasons for breast cancer disparities in African American women in Duval County, FL

Abstract Background/Purpose: Cancer registry data suggests that Duval County (greater Jacksonville, FL) has the highest breast cancer mortality rate for African American (AA) women in the southeastern US. Recent research revealed that race, residence, and insurance were associated with significantly poorer breast cancer outcomes in this area. Therefore we conducted a series of focus groups with AA breast cancer survivors from the urban core of Jacksonville, FL to directly address the disparities observed in our quantitative data. Methods: A series of focus groups were conducted to obtain qualitative data topics that included: breast cancer beliefs; delays to diagnosis and treatment; disparities; and health behaviors. Results: A total of 56 AA breast cancer survivors living in the urban core, with either Medicaid or who were uninsured, participated in the focus groups. Mean age was 62 years, with an average of 3.4 years since diagnosis. Only 21% of women were employed. Participants reported their mean time to see a doctor initially for their breast cancer was 39 days, and mean time to first treatment was 178 days. Participants responded that fear, financial limitations, and personal beliefs played the biggest roles in delays to diagnosis and treatment. Participants responded that poor health behaviors, genetics, lack of education, and personal beliefs accounted for both causing breast cancer, and the disparities observed in breast cancer mortality, and felt that environmental factors from living in the urban core also contribute. Conclusions: Our findings highlight several areas for potential intervention to reduce disparities in breast cancer. Citation Format: Sarah Osian, Monica Albertie, David Monticalvo, Steven Ames, Laila Samiian, Gerardo Colon-Otero. Examining reasons for breast cancer disparities in African American women in Duval County, FL. [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 C06.

Abstract A19: A mixed methods approach to assessing ehealth activity among African American cancer survivors

Abstract The research literature on eHealth activity across different patient populations is rapidly expanding, yet little is known about eHealth among diverse cancer survivors. Most existing measures of such activity are quantitative (QUAN). Compared to qualitative (QUAL) methods, QUAN methods are limited in capturing in-depth information regarding eHealth experiences that can inform user-centered design of technologies optimized for survivors' use. The goal of the pilot project reported here was to develop a mixed methods approach to assessing the full scope of eHealth activity among African American cancer survivors. Based on a literature review, study investigators created a measure that included 27 eHealth activities across 5 domains: informational, communal, self-care/management, expert care, and transactional. An embedded mixed methods design was used in which QUAN items represented the “primary strand” of data and QUAL probes represented the “secondary strand.” Within each domain, participants responded to QUAN items regarding each activity that asked if they were aware the activity was possible; if they had ever engaged in the activity personally; whether someone else (surrogate) had engaged in the activity on their behalf; the recency of the eHealth activity; how often the activity was related to their cancer; and their interest in engaging in the activity in the future. Then, QUAL probes were presented asking about the reasons they had participated in domain-specific activities and general problems or challenges within activities, or what had kept them from engaging in the activities and the support/resources needed to do so in the future. Participants were 23 African American breast, prostate, and colorectal (CRC) cancer survivors (12 breast; 7 prostate; 2 female CRC; 1 male CRC) identified through the Metropolitan Detroit Cancer Surveillance System, a member of NCI's SEER program. The mean age among participants was 60 years and time since end of primary treatment ranged from 13-46 months. In this pilot sample, 78% reported using the internet. Personal engagement in eHealth activities was highest in the informational domain (range: 9-72% across items) and the most reported activity was searching online for information about specific symptoms or problems. Personal engagement was lowest in the transactional domain. Across both personal and surrogate engagement, eHealth activities most often reported as related to cancer most or all of the time were searching online for information about how to reduce healthcare costs (60%), searching online for information about a hospital or healthcare facility (62.5%), and using technology to track medical symptoms (100%). Across all participants, interest in future engagement was greatest in the informational domain, including searching online for information about specific symptoms (86%), medical treatments or procedures (78%), and signing up to receive online, email or mobile updates on medical issues (74%). Interest in the future engagement was lowest for the communal domain. QUAL probes revealed several challenges within eHealth activities including difficulties in identifying credible health-related online resources; verifying the credibility of online health information; determining effective search terms to find relevant information; managing different policies across healthcare providers related to the electronic exchange of information; and technical problems with devices. Findings led to the revision of this mixed methods approach such that additional QUAN items and QUAL probes were added, with QUAL probes specific to eHealth activities rather than eHealth domains . The revised measure is currently being administered as part of an AHRQ-funded R01 study of eHealth activity among 1200 African American and white cancer survivors in the metropolitan Detroit area. Citation Format: Hayley S. Thompson, Anne Katz, Charity Barnes, Mary Smith, Tara Eaton. A mixed methods approach to assessing ehealth activity among African American cancer survivors. [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 A19.

Breast cancer recurrence risk-reduction beliefs and behaviors among African American breast cancer survivors.

180 Background: A growing body of evidence suggests that breast cancer (BC) recurrence risk is linked to lifestyle behaviors. This study examined correlations between BC recurrence, risk reduction beliefs and related behaviors among African American (AA) breast cancer survivors (BCSs). Methods: 191 AA BCSs, mean age = 56.3 years (standard deviation = 11.4 years) completed a lifestyle assessment tool. Results: Most respondents believed that being overweight (52.7%), lack of physical activity (48.7%) and a high fat diet (63.2%) are associated with BC recurrence. 66.3% considered themselves overweight; one third (33.5%) endorsed that losing weight could prevent BC recurrence; another third (33%) did not, while the remainder (33.5%) don’t know; and nearly half (47.9%) believed that BC recurrence could be prevented by increasing physical activity. 87.3% survivors with BMI < 25 Kg/M2 reported no recurrence compared to 75.7% with BMI > 25 Kg/M2 (p = 0.0580); almost all the women (99.2%) answered ‘yes’ to seeking professional help to lose weight, 79.7% of which were recurrence-free (p = 0.0508). Conclusions: These results provide information about AA BCSs’ beliefs and behaviors protective against BC recurrence. Additional research is warranted to determine the effectiveness of educational interventions for AA BCSs that promote consumption of a healthy diet and engaging in regular physical activity.

Determinants of adherence to physical activity guidelines among overweight and obese African American breast cancer survivors: Implications for intervention approach.

178 Background: 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 (PA) recommendations. To address the research question, “what prevents AA BCSs from following PAGs,” we examined socioeconomic, clinical, and psychosocial correlates with PA levels. Methods: AA women diagnosed and treated for breast cancer participating in a breast cancer support group (n = 191) completed a lifestyle assessment tool (LAT) capturing demographic characteristics; breast cancer diagnosis and treatment history; health-related quality of life (HR-QoL); weight history, including body mass index and post-diagnosis weight gain; and physical activity. Logistic regression and analysis of variance were used to determine whether these covariates were associated with meeting ( > 17.5 MET h/wk); partially meeting (8.75-17.5 MET h/wk); or not meeting ( < 8.75 MET h/wk) PAGs. Results: Preliminary results indicate that 44.44% of AA BCSs met PAGs. This percent is below the national average for AA women (56.5%) and white women (67.5%). Conclusions: Identifying factors that influence adherence to physical activity behaviors is important in developing effective interventions. These findings may help generate hypotheses for future research to undergird efforts to increase PA among AA BCSs.

Evaluating a clinically and culturally informed survivorship care plan trial for African American breast cancer survivors (AABCS).

71 Background: This randomized control study was designed to evaluate the impact of trial participation on access to survivorship care planning (SCP) and adherence to surveillance recommendations among AABCS. Methods: AABCS were recruited from the State Cancer Registry and support groups. This trial consisted of 1:1 randomization into two conditions: 1) peer navigation + clinically- and culturally-informed breast cancer (BC) materials, and 2) clinically- and culturally-informed BC materials, only. AABCS (N= 29) from advocacy groups were trained as peer navigators, with on-going supervision and monitoring by the research team. The ASCO-SCP template was modified based on input from survivor-advocates to increase clinical, cultural and socio-ecological relevance. The study was implemented using community based-participatory approach. Mailed, self-report assessments were taken at baseline and at 6- and 12-month follow-up. Results: In total, 112 AABCS who were 6-18 months post initial primary treatment for stage 0-3 BC participated in the study. There was a 74% participation rate and a 64% completion rate. At 6- and 12-month follow-up, 65% and 73% reported access to a SCP, respectively. Improvements from baseline in adherence to SCP surveillance recommendations were observed at 6- and 12- month follow-up assessments regarding physical exam (45.6%, 71.2%, 71.0%, respectively), pelvic exam (39.7%, 45.2%, 46.5%, respectively), breast self-exam (45.0%, 79.0%, 81.2%, respectively), and breast imaging (31.1%, 75.6%, 81.1%, respectively) (p< 0.05). There we no significant demographic, medical or study outcome differences by study condition. Conclusions: Our study findings demonstrate the effectiveness of trial participation in facilitating access to SCP and improved adherence to recommended surveillance. Participation of survivor-advocates in developing culturally-informed BC informational and survivorship care strategies can enhance acceptability and sustainability, especially in community and primary care settings. Untapped opportunities exist for survivor-advocate engagement in survivorship research and practice to address inequities. Clinical trial information: NCT01824745.

Formative research to develop a lifestyle application (app) for African American breast cancer survivors.

BackgroundThere is a proliferation of lifestyle-oriented mobile technologies; however, few have targeted users. Through intervention mapping, investigators and community partners completed Steps 1–3 (needs assessment, formulation of change objectives, and selection of theory-based methods) of a process to develop a mobile cancer prevention application (app) for cancer prevention. The aim of this qualitative study was to complete Step 4 (intervention development) by eliciting input from African American (AA) breast cancer survivors (BCSs) to guide app development.MethodsFour focus group discussions (n=60) and three individual semi-structured interviews (n=36) were conducted with AA BCSs (40–72 years of age) to assess barriers and strategies for lifestyle change. All focus groups and interviews were recorded and transcribed verbatim. Data were analyzed with NVivo qualitative data analysis software version 10, allowing categories, themes, and patterns to emerge.ResultsThree categories and related themes emerged from the analysis: 1) perceptions about modifiable risk factors; 2) strategies related to adherence to cancer prevention guidelines; and 3) app components to address barriers to adherence. Participant perceptions, strategies, and recommended components guided development of the app.ConclusionsFor development of a mobile cancer prevention app, these findings will assist investigators in targeting features that are usable, acceptable, and accessible for AA BCSs.

Determinants of adherence to nutrition-related cancer prevention guidelines among African American breast cancer survivors.

BackgroundMortality rate for breast cancer is higher among African American (AA) women than for women of other racial/ethnic groups. Obesity, also higher among AA women, may increase the risk of breast cancer development and recurrence. Lifestyle factors such as healthy nutrition can reduce the rate of obesity and breast cancer. This study examined the determinants of adherence to nutrition-related cancer prevention guidelines among AA breast cancer survivors.MethodsAA breast cancer survivors (n=240) were recruited from a breast cancer support group to complete a lifestyle assessment tool for this cross-sectional study. Chi-square test and ordinal logistic regression analysis were used to examine the relationship between adherence to nutrition-related cancer prevention guidelines and potential predictors of adherence.ResultsMajority of the survivors met the guideline for red and processed meat (n=191, 83.4%), but did not meet the guideline for fruits and vegetables (n=189, 80.4%). For survivors with annual household incomes < $25,000, the odds of meeting or partially meeting the guideline for fruits and vegetables was 75.4% less than for participants with incomes > $50,000 (OR= 0.25, 95% CI: 0.08, 0.80). Poor physical functioning (OR= 38.48, 95% CI: 2.26, 656.58), sleep disturbances (OR= 60.84, 95% CI: 1.61, 2296.02), and income > $50,000 (OR= 51.02, 95% CI: 1.13, 2311.70) were associated with meeting the guideline for red and processed meat.ConclusionsMany AA breast cancer survivors are not meeting the nutrition-related cancer prevention guidelines. For this population, more interventions that enhance access to and consumption of healthy diets are needed.

Health-Related Quality of Life of African American Female Breast Cancer Survivors, Survivors of Other Cancers, and Those Without Cancer, National Health Interview Survey, 2010

Health-Related Quality of Life of African American Female Breast Cancer Survivors, Survivors of Other Cancers, and Those Without Cancer, National Health Interview Survey, 2010

Engaging African Americans in developing an intervention to reduce breast cancer recurrence: A brief report.

BackgroundTo develop a culturally appropriate lifestyle intervention, involvement of its intended users is needed.MethodsMembers of an African American (AA) breast cancer support group participated in two 4-hour guided discussions, which were audiotaped, transcribed, and analyzed to guide the content.ResultsThe support group collaborated with researchers to develop 24 experiential nutrition education sessions using a social cognitive framework and incorporating self-regulation skills (goal-setting, self-monitoring, problem-solving, stimulus control) and social support to enhance self-efficacy for changes in dietary intake.ConclusionsCommunity engagement fostered autonomy, built collaboration, and enhanced the capacity of AA breast cancer survivors to participate in developing a lifestyle intervention.

Beliefs and Behaviors about Breast Cancer Recurrence Risk Reduction among African American Breast Cancer Survivors.

A growing body of evidence suggests that breast cancer recurrence risk is linked to lifestyle behaviors. This study examined correlations between breast cancer recurrence, risk reduction beliefs, and related behaviors among African American breast cancer survivors (AA BCSs). Study participants included 191 AA BCSs, mean age = 56.3 years, who completed a lifestyle assessment tool. Most respondents believed that being overweight (52.7%), lack of physical activity (48.7%), and a high fat diet (63.2%) are associated with breast cancer recurrence. Over 65% considered themselves overweight; one third (33.5%) agreed that losing weight could prevent recurrence, 33.0% disagreed, while the remaining 33.5% did not know; and nearly half (47.9%) believed that recurrence could be prevented by increasing physical activity. Almost 90% survivors with BMI < 25 Kg/M2 reported no recurrence compared to 75.7% with BMI ≥ 25 Kg/M2 (p = 0.06); nearly all of the women (99.2%) answered “yes” to seeking professional help to lose weight, 79.7% of which were recurrence-free (p = 0.05). These results provide information about AA BCSs’ beliefs and behaviors protective against breast cancer recurrence. Additional research is warranted to determine the effectiveness of educational interventions for AA BCSs that promote consumption of a healthy diet and engaging in regular physical activity.

A Community-Based Exercise and Support Group Program Improves Quality of Life in African-American Breast Cancer Survivors: A Quantitative and Qualitative Analysis.

African-American (AA) breast cancer (BCa) survivors have higher mortality rates, more comorbidities and are less likely to meet national physical activity guidelines after diagnosis compared to Caucasian BCa survivors. We previously reported that a 20-week resistance exercise intervention coupled with a support group and home walking program, conducted using facilities and personnel at a community cancer support center, in Stage I-III AA BCa survivors improved strength, fitness and circulating C-peptide levels. Here, we report our findings on changes in quality of life (QoL) and other behavioral measures associated with this 20-week intervention and, discuss findings from a qualitative analysis of semi-structured patient interviews. We found a clinically relevant improvement in QoL using the Functional Assessment of Cancer Therapy for Breast Cancer (FACT-B) (Baseline, B: 101.1 ± 21.5; End-of-Intervention, EOI: 108.5 ± 21.6; p = 0.05) and, a significant decrease in depression using the Beck Depression Inventory-II (B: 11.9 ± 8.1; EOI: 9.0 ± 5.5; p = 0.03). Our analysis of the patient interviews support improvements in these behavioral measures in that participants stated that they "feel better", were "more motivated" and "uplifted" after the program. The patient interviews also provided insights to the primary motivators (e.g., social support, improvements in strength and function, weight loss) and barriers (e.g., family and health issues) in adhering to the program and provided suggestions for improving the program (e.g., incorporating nutritional and treatment related side-effect discussions). Our results suggest that community-based lifestyle interventions may improve QoL and depression in AA BCa survivors and lend insights for improving future programs.

Evaluating Survivorship Experiences and Needs Among Rural African American Breast Cancer Survivors.

Disparities in cancer survivorship exist among specific populations of breast cancer survivors, specifically rural African American breast cancer survivors (AA-BCS). While effective survivorship interventions are available to address and improve quality of life, interventions must be culturally tailored for relevance to survivors. Here, we report the results of our formative research using focus groups and in-depth interview to better understand unique rural AA-BCS survivorship experiences and needs in the Alabama Black Belt. Surveys were used to gather sociodemographic and cancer treatment data. Fifteen rural AA-BCS shared their experiences and concerns about keeping their cancer a secret, lack of knowledge about survivorship, lingering symptoms, religion and spirituality, cancer surveillance, and general lack of survivorship education and support. Rural AA-BCS were unwilling to share their cancer diagnosis, preferring to keep it a secret to protect family and friends. Quality-of-life issues like lymphedema body image and sexuality were not well understood. They viewed spirituality and religion as essential in coping and accepting cancer. Participants also discussed the importance of and barriers to maintaining health through regular check-ups. They needed social support from family and friends and health care providers. Overall, rural AA-BCS expressed their need for knowledge about survivorship self-management by providing a vivid picture of the realities of cancer survival based on shared concerns for survivorship support and education within the context of culture.

Weight loss with mindful eating in African American women following treatment for breast cancer: a longitudinal study.

Women with higher body mass index (BMI) following breast cancer (BC) treatment are at higher risk of BC recurrence and death than women of normal weight. African American (AA) BC patients have the highest risk of BC recurrence and gain more weight after diagnosis than their white counterparts. The purpose of this study was to evaluate the association between a mindful eating intervention and weight loss in AA women following chemotherapy for BC. A single-group 24-week longitudinal pilot study with repeated measures was conducted. AA women (N = 22, BMI = 35.13 kg/m(2), range = 27.08-47.21) with stage I-III BC who had finished active cancer treatment received a 12-week mindful eating intervention with individual dietary counseling and group mindfulness sessions, followed by bi-weekly telephone follow-up for 12 weeks. Linear mixed models were used to evaluate the effects of the intervention and of baseline mindfulness on the weight change over time. In the overall group (N = 22), MEQ scores increased over time (p = 0.001) while weight decreased over time (-0.887 kg, p = 0.015). Weight loss over time was associated with higher T1 MEQ scores (p = 0.043). Participants in the higher MEQ group (n = 11) at T1 experienced significant weight loss over time (-1.166 kg, p = 0.044), whereas those in the low MEQ (n = 11) did not lose weight. Participants who were diagnosed with stage 1 BC experienced significant weight loss over time (-7.909 kg, p = 0.014). This study suggests that a mindful weight loss program may be effective for weight reduction and maintenance in some AA women who have completed treatment for BC, particularly those diagnosed with stage 1 BC and with initially higher mindful eating behaviors. Mindful weight loss program is proposed as a promising way in which to reduce obesity-related conditions in AA BC survivors.

Abstract A58: Comorbid conditions among African American breast cancer survivors

Abstract Background: There is compelling evidence that ethnicity is a significant independent risk factor for breast cancer disparity among some racial groups in various geographical locations. In California, African American women carry a disproportionate burden of this disease with a higher mortality rate, when compared to other women. Although the etiology of the burden may be due to multiple factors such as an aggressive phenotype, treatment modalities, etc.., there is growing evidence that the existence and possible interplay of co-morbid conditions may have a negative effect on cancer survivorship outcomes. The aim of our study was to investigate the co-morbid conditions among a cohort of African American breast cancer survivors. Methods: Via recruitment flyers, support groups, and word-of-mouth, we recruited and screened 169 women from breast cancer support groups and community-dwellers in Southern and Northern California. One hundred and sixty women were eligible and n =155 participated. The inclusion criteria were women who self-identified as African/Black American, age 25 years or older, diagnosed with breast cancer and at least 1 year post-active treatment. As part of a larger study, the breast cancer survivors completed a self-report demographic data questionnaire including, height and weight, cigarette smoking, alcohol intake, breast cancer stage, treatment and the presence of co-morbid conditions. Results: Our study revealed that over 79% of the survivors reported 1 or more co-morbid conditions inclusive of heart disease, diabetes, high cholesterol, hypothyroidism, and hyperthyroidism. Hypertension was the most prominent (24.5 %) co-morbid condition and 20.6% reported that they did not have any co-morbid conditions. Conclusion: Our findings suggest the importance of assessing for co-morbid conditions among African American breast cancer survivors as we might have a better understanding of risk and facilitate the need for a collaborative care approach and intervention to manage these co-morbid conditions and thus improve survivorship outcomes. Citation Format: Claudia M. Davis, Hector F. Myers. Comorbid conditions among African American breast cancer survivors. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A58.

Abstract B08: Correlations between weight gain and physical health among African American breast cancer survivors

Abstract Purpose: Weight gain after diagnosis is common among women with breast cancer and may affect physical functioning and recurrence; yet few studies have addressed this problem among African American breast cancer survivors. The purpose of our study was to examine associations between weight gain and physical functioning in a population with disparities in overweight/obesity, health-related quality of life (HR-QoL) and breast cancer recurrence. Procedures: We examined the effects of weight gain in a cohort of 220 African-American women diagnosed with breast cancer. Participants completed a 45-minute assessment tool recording weight and breast cancer history, physical health and general well being. Factorial analysis of variance (ANOVA) was used to assess the association between weight gain (pounds) and HR-QoL. We also determined the moderating effects of demographic variables on post-breast cancer diagnosis weight gain. Results: More than half of the study sample (n=113) gained 10 pounds or more after breast cancer diagnosis. Predictors for weight gain included: 1) breast cancer recurrence-78% (p=0.0067); 2) annual income- from $25,000 to $49,999 55% (p=0.0167); 3) some college education-51% (0.0205), and 4) unmarried 46% (p=0.0007). Participants reporting poorer overall quality of life (p=0.0109), poorer physical health quality of life (p=0.0002), and poorer physical functioning (p=0.0263) were more likely to report weight gain after breast cancer diagnosis than those who reported a better quality of life. Conclusions: These results highlight the importance of weight control for African American women after breast cancer diagnosis. Citation Format: Selina A. Smith, Mechelle D. Claridy, Mary S. Whitehead, Joyce Q. Sheats, Bakak Baban, Wonsuk Yoo, Ruben R. Gonzalez-Perez, Ernest Alema-Mensah. Correlations between weight gain and physical health among African American breast cancer survivors. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B08.

Abstract A61: Perspectives on transitioning from cancer treatment to breast cancer survivorship

Abstract Introduction: The population of breast cancer survivors continues to grow due to improved medical treatments and education. Yet there is a lack of comprehensive survivorship care planning to manage overall health following cancer treatment. The Institute of Medicine (IOM) recommends psychosocial components be included in survivorship care plans to address long-term psychological distress. African Americans in particular experience disproportionate levels of psychosocial distress in breast cancer survivorship. Thus the goal of this study was to understand the psychosocial needs, resources, and cultural influences during the transition from treatment to survivorship from the perspectives of both the oncology professionals and survivors themselves. Methods: Twenty-nine, semi-structured one-on-one interviews were conducted in Washington State by African-American community advocates as part of a larger on-going study. Twelve oncology professionals (OPs) and 17 female African-American breast cancer survivors (BCSs) were interviewed. Open-ended interview guides were tailored for BCSs and OPs respectively. Interviews were transcribed, coded, and analyzed using principles of constant comparison grounded theory, in which concepts were identified and themes derived from interview data. Interviews were approximately 45 minutes in duration and participants received $40 compensation for their time. Results: Similar to previous literature, psychosocial needs identified by both BCSs and OPs included fear of recurrence, emotional and financial distress, and support issues. However, the role of daily stressors and microaggressions described by many BCSs were not widely identified by OPs. BCSs also indicated a need for more empathetic interactions from OPs during medical visits. A major gap identified between the BCSs and OPs was found in the source of psychosocial information provided to BCSs. Nearly half of the BCSs indicated psychosocial support was received from community-based programs (spiritual and secular) whereas many OPs believed support was provided as part of clinical services at their institution. However, several OPs did state that there are numerous community resources available to survivors. Many professionals stated that a structured protocol is not in place to help survivors identify available services and some specifically identified the need to include psychosocial factors in the survivorship care plan. A few OPs suggested that follow-up appointments with survivors 3-, 6- and 12-months after cancer treatment may reduce feelings of isolation and lack of support. With regard to cultural factors that may impact the transition to survivorship, many of the BCSs noted they did not openly share their cancer experience with others, family/friends or professionals, which they indicated is an African-American cultural trait; specifically, the desire to appear as a “strong” woman. Some OPs also mentioned this aspect of the African-American culture as a possible barrier to communication about psychosocial well-being during medical visits. Some survivors conveyed interest in mentoring future BCSs stating a need for African Americans to support each other, but did not specifically describe how this support would differ from other sources of support. OPs discussed historical injustices as a potential source of mistrust within African American breast cancer survivors. Conclusion: While there are many areas of overlap between BCSs and OPs regarding psychosocial needs of African-American BCSs, there remain gaps of primarily social and institutional systemic barriers to care. Study limitations and some recommendations to meet the psychosocial needs of African American breast cancer survivors have emerged from the interviews and are discussed. Citation Format: Swati Somuri, Rachel M. Ceballos, Sarah H. Hohl, Rachel M. Malen, Bridgette Hempstead, Jacci Thompson-Dodd. Perspectives on transitioning from cancer treatment to breast cancer survivorship. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A61.

Abstract B26: The effect of neighborhood context on physical and mental health among ethnic minority breast cancer survivors

Abstract Background: Contextual determinants of health risk and outcomes, including physical and social environments, are increasing priority areas for health disparities research and practice. Individual-level social determinants of health among ethnic minority cancer survivors, such as education and income, have been well documented. However, little is known about the effect of neighborhood context on health among this vulnerable population. Learning more about the source and relative impact of health determinants is especially critical to public health and policy strategies to promote address health disparities and improve health equity. Purpose: This study examined the relationship between neighborhood context and patient reported outcomes. Specifically, we hypothesized that greater neighborhood stress would be significantly related to poorer physical and mental health status in post-treatment Latina (LBCS) and African-American breast cancer survivors (AABCS). Method: We used a mixed-methods recruitment approach to enroll 320 LBCS and AABCS from population-based sources. Neighborhood context was assessed using a self-rated neighborhood stress scale for the following aspects of neighborhood context: housing situation, neighborhood environment, transportation, availability of public services, crime and violence, and relation with police. Two domains of health were used: general health, measured by five-point Likert-type item along with the number of self-reported comorbidities; and mental health, assessed using the Center for Epidemiologic Studies Depression (CES-D) Scale, in conjunction with self-reported psychological difficulties. Results: Of the participants, 88 (27.5%) self-identified as African American and 232 (72.5%) self-identified as Latina. Participant age ranged from 26 to 89 years with a mean of 54.49 years (SD =11.49). LBCS were older, less educated, and more financially disadvantaged (p&amp;lt;0.5) compared to AABCS. In addition, LBCS were more likely to be married, to be homemakers, to be born outside of the US, to have spent fewer years residing in the U.S., and to receive chemotherapy. Generalized linear regression analyses show that among ethnic minority breast cancer survivors, higher self-reported neighborhood stress was significantly associated with worse self-rated health status (p &amp;lt;0.05), more frequent depressive symptoms (p &amp;lt;0.01), higher number of comorbidities (p &amp;lt;0.01), and increased likelihood of having psychological difficulties (p &amp;lt;0.001) after adjusting for important individual sociodemographic and medical covariates such as ethnicity, age, income, education, cancer treatment and cancer stage. Significantly, LBCS had higher likelihood of experiencing psychological difficulties than AABCS (OR=2.27, 95% CI: 1.03-5.00). In addition, self-rated health was shown to be significantly impacted by working status (p&amp;lt;0.05). Unexpectedly, some seemingly important sociodemographic factors were not shown to have an impact on self-reported health status: education level and annual household income were not significantly correlated with health. However, individuals with annual incomes at or above the national median reported significantly less depressive symptoms than those individuals who made less than $15,000 per year. Conclusion: Self-reported neighborhood contextual factors were shown to be an influential predictor of physical and mental health among both AABCS and LBCS. These findings underscore the importance of taking neighborhood context into account in investigating health outcomes. The impact of contextual determinants, including neighborhood resources, on cancer-related and overall physical and mental health requires further investigations. Future studies should incorporate population level data, e.g., census tract, to obtain a fuller picture of neighborhood status and resources to better inform interventions and/or policies to improve health outcomes among lower income and vulnerable populations. Citation Format: Mayra Serrano, Kimlin Ashing, Lisa Barcelo, Chenkai Wu. The effect of neighborhood context on physical and mental health among ethnic minority breast cancer survivors. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B26.