African American Prostate Cancer Survivors Research Articles

Abstract B052: Exploring supplement utilization patterns among African American prostate and breast cancer survivors

Abstract Introduction: The American Cancer Society (ACS) defines dietary supplements as “vitamins and minerals, herbs and other botanicals, amino acids, enzymes, and more.” ACS advises against supplement use for cancer prevention, with no suggestions for survivors. Regardless, 64-81% of cancer survivors and 14-32% of recently diagnosed cancer patients in the U.S. will begin taking supplements to improve health outcomes. Despite this prevalence, few studies have examined supplement use in African American cancer survivors, and studies that have been done include small samples. This project examines supplement use across two genders and two cancer types within a population group historically underrepresented in research. Given the dearth of research to date, this project adds novel findings to the literature and informs future research.Objectives: This study describes supplement use in African American breast and prostate cancer survivors engaged in lifestyle intervention trials, identifies potential correlates of supplement use; and compares supplement use between the two populations. Methods: Men Moving Forward (MMF) is an ongoing lifestyle intervention study for African American prostate cancer survivors. Moving Forward (MF) is a completed lifestyle intervention study that included African American breast cancer survivors. Both studies examine the efficacy of a community-based intervention that promotes adherence to the American Cancer Society Nutrition and Physical Activity Guidelines. At baseline, study participants completed interviews that included a measure of supplement use including type, dose, frequency, and reason for use. Supplements were then categorized by type (e.g., Vitamin D, Vitamin B12) and descriptive analyses were conducted to examine most common types of supplements used, potential correlates of use, and to compare the two cancer survivor groups. Results: 114 men currently enrolled in the MMF study, and 223 women enrolled in MF completed the supplement use measure. Average ages of participants are 66.2 years (SD=7.5) for MMF and 57.5 years (SD=10.1) for MF. Supplement use was common, with 64.0% of MMF participants and 65.9% of MF participants using at least one supplement at baseline. Mean number of supplements was 1.62 (SD=1.9) for MMF and 1.76 (SD=2.0) for MF. The most used supplements were the same across survivor groups: Vitamin D (37.7% MMF, 38.1% MF), Multivitamins (27.2% MMF, 32.7% MF) and Omega-3 Fatty Acids (8.8% MMF, 19.3% MF). Age, education, and income will be explored as predictors of usage. Conclusions: Supplement use was prevalent among both survivor groups, consistent with national data for adult cancer survivors who report supplement use. However, our sample had higher usage rates compared to Non-Hispanic Black US adults without cancer (39.3% of men, 56.2% of women) from the 2023 National Health Statistics Report. Understanding supplement use in cancer survivors can identify potential risks and benefits of use, enhance patient-provider communication, and improve the quality-of-care patients receive. Citation Format: Carlene Kranjac, Estefania Alonso, Margaret Tovar, Sandra Contreras, Iwalola Awoyinka, Patricia Sheean, Melinda Stolley. Exploring supplement utilization patterns among African American prostate and breast cancer survivors [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B052.

Abstract B068: Physical function and fitness of African American prostate cancer survivors at baseline of Men Moving Forward, a lifestyle intervention program

Abstract Background: Prostate cancer (PC) is the most commonly diagnosed cancer in American men with 1 in 8 men diagnosed in their lifetime. African American men have the highest rates of incidence and mortality for PC in the USA, due to a myriad of socio-biological factors. Fortunately, given advances in screening and treatment options the survival rate of PC is high with a 97% 5-year survival rate. However, PC treatments can cause muscle atrophy and reduced physical functioning and quality of life (QoL). Physical function and strength can serve as proxy measurements for cellular aging, longevity, and QoL. Handgrip is related to overall strength, upper limb function, bone mineral density, and mortality. Sit-to-stand measures leg strength and endurance and is used to evaluate fall risk. The 6-minute walk test (6MW) is used to assess aerobic capacity. Men Moving Forward (MMF) is one of the first community-based lifestyle programs developed with and for African American Prostate Cancer Survivors (AAPCS). This study examines objective and subjective physical function of MMF participants at baseline. Methods: MMF is a randomized, wait-list control trial with a 16-week group-based lifestyle intervention focused on physical activity, nutrition and QoL, led by local health coaches. Participants complete physical assessments and surveys at baseline, post-intervention and 12 months. Physical assessments consist of a blood draw, DXA scan, anthropometric measurements, handgrip strength, 30-second sit-to-stand, and 6MW (added with second cohort). Participants also answer surveys on their health and physical function. Pearson’s correlation was used to assess linear correlation between fitness measures and self-reported physical function. Results: At baseline, 100 AAPCS completed both the physical assessment and survey. Participants had a mean age of 65.8 ± 7.26 years, 49% were married/living with a partner, 47.6% were retired, and education levels varied. Top comorbidities include hypertension, obesity, diabetes, and hypercholesterolemia. Mean hand grip scores were 39.8 ± 7.5kg for right and 38.4 ± 7.7kg for left. Handgrip scores 28.2-44.0kg for men aged 64-69 are considered normal. Mean sit-to-stand (n=96) was 12.2 ± 4.3 reps in 30 seconds. Since 6MW was added later in the study, 68 men completed with a mean score of 0.42 ± 0.10 km. Normal ranges for men aged 65-69 is 15 reps for sit-to-stand and 0.572km for 6MW. 50% of participants rated their overall health as “good”, 21% as “very good”, and 20% as “fair” on a five-point Likert scale. PROMIS physical function measures had an average of 50.3 ± 7.3 for men at baseline. PROMIS physical function was weakly correlated with 6MW and sit-to-stand with r = 0.34, p-value=0.004 and r = 0.27, p- value=0.009, respectively. Conclusion: Data reflect the value of supporting AAPCS in lifestyle changes to improve physical function. Few efforts have addressed lifestyle among AAPCS, despite high prostate cancer burden. Future reports will examine the efficacy of MMF in improving physical function, overall health, and QoL. Citation Format: Margaret Y. Tovar, Iwalola Awoyinka, Patricia Sheean, Paula Papanek, Toni Uhrich, Sandra Contreras, Meheret Gebreegziabher, Estefania Alonso, Jayme Ewens, Shannon Reed, Diana Navarro Suarez, Kathleen O'Connell, Kathryn Flynn, Kathryn Bylow, Deepak Kilari, Melinda Stolley. Physical function and fitness of African American prostate cancer survivors at baseline of Men Moving Forward, a lifestyle intervention program [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B068.

Abstract A088: Examining associations between objective and perceived stress and allostatic load in African American prostate cancer survivors

Abstract Background. Racial disparities in prostate cancer survivorship persist despite clinical advancements. Stress has been implicated as a potential driver of these disparities, with both chronic and perceived stress found to be associated with adverse cancer survivorship. Allostatic load (AL), one such marker of chronic stress, has been associated with decreased survivorship and worse quality of life (QoL) in cancer survivors. Perceived stress has also been associated with outcomes in cancer survivorship including increased symptom burden and worse quality of life. Despite this, few studies incorporate direct measures of stress or examine how these measures contribute to AL This study examines the relationship between AL, objective stress (as measured by occurrence of stressful life events), and self-reported perceived stress in a subset of African American prostate cancer survivors (N=59) enrolled in Men Moving Forward, a randomized trial to improve body composition through lifestyle change. Methods. At baseline, participants completed an adapted version of the Crisis in the Family Systems (CRISYS) survey, an instrument designed to measure recent (past 4 months) contemporary life stressors. The survey was tailored for AAPCS via feedback from the community advisory board. 41 items reflective of 11 domains were included. Overall CRISYS scores and scores by domain were calculated. Feelings of perceived stress in the past month were measured via the 10-item perceived stress scale, with higher scores reflecting higher perceived stress. AL scores used 15 criterion reflecting neuroendocrine, cardiovascular, immune, and metabolic systems. Each criterion was assigned a score of 0 or 1: 1 if in the high-risk range based on clinical guidelines. An index score was generated by summing high-risk indicators. Pearson correlations were used to explore the relationship between stress measures. Logistic regression comparing the those with highest quartile AL to lower AL was also performed. Results. The mean AL score was 5.6 (SD ± 2.4) of a maximum score of 15. The mean summative score for CRISYS was 4.8 (SD ± 3.3). The most common domains of stress experienced were safety in the community (67%), relationships (66%), and medical issues of loved ones (44%). The Mean PSS was 11.5 (SD ± 6.0), with 64% of men reporting low stress and 36% moderate stress levels. Significant correlations were found between CRISYS and PSS, however no correlations with AL were detected. No significant findings were identified in the regression analysis. Conclusions. Objective and perceived stress measures were correlated, but no associations were found between the perceived or objective stress measure and AL in this sample.. Given AL is meant to reflect the physiological impact of cumulative and chronic stress burdens, it is possible that the shorter-term context of the objective (past 4 months) and perceived stress (past month) measures were not sufficiently aligned with the longer-term context of AL. Citation Format: Iwalola Awoyinka, Deepak Kilari, Kathryn Bylow, Jennifer Knight, Alexis Visotcky, Anjishnu Banerjee, Patricia Sheean, Paula Papanek, Melinda Stolley. Examining associations between objective and perceived stress and allostatic load in African American prostate cancer survivors [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A088.

Abstract B062: Physical Activity in African American Prostate Cancer Survivors and a Comparison of Self-report versus Accelerometer-Derived Measurement

Abstract Authors: Shannon Reed, Margaret Tovar, MPH, Paula Papanek, PhD, Patricia Sheean, Deepak Kilari, MD, Katie Bylow, MD, PhD, Whitney Morelli, PhD, Melinda Stolley, PhD Background: The Men Moving Forward intervention examines a lifestyle intervention's effects on body composition among Black/African American prostate cancer survivors (AAPCS). AAPCS. To assess PA, self-report and objective measures are being used. Studies use self-report measurements due to their simplicity and low cost, however, the congruent validity of self-report PA is often questioned. This study describes PA and strength training and also compares self- report PA to accelerometry-derived PA among AAPCS at baseline. Methods: AA men with non-metastatic PC were recruited to participate in a randomized, waitlist control trial testing the efficacy of a lifestyle intervention. The 16-week group and community-based intervention was developed with and for AAPCS and is grounded in the ACS Nutrition and Physical Activity Guidelines for Cancer Survivors. Participants completed the Godin Leisure Time Physical Activity Questionnaire (GLTPAQ) which queries about moderate and vigorous activities. The study added a question about the frequency of strength training. Participants also wore a GT3X accelerometer (Actigraph) for 7 days. Only men who wore the actigraph for at least 10 hours across 4 days were included in this analysis. Troiano 2008 cut points were used to measure moderate-vigorous PA (MVPA). Pearson’s correlation was used to assess linear correlation between objectively measured and self-reported MVPA. Statistical significance was set at p<0.05. Results: 73 AAPCS with a mean age of 65.8 years ± 6.9 were included in the analyses. Mean Godin score was 23.32 +16.80 (insufficient activity) with 45.2% classified as active (Godin score >24) and 54.8% as insufficiently active (Godin score<23). 30.2% strength trained at least twice weekly. Actigraph data showed a mean of 101.19 minutes per day of MVPA and that 73.68% of participants did not meet the guideline for 150 minutes per week of MVPA. The analysis revealed a weak positive correlation (r = 0.274, p = 0.019) between actigraph-recorded MVPA and self-reported MVPA. Conclusion: Study results suggest AAPCS overestimate their MVPA using the GLTPAQ when compared to accelerometry. Notably, a significant proportion did not meet the recommended level of physical activity. These findings underscore the importance of including objective measures of PA and the value of programming that is intentionally inclusive of AAPCS. To better support validity and reliability, participant perceptions of PA time and intensity may require improved clarification and description in studies relying solely on SR questionnaires. Citation Format: Shannon Reed, Margaret Tovar, Paula Papanek, Patricia Sheean, Deepak Kilari, Whitney Morelli, Katie Bylow, Melinda Stolley. Physical Activity in African American Prostate Cancer Survivors and a Comparison of Self-report versus Accelerometer-Derived Measurement [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B062.

Examining the role of social relationships on health and health behaviors in African American men with prostate cancer: a qualitative analysis.

Cancer survivor cohort studies document the positive impact of health behaviors on cancer survivorship by influencing quality of life, comorbidity burden, and cancer recurrence. Social networks can be instrumental in supporting health behavior changes. This study used qualitative interviews to explore how social networks may impact health and health behaviors of African American Prostate Cancer Survivors (AAPCS) enrolled in Men Moving Forward (MMF), a lifestyle intervention designed with and for AAPCS. Specifically, we sought to understand how different relationships within social networks influence health and health behaviors, and to identify potential mechanisms for this influence. Eighteen men who completed the MMF intervention participated in a semi-structured interview which explored social connections, health and health behaviors, stress, and the cancer experience. Interviews were recorded and transcribed, and thematic analysis was performed by two coders. Participants described robust social networks of friends and family. Four distinct yet overlapping themes were identified that described how relationships influence health and health behaviors among AAPCS: (1) provision of knowledge, (2) health and behavior history, (3) encouragement and support, and (4) shared behavior. These results provide initial insight into the types of relationships that influence health, and the intersecting and multifaceted mechanisms through which this influence occurs.

Abstract A021: Prevalence of metabolic syndrome and its association with physical activity in African American prostate cancer survivors at baseline of Men Moving Forward, a lifestyle intervention program

Abstract Background: Black/African American (Bl/AA) men have the highest death rate from Prostate Cancer(PC) compared to any other race/ethnicity. PC is also the second leading cause of death in this population. Men Moving Forward (MMF) is the first community-based lifestyle intervention developed with and for African American Prostate Cancer Survivors (AAPCS). This study assesses the prevalence of Metabolic Syndrome(MetS) in MMF cohort at baseline and explores the association between physical activity (PA) and MetS. MetS is implicated as a possible risk factor for the progression of PC and is a well-established risk factor for Cardiovascular (CV) disease, the most common cause of death among PC survivors cured of their cancers. MetS is defined as having three or more risk factors: waist circumference > 40-inches, blood pressure (BP) > 130/80 mmHg, fasting blood glucose >100 mg/dl, HDL level <40mg/dl and triglyceride level > 150 mg/dl. Notably, physical inactivity is a known risk for MetS, CV disease and PC. Methods: MMF is a 16-week group-based lifestyle intervention, led by local health coaches. To be eligible, men must have a BMI > 23 kg/m2, completed treatment or on active surveillance, and non-adherent to ACS nutrition OR PA guidelines. Men complete surveys, physical assessments, and blood draws at baseline, post-intervention, and 12-months. Baseline waist circumference, resting BP measurement, fasting glucose level, HDL level, and triglyceride level were examined. PA was measured using the Godin Leisure-Time Exercise scale with scores stratified into three activity levels: insufficiently active (< 14 ), moderately active(14-23), and active(> 24). The association between PA and MetS was assessed using Chi-square test of independence. Results: 117 AAPCS were enrolled at baseline, with 98 having complete PA and MetS data. These participants had a mean age of 66.21 ± 7.378. Top comorbidities include hypertension (71%), obesity (51%), diabetes (31%), and hypercholesterolemia (48%). 36.27% of participants had MetS at baseline, higher than the prevalence observed in NHANES for Bl/AA men without cancer (16.7%). Many had risk factors for MetS: 27% had BP >130/80 mmHg, 65% had fasting glucose levels > 100mg/dl, 27% had HDL level <40 mg/dl, 17% had triglyceride levels > 150 mg/dl and 73% had waist circumference > 101.6cm(40 inches). When assessing physical activity at baseline 39% were active, 28% were moderately active and 33% were insufficiently active. 41% of those with MetS were insufficiently active. PA and MetS were not significantly associated X2(2, N = 98) = 0.370, P = 0.833. However, among MetS components, PA was significantly associated with high BP, X2(2, N = 108) = 10.51, P = 0.0052. Conclusion: Data reflects the value of supporting AAPCS in lifestyle changes to increase PA and to improve the burden of CV disease and PC recurrence risk. Few efforts have addressed lifestyle among AAPCS, despite high PC prevalence. Future reports will examine other factors associated with MetS and prostate cancer such as dietary intake and body composition. Citation Format: Meheret B. Gebreegziabher, Patricia Sheean, Paula Papanek, Alexis Vistcky, Awoyinka Iwalola, Anjishnu Banerjee, Toni Uhrich, Margaret Tovar, Miracle Powell, Sandra Contreras, Kathleen O'Connell, Melinda Stolley. Prevalence of metabolic syndrome and its association with physical activity in African American prostate cancer survivors at baseline of Men Moving Forward, a lifestyle 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 A021.

Abstract A106: Examining the role of social connection on allostatic load and quality of life in African American prostate cancer survivors

Abstract Background. Racial disparities in prostate cancer (PC) survivorship persist despite clinical advancements. Chronic stress may contribute to these disparities, with allostatic load (AL) considered a measure of such stress. Associations between AL and survivorship outcomes such as quality of life (QoL) are documented, yet less is known about factors influencing these relationships. Social connections (SC) (e.g., social networks, social support) are associated with improved QoL in survivors, yet which aspects of SC and which pathways linking SC to QoL remain unclear. Additionally, little is known about the SC of African American PC survivors (AAPCS) and how these relate to QOL, stress, and AL. This study explores the relationship between SC, stress (perceived and AL) and QOL in in 48 AAPCS enrolled in Men Moving Forward, a randomized trial to improve body composition through lifestyle change. Methods. At baseline, participants completed surveys including: the Cohen Social Network Index assessing 3 aspects of social networks: network size (# of ties with regular contact), diversity (# of roles with regular contact) and embeddedness (# of domains with 4 or more regular contacts); Patient-Reported Outcomes Measurement Information System (PROMIS) measures of social support (companionship, emotional and informational support); the perceived stress scale, and PROMIS measures of physical function, anxiety, depression, fatigue, sleep disturbance, social function, and pain intensity. The latter were used to generate summative physical (PQOL) and mental (MQOL) health standardized T-scores (U.S. population mean=50, SD=10). AL scores used 15 criterion reflecting neuroendocrine, cardiovascular, immune, and metabolic systems. Each criterion was assigned a score of 0 or 1: 1 if in the high-risk range based on clinical guidelines. An index score was generated by summing high-risk indicators. Pearson correlations were used to explore the relationship between aspects of SC and QOL and SC and stress variables. Results. The average AL score was 5.8 (SD ± 2.3) of a maximum 15. No significant correlations were found between any SC domains and AL. However, negative associations were identified between network size (r=-.313, p=0.030), emotional support (r=-.319, p = 0.027), companionship (r=-.313, p=0.030) and perceived stress. A positive association was found between loneliness and perceived stress (r=.521, p<0.000). MQOL was positively related to network size (r=.364, p=0.011), emotional support (r=.366, p=0.011), and companionship (r=.288, p=0.047). Loneliness was negatively associated with MQOL (r=-.626, p<0.000) and PQOL (r=-.407, p=0.006). Conclusions. These findings suggest SC has a positive impact on survivorship in AAPCS, and that structural and functional aspects of SC may be involved. Currently, limited resources are available for PC survivors, and even fewer are tailored for AAPCS. Future efforts to improve survivorship for AAPCS should consider assessing social networks and access to social support when initiating survivorship care. Citation Format: Iwalola A. Awoyinka, Kathryn Flynn, Deepak Kilari, Kathryn Bylow, Jennifer Knight, Jamila Kwarteng, Anjishnu Banerjee, Kirsten M. Beyer, Staci Young, Patricia Sheean, Paula Papanek, Melinda Stolley. Examining the role of social connection on allostatic load and quality of life in African American prostate 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 A106.

Recruiting African American Prostate Cancer Survivors for a Population-based Biobank Study.

Prostate cancer affects African American men disproportionately compared with men of other racial/ethnic groups. To identify biological bases for this health disparity, we sought to create a state-wide biobank of African American prostate cancer survivors in Florida. African American men diagnosed with prostate cancer between 2013 and 2017 and living in Florida at diagnosis were identified through the State of Florida's cancer registry. Individuals were approached via mail and telephone, assessed for eligibility, and asked for informed consent. χ2 and t tests were conducted to identify differences between eligible and reachable individuals (i.e., had valid contact information) versus consented participants. Of the 5,960 eligible and reachable individuals, 3,904 were eligible and contacted at least once, and 578 consented [overall consent rate = 10% (578/5,960); adjusted consent rate = 15% (578/3,904)]. Statistically significant (Ps < 0.05) but small differences in demographic and clinical variables were observed. Consented participants were less likely to be older than 64 (35% vs. 41%) and less likely to have received radiotherapy (36% vs. 41%) and hormone therapy (16% vs. 21%), but more likely to have regional prostate cancer (13% vs. 11%) and have undergone surgery (44% vs. 39%). Consented participants did not differ from reachable individuals on other demographic and clinical factors (Ps > 0.05). Recruiting African American prostate cancer survivors to biobanking research through a cancer registry is feasible. However, the consent rate was low, and existing challenges limit consent and participation. Strategies for overcoming barriers to informed consent and increasing participation in biospecimen research are needed to address cancer disparities.

Abstract A034: Health-related quality of life among African American prostate cancer survivors enrolled in a lifestyle intervention program

Abstract Background: Prostate cancer (PC) is the most diagnosed non-skin cancer among men in the United States, with African American (AA) men experiencing the highest incidence of all racial/ethnic groups. Screening and treatment advances for PC have resulted in men living years beyond their diagnosis; however, side effects of PC treatments can impact health-related quality of life (QoL). African American PC survivors (AAPCS) may be at increased risk of experiencing lower QoL. Lifestyle interventions show potential for improving QoL through changes in health behavior and symptom improvement, yet few have focused on AAPCS. This study explores QoL of AAPCS enrolled in Men Moving Forward (MMF), a randomized trial to improve body composition through lifestyle change. Methods: Baseline data from 83 AAPCS enrolled in MMF were used in analysis. Participants completed Patient-Reported Outcomes Measurement Information System (PROMIS) computerized adaptive tests for physical function, anxiety, depression, fatigue, sleep disturbance, social function, and pain intensity. Standardized T scores (U.S. general population mean = 50, SD =10) were generated for all domains except pain intensity (0-10), and summary scores for physical and mental health were generated. A higher score reflects more of a construct being measured. Thus, for symptoms, scores above the mean are worse, while for functioning domains, scores below the mean are worse. Summary scores for physical and mental QoL were also calculated. Questionnaires related to physical activity, self-efficacy, perceived stress, social support, and resilience were also collected. We compare sample means to published norms of U.S. PC survivors, considering a difference of 3 points (1/3 SD) as clinically meaningful. Multiple linear regression analyses were used to examine factors associated with physical and mental health summary scores. Results: AAPCS scores were similar to the U.S. PCS means for depression (45.6 vs 45.4), fatigue (47.9 vs 47.3), sleep disturbance (48.4 vs 48.2), and physical function (50.4 vs 50.2). AAPCS scores were worse than the U.S. PCS means for anxiety (49.4 vs 45.9) and social participation (51.2 vs 55.1). The average mental health summary score for AAPCS was better than the U.S. general population (53.4 vs 50), while the physical health summary score was similar (51.4 vs 50). Perceived stress (p&amp;lt;0.000) was negatively associated with mental health. Comorbidities (p=0.002) were negatively associated with physical health, while physical activity (p=0.034) was positively associated with physical health. Conclusions: Our sample of AAPCS was similar to U.S. PCS except for worse anxiety and social function. We also found that factors that could be impacted by a lifestyle intervention were associated with physical and mental health. Future work will examine additional correlates and explore the impact of the MMF lifestyle intervention on changes in QoL. Citation Format: Iwalola Awoyinka, Kathryn E. Flynn, Anjishnu Banerjee, Alexis Visotcky, Sophia Aboagye, Margaret Tovar, Deepak Kilari, Kathryn A. Bylow, Paula Papanek, Patricia M. Sheean, Melinda R. Stolley. Health-related quality of life among African American prostate cancer survivors enrolled in a lifestyle intervention program [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A034.

Abstract B032: Diet quality and physical activity of African American prostate cancer survivors at baseline of Men Moving Forward, a lifestyle intervention program

Abstract Background: In the United States, approximately 41,600 new cases of prostate cancer will be diagnosed in Black/African American men in 2022. Lifestyle can impact cancer survivorship, including recurrence risk, comorbidity burden and quality of life. The American Cancer Society has set physical activity and nutrition guidelines for cancer survivors that include plant-based eating and regular physical activity and strength training. However, many cancer survivors are unaware of these guidelines, and they often face challenges in adopting such behaviors. Men Moving Forward (MMF) is among the first community-based lifestyle intervention developed with and for African American Prostate Cancer Survivors (AAPCS). This study examines the diet and physical activity patterns of MMF participants at baseline. Methods: MMF is a 16-week group-based lifestyle intervention, led by local health coaches. Men complete surveys and physical assessments at baseline, post-intervention and at a 12-month follow-up. The VioScreen Food Frequency Questionnaire (FFQ) was used to obtain dietary intake and diet quality scores for participants at baseline. The Healthy Eating Index-2015 (HEI-2015) is used to assess adherence to the Dietary Guidelines for Americans (DGA) 2015-2020. Baseline HEI-2015 scores of men in the Multiethnic Cohort Study (MEC) were used to provide a population-based comparison. We also examined how many men received an HEI-2015 total score &amp;gt;80, reflecting an ideal diet for reducing premature death and chronic disease risk. Physical activity was measured using the Godin Leisure-Time Exercise Questionnaire (Godin) with an item added to query on frequency of strength training. Results: At baseline of MMF, 80 AAPCS completed the FFQ and 83 AAPCS completed the Godin. MMF participants had a mean age of 66.4 ± 6.86, 49.4% were married/living with a partner, and had varying incomes and education levels. Top comorbidities include hypertension (71%), obesity (51%), diabetes (31%), and hypercholesterolemia (48%). MMF participants had lower total HEI-2015 scores than MEC study men with average scores of 60.3 ± 11.0 and 65.6 ± 10.3, respectively. About half of the HEI-2015 component scores were similar between MMF and MEC participants. However, MMF participants reported 1 or more points higher component scores for “dairy” and “refined grains”, and 1 or more points lower scores for “seafood &amp; plant proteins”, “fatty acids”, “sodium”, and “saturated fats” than their MEC counterparts. Although AAPCS in MMF reported similar HEI-2015 scores to typical American men, only 3 of the 80 AABCS at baseline reported HEI-2015 scores &amp;gt;80, highlighting a need for diet quality improvement. At baseline, 40% of participants were considered active and 33% reported strength training at least twice weekly. Conclusion: Data reflect the value of supporting AAPCS in lifestyle changes to improve dietary quality, physical activity and strength training. Few efforts have addressed lifestyle among AAPCS, despite high prostate cancer burden. Future reports will examine the efficacy of MMF. Citation Format: Margaret Y. Tovar, Patricia Sheean, Paula Papanek, Alexis Visotcky, Lola Awoyinka, Anjishnu Banerjee, Kathryn Bylow, Deepak Kilari, Kathryn Flynn, Toni Uhrich, Sophia Aboagye, Sandra Contreras, Kathleen Jensik, Melinda Stolley. Diet quality and physical activity of African American prostate cancer survivors at baseline of Men Moving Forward, a lifestyle intervention program [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B032.

Abstract B064: The role of peer support in the survivorship experience of African American prostate cancer survivors

Abstract Background: The link between social connections and health behaviors in the general population has been well documented. However, information on how social connections may impact African American prostate cancer survivors (AAPCS) is limited. This study uses qualitative interviews to explore how social connections may impact the health and health behaviors of AAPCS enrolled in Men Moving Forward (MMF), a lifestyle intervention designed for and by AAPCS. Specifically, we sought to understand how different aspects of the social network may impact health or health behaviors and identify opportunities to leverage social connections to improve the survivorship of AAPCS. Methods: Men completing the MMF program were invited to participate in the qualitative interview. A semi-structured interview guide exploring social networks, health and health behaviors, and cancer survivorship was developed and revised in consult with the MMF community advisory board. Interviews were scheduled at the convenience of participants and held via zoom or at a study site location of the participants choosing. Interviews were audio recorded, transcribed verbatim, and coded by two coders using MAXQDA software. A grounded theory approach to coding was taken, with initial line-by-line coding done using an open coding approach, followed by axial coding to thematically organize codes. Results: To date, 14 of 20 interviews have been completed and some preliminary findings are included here. Early findings have identified themes around the importance of peer support and shared experiences and sharing of stories across the survivorship continuum. Within this theme, the following sub-themes were identified: 1) Connecting with other survivors helped with acceptance and isolation following diagnosis. 2) Feedback, advice, and information sharing felt more credible and valued when coming from someone who understood what they had been through. 3) Shared experience helped men feel understood and able to share without fear of judgement. 4) Telling their story to others offered a way to confront stigma around prostate cancer and offer support to men in their communities. This sharing also offered comfort to the survivors. Conclusions: Peer support and shared experience offer an opportunity to provide support and education to AAPCS. Currently, peer support resources for men are limited, and even fewer offer culturally tailored support or programming. Enhancing efforts to create and activate social connections between survivors may offer additional an opportunity to improve survivorship outcomes in AAPCS. Citation Format: Iwalola Awoyinka, Margaret Tovar, Staci A. Young, Melinda R. Stolley. The role of peer support in the survivorship experience of African American prostate cancer survivors [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B064.

Faith as a Mechanism for Health Promotion among Rural African American Prostate Cancer Survivors: A Qualitative Examination.

Conceptualized using critical race theory as a theoretical underpinning, this study analyzed the lived experiences of older, rural, African American male prostate cancer (hereafter referenced as PrCA) survivors’ faith and health promotion practices within Northeast Louisiana. Qualitative data from journaling, observations, and semi-structured interviews were obtained from ten older, African American male PrCA survivors residing in four rural parishes of Louisiana. The data analysis employed a two-stage approach known as Polkinghorne’s analysis of narratives and narrative analysis using an art-based methodological approach. Framed as composite character counterstories, survivors’ narratives revealed how survivors made sense of and gave meaning to their PrCA diagnosis, treatment, recovery, and survivorship. Specifically, their counterstories indicate that centering and honoring the unique and often taken-for-granted perspectives of older, rural, African American male PrCA survivors offered a deeper understanding of the multiple factors influencing their quality of life, as well as the sociostructural mechanisms impacting their survivorship care. Faith was examined as both a secular and sacred source of support that these men viewed as central to the acceptance of their diagnosis, treatment, recovery, and survivorship.

Cultural Adaptation of Evidence-Based Lifestyle Interventions for African American Men With Prostate Cancer: A Dyadic Approach.

Although a number of lifestyle interventions have been developed for cancer survivors, the extent to which they are effective for African American men with cancer is unclear. Given that African American men have the highest prostate cancer burden and the lack of proven interventions, this study developed a culturally-tailored lifestyle intervention for African American men with prostate cancer and their partners that aimed to improve healthy lifestyle behaviors (physical activity and healthy eating) and quality of life. The aim of the present study is to provide a detailed overview of the model-based process of intervention adaptation. Based on the IM Adapt approach (Highfield et al., 2015) and Typology of Adaptation (Davidson et al., 2013), the present study adapted existing, evidence-based interventions to address African American prostate cancer survivors’ and their partners’ potential unmet needs including anxiety/uncertainty about cancer progression, communication between partners, cultural sensitivity, and concordance/discordance of motivation and behaviors between partners. The intervention adaptation was a comprehensive and fluid process. To the best knowledge of the author, this is the first couple-based lifestyle intervention specifically developed for African American men with prostate cancer. The present study will be highly informative to future investigators by providing flexible and detailed information regarding lifestyle intervention adaptation for racial/ethnic minority men with prostate cancer and their partners.

Study protocol: a lifestyle intervention for African American and Hispanic prostate cancer survivors on active surveillance and their partners

BackgroundProstate cancer is the most commonly diagnosed cancer in both African American and Hispanic men. Active surveillance is a treatment option for low- or very low-risk prostate cancer survivors, and lifestyle interventions have been found to reduce the disease progression and improve the quality of life for both survivors and their partners. To date, no lifestyle interventions that specifically target African American or Hispanic men and their partners exist. This protocol describes a study that tests the feasibility of a randomized controlled trial, a lifestyle intervention developed to enhance healthy lifestyle and quality of life among African American and Hispanic men on active surveillance and their partners.MethodsA mixed-method study, including a two-arm randomized controlled trial (n = 30 dyads in the intervention arm and n = 10 dyads in the control arm) and in-depth interviews, will be conducted. Intervention arm participants will receive bi-weekly health coaching calls (a total of 12 calls based on Motivational Interviewing), as well as physical activity-specific (e.g., power point slides, print materials about physical activity, and activity trackers for self-monitoring) and nutrition-specific education (e.g., two nutrition counseling sessions from a registered dietitian, print materials about nutrition, and food intake recording for self-monitoring) over 6 months. All participants will be assessed at baseline, month 3, and month 6. Blood will be collected at baseline and month 6 from the prostate cancer survivors. Finally, in-depth interviews will be conducted with subsamples (up to n = 15 dyads in the intervention arm and up to n = 5 dyads in the control arm) at baseline and months 3 and 6 to conduct a process evaluation and further refine the intervention.DiscussionIf effective, the intervention may have a higher health impact compared with a typical lifestyle intervention targeting only survivors (or partners), as it improves both survivors’ (tertiary prevention) and partners’ health (primary prevention). Results from this study will provide important information regarding recruiting racial/ethnic minority cancer survivors and their partners. Lessons learned from this study will be used to apply for a large-scale grant to test the impact of the dyadic intervention in a fully powered sample.Trial registrationClinicalTrials.gov (NCT No. 03575832) registered on 3 July 2018.

African-American survivors of prostate cancer: a meta-synthesis of qualitative studies.

The purpose of this study is to systematically review the current literature on the post-treatment survivorship experiences of African-American men with prostate cancer by exploring qualitative studies to gain a deep understanding of their survivorship experiences. We searched five databases for studies published from 2008 to 2018. We identified ten relevant qualitative studies, conducted a meta-synthesis using Noblit and Hare's meta-ethnography approach, and evaluated their quality appraisal using the validated Critical Appraisal Skills Program. This review generated a total of four main themes and nine subthemes. The Four main themes included coping strategy, psychophysical impact, health system influence, and socioeconomic impact. Spirituality, healthy behaviors, supportive care of spouse/family/friends and non-communicating/reticent were subthemes identified in the coping strategy theme; physical well-being and sexuality and masculinity were subthemes in the psychophysical impact theme; healthcare provider interaction and treatment decision-making were subthemes identified in the health system influence theme, and health insurance status was the subtheme in the socioeconomic impact theme. Our findings reveal that the experiences of African-American prostate cancer survivors are complex and multidimensional. This review highlights the need for further studies with African-American prostate cancer survivors, precisely identify their needs and plan a culturally appropriate intervention to meet those needs.

Abstract B006: Developing Men Moving Forward, a lifestyle intervention for African American prostate cancer survivors

Abstract African American men are disproportionally affected by high prostate cancer incidence and mortality, and also comorbidities. African American prostate cancer survivors (AAPCS) report lower quality of life (QOL) relative to Non-Hispanic white (NHW) survivors. Many factors drive these differences, including weight status and health behaviors. The American Cancer Society has nutrition and physical activity guidelines to help cancer survivors achieve optimal health and QOL. AAPCS are more likely than NHW survivors to be non-adherent. Poor diet and physical inactivity often result in adverse body composition (high adiposity, low lean muscle) leading to hormonal changes, increased systemic inflammation and insulin resistance theorized to promote carcinogenesis and chronic diseases. Studies document positive results for lifestyle interventions focusing on NHW prostate cancer survivors, but inclusion of AAPCS is limited. We conducted an exploratory mixed methods study with AAPCS to inform the development and implementation of Men Moving Forward, a lifestyle intervention currently being tested in a randomized efficacy trial. Methods: 22 AAPCS completed a focus group and validated questionnaires on diet, physical activity patterns, QOL, and unmet needs related to lifestyle changes. Results: 75% of the participants were overweight/obese, 82% were considered insufficiently active, only 10% engaged in resistance training. Diets were high in saturated fat and sugar, low in fiber, fruits and vegetables. Compared to other prostate cancer survivors, AAPCS reported lower rankings on all QOL domains. Compared to the general population, men had worse physical functioning, pain interference, and sexual functioning. Qualitative data reflected high interest in a lifestyle intervention that would provide opportunities to build strength, learn about healthy eating, and bring men together to talk about relevant survivorship issues. Conclusions: Interventions are needed to address the lifestyle and QOL needs of AAPCS. The community-based Men Moving Forward trial will examine the feasibility and effects of a 4-month lifestyle program with 200 AAPCS. Outcomes include body composition (adiposity, lean muscle mass), behavior (diet, physical activity), strength, biomarkers of general health (lipids, blood pressure, glucose, and insulin) and prostate cancer recurrence (inflammation, insulin resistance, hormones) and QOL. This study is being conducted in partnership with the Milwaukee Public Recreation system which increases the potential for program sustainability. Citation Format: Jamal A. Jarrett, Lauren Matthews, Patricia Sheean, Kathryn Flynn, Kathryn Bylow, Deepak Kilari, Paula Papanek, Tina Johnson, Melinda Stolley. Developing Men Moving Forward, a lifestyle intervention for African American prostate cancer survivors [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B006.

An Exploration of Precancer and Post-Cancer Diagnosis and Health Communication Among African American Prostate Cancer Survivors and Their Families.

Prostate cancer is the second most common cancer among American men, with Black men at the highest risk for the disease. Few studies have been published on how communication between Black prostate cancer survivors and their family members affect health outcomes and subsequent health communication. The purpose of this study was to understand cancer and health communication among Black prostate cancer survivors and their families before and after disclosing their diagnosis. Through a mixed method design, 11 Black prostate cancer survivors participated from the Southeastern region of the United States, completed questionnaires, and took part in a focus group. The study utilized 4 focus groups of Black prostate cancer survivors ranging in age from 51 to 76 years. Descriptive statistics revealed 91% (n = 10) of participants indicated they could openly discuss health issues in their family and 82% (n = 9) indicated a female relative as the person responsible for teaching about health. An analysis of the transcripts revealed four themes utilizing thematic network: (a) communication over the life course of the prostate cancer survivor, (b) parents’ communication with family, (c) disclosing prostate cancer diagnosis, and (d) treatment options for prostate cancer. Results suggested the participants recognized the importance of discussing prostate cancer with their families to reduce fears and misconceptions about the disease. Through the exploration of cancer and health communication within Black families, solutions can be derived for increasing health behaviors and health knowledge among men.

Exploring health behaviors, quality of life, and support needs in African-American prostate cancer survivors: a pilot study to support future interventions.

Prostate cancer incidence and mortality rates are highest among African-American men. Comorbidity burden and quality of life (QOL) challenges are also high. Many factors drive these differences; health behaviors are important modifiable contributors. Studies document positive results for lifestyle interventions targeting NHW prostate cancer survivors, but inclusion of African-Americans is limited. We conducted an exploratory mixed-methods study with AAPCS to inform the development of a culturally relevant lifestyle intervention. Twenty-two AAPCS completed questionnaires and a discussion group on dietary and physical activity patterns, QOL, and unmet needs related to lifestyle changes. Seventy-five percent of the participants were overweight or obese, 82% had physical activity patterns considered insufficiently active and only 10% did resistance training at least twice weekly in accordance with current survivorship guidelines. Diets were high in saturated fat and sugar, low in fiber, fruit, and vegetable intake. PROMIS-29 scores indicated that AAPCS had worse physical functioning, pain interference, and sexual functioning, but less social isolation compared to the general population. Compared to other prostate cancer survivors, participants reported poorer status on all domains. Qualitative data highlighted barriers to healthy lifestyles including access, knowledge, and skills, as well as motivators including health benefits and building strength to feel more "manly." Participants shared high interest in programs to exercise, learn about affordable healthy eating, and bring survivors together to discuss survivorship issues. Lifestyle interventions targeting AAPCS are warranted. To increase impact of these efforts, consideration of environmental, cultural, and survivor contexts will be key.

Men Moving Forward: A Lifestyle Program for African-American Prostate Cancer Survivors

Men Moving Forward: A Lifestyle Program for African-American Prostate Cancer Survivors

‘I’m not a chance taker’: A mixed methods exploration of factors affecting prostate cancer treatment decision-making

ABSTRACT Objectives African American prostate cancer survivors experience post-treatment decisional regret more often than European Americans, which can lead to negative long-term effects on quality of life. A prominent driver of health-related decision-making is emotion, yet little work has examined the impact emotions may have on decisional regret. The goal of this study was to explore experiences, perceptions, and emotions of prostate cancer survivors in relation to their diagnostic and treatment decision-making processes, prostate cancer treatment, and outcomes. Additionally, we sought to identify factors that might explain differences in prostate cancer outcomes between African and European Americans. Design This mixed-methods study utilized a convergent parallel design, in which quantitative and qualitative data were collected simultaneously and then integrated to more robustly explain relationships between variables. Survivors were eligible for the study if they had been previously diagnosed with localized prostate cancer and were no more than six months post-treatment. The study was guided by the Risk as Feelings Model, which predicts the relationship between emotion and cognition in high-risk decision-making. Results No men experienced decisional regret following treatment, even if they experienced side effects. While all men reported being surprised about their prostate cancer diagnosis, strong negative emotions were more common among men under 65. Family support and spirituality appeared to mitigate negative emotions. Perceived authenticity of provider communication was the most influential mediator in men’s decision-making and positive perceptions of their outcomes. Conclusions To mitigate the impact emotional responses have on decision-making and post-treatment regret, providers should explore alternate therapies (e.g. counseling for men diagnosed with prostate cancer at a young age) and include family members in prostate cancer treatment discussions. Most importantly, providers should be aware of the importance of quality communication on men’s cognitive and emotional processes and their perceptions of treatment outcomes.