American Breast Cancer Survivors Research Articles

Abstract B144: Associations between experiences of discrimination and quality of life in a cohort of Black/African American breast cancer survivors

Abstract Introduction: Racism and discrimination have been associated with poorer mental and physical health, and decreased health-related quality of life (QoL) in the general population, however; there are limited studies examining the impact of discrimination in cancer survivors. We examined the relationship between experiences of discrimination and QoL in Black women diagnosed with breast cancer. Methods: Data were obtained from women enrolled in the Women’s Circle of Health Follow-up Study, a population-based cohort study of Black breast cancer survivors in New Jersey, enrolled within 10 months of diagnosis. Women included in these analyses were diagnosed between 2015-2019. Self-reported experiences of discrimination along with information on potential covariates and effect modifiers were collected during baseline in-person interviews. QoL was assessed at follow-up visits approximately 24 months post-diagnosis using a validated self-reported QoL of measure, the Functional Assessment of Cancer Therapy – Breast (FACT-B), which consists of 5 individual domains (emotional, functional, social/family, and physical wellbeing, as well as a disease specific domain for breast cancer). We examined the association of experiences of discrimination (none, low (<median 43%), high (≥ median 43%)) with continuous total QoL score using linear regression, adjusted for age at diagnosis, tumor stage, educational attainment, household income, smoking status, insurance, and body mass index. We also examined statistical interaction by neighborhood socioeconomic index (nSES), coping strategy (assessed using the Brief Resilient Coping Scale), and spirituality (assessed using the Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being (FACIT-Sp-12) scale) using cross-product terms with experiences of discrimination. Results: Of 220 study participants, 73% of participants reported experiencing any discrimination. In age adjusted models, women who reported the highest experiences of discrimination had lower QoL for overall FACT-B scores and the subscale scores (no discrimination, mean overall FACT-B:117.7, 95% confidence interval (CI): 112.4, 122.9; high discrimination, mean overall FACT-B: 106.8, 95% CI: 102.1, 111.5). Similar associations were observed in fully adjusted models, where women who reported the highest experiences of discrimination had lower QoL. For example, for women who reported no discrimination the mean overall FACT-B score was 114.7 (95% CI: 107.9, 121.4) and 100.8 (95% CI: 94.2, 107.5) for women who reported the highest level of discrimination. No evidence of statistically significant interaction was observed for nSES, spirituality, or coping strategy. Conclusions: In a population-based study of Black breast cancer survivors, experiences of discrimination were associated with poorer QoL, as measured by FACT-B. Citation Format: Nur Zeinomar, Marley M. Perlstein, Bo Qin, Hari S. Iyer, Jesse J. Plascak, Christine B. Ambrosone, Kitaw Demissie, Chi-Chen Hong, Elisa V. Bandera. Associations between experiences of discrimination and quality of life in a cohort of Black/African American breast 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 B144.

Illuminating Black, Hispanic, and Asian Women’s Breast Cancer-related Cognitive Impairment Symptom Experience: An Integrative Review

Background: Cancer-related cognitive impairment (CRCI) affects up to 75% of breast cancer survivors (BCSs). Biopsychosocial stressors contribute to CRCI. Thus, given the socioeconomic disparities and discrimination experienced by racial/ethnically minoritized women in the Unites States, it is important to understand how these women experience CRCI when diagnosed with breast cancer. Objective: To synthesize and evaluate published literature from 2000 to 2021 addressing the CRCI symptom experience throughout breast cancer survivorship for racial/ethnically minoritized women in the United States. Methods: Systematic search of PubMed, PsycINFO, CINAHL, Google Scholar, Embase, and Scopus and review following Whittemore and Knafl’s methodology. Results: Of 970 identified articles, 13 were included. Literature primarily focused on Black BCSs. Black and Hispanic BCSs were more likely than White BCSs to experience cognitive impairment pre- and postchemotherapy. Black BCSs consistently perceived greater CRCI than White BCSs contributing to overall symptom burden and challenging quality of life. Conclusions: Studies describing the CRCI experience of Black, Hispanic, and Asian American BCSs are limited with few focused on CRCI as the primary variable of interest, delineating minoritized women’s data from others’, or assessing via neurological batteries or brain imaging, pointing to gaps in this field. Implications for Practice: Health practitioners should assess Black, Hispanic, and Asian BCSs for CRCI throughout their cancer trajectory and intervene to reduce the contribution of co-occurring symptoms and institutional racism to CRCI. What is Foundational: This review identifies knowledge gaps and limitations in the existing body of evidence to support future research on CRCI among Black, Hispanic, and Asian BCSs.

Social constraints and fear of recurrence among Chinese American breast cancer survivors: An exploration of psychosocial mediators.

Fear of cancer recurrence (FCR) is commonly experienced among Caucasian and Chinese American breast cancer survivors (BCS). Emerging studies have suggested that Caucasian BCS' communication with family members contributes to their FCR. However, whether such findings apply to Chinese American BCS has yet to be explored. This study examined the association between social constraints (i.e., perceived barriers from significant others inhibiting cancer-related disclosure) and FCR among 136 Chinese American BCS, plus proposed that self-stigma (i.e., internalized feelings of shame about having cancer), bodily pain, and ambivalence over emotional expression (AEE; conflict between the desire to express emotions and the fear of its consequences) would mediate the association. Participants recruited through cancer associations in the USA were invited to complete a cross-sectional survey measuring their socio-demographic/cancer-related variables and the above-mentioned psychological variables. Higher levels of social constraints, AEE, self-stigma, and bodily pain were associated with higher FCR (rs ranged from 0.27 to 0.40, ps<0.01). After controlling for covariates, path analysis results supported the proposed mediation model with satisfactory fit indices (χ2 (7)=2.08, Comparative Fit index=1.00, Tucker Lewis Index=1.08, Root Mean Square Error of Approximation=0.00). Specifically, social constraints were associated with higher FCR through increased self-stigma (β=0.10, 95% confidence interval [CI]=0.02, 0.17), AEE (β=0.14, 95% CI=0.01, 0.27), and bodily pain (β=0.09, 95% CI=0.02, 0.17), indicating significant mediation effects. After considering the mediators, the direct effect from social constraints to FCR was no longer significant. The association between social constraints and higher FCR could be mediated by increased self-stigma, AEE, and bodily pain among Chinese American BCS. Interventions targeting to address those variables may reduce FCR among those BCS.

Abstract PR06: Different places, same problems: Tales of Deep South and Midwestern young African American breast cancer survivorship care

Abstract Background Breast cancer survival rates continue to improve, yet disparities in breast cancer survivorship outcomes (e.g., higher mortality and poorer quality of life) exist. The paucity of culturally sensitive interventions for women from underrepresented racial-ethnic backgrounds only further exacerbates disparities in survivorship care. Young women, less than age 45, who are African American (AA) breast cancer survivors (BCS) experience disparate survivorship outcomes and are often understudied. Without representation, existing frameworks for survivorship care and their delivery may not meet the needs of this growing population of survivors. The purpose of this paper is to describe young AA breast cancer survivorship care in the Deep South (Alabama, Louisiana, and Mississippi) and Midwestern (Ohio) regions. Methods Semi-structured interviews were conducted with young AA BCS and healthcare providers. Fifteen young AA BCS living in the Deep South and six young AA BCS living in the Midwest responded to questions about their lived experiences of breast cancer survivorship including changes in quality of life, adverse effects of diagnosis and treatment, and experiences with/ preferences for survivorship care delivery. Six Midwestern healthcare providers responded to questions about their experiences caring for young AA BCS. Interviews were transcribed verbatim and placed in NVivo 12 software for thematic analysis within and between data from young AA BCS and healthcare providers. Two-independent coders analyzed then iteratively compared codes. Inter-coder agreement was met in determination of the final coding scheme. Results Themes emerged within young AA BCS (mean age = 38 years; years of survivorship = 3 years): management of survivorship along with “everyday” age- and socioculturally-related challenges, communication of survivorship care lacks representation, and care coordination to address survivorship needs is not always ideal. Themes within healthcare provider interviews were: young AA BCS experience changes throughout survivorship that challenge their well-being, care individualization is provided but may not involve cultural humility, and healthcare providers need more training on supportive care options. The cross-cutting theme across all groups indicates that young AA BCS have unmet needs that should be addressed with targeted interventions as they navigate survivorship care. Conclusion Deep South and Midwestern young AA BCS report similar experiences of life after a breast cancer diagnosis, which are largely congruent with healthcare providers’ observations. Despite this concordance between young AA BCS and healthcare providers, survivorship care is often lacking supportive interventions that are targeted to manage the needs of young AA BCS. More work is needed to define best practices for survivorship care that operationalizes cultural humility to promote equitable survivorship outcomes among young AA BCS. Citation Format: Timiya S. Nolan, Sarah Addison, Barbara Andersen, Maryam Lustberg. Different places, same problems: Tales of Deep South and Midwestern young African American breast cancer survivorship care [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PR06.

Abstract PO-062: An exploration of patient navigation on various outcomes of African American breast cancer survivors

Abstract Introduction: Patient navigation (PN) programs are used throughout the cancer continuum to address barriers faced by African American women and other vulnerable populations. Research has suggested PN can be effective in improving screening and diagnostic care uptake; however, less research has examined its effects post-diagnosis. Although effective for its short-term outcomes (e.g., receipt of screening; care decisions; stage at diagnosis), PN may be limited in its long-term effects during survivorship (e.g., quality of life). Therefore, the objective of this study was to assess the effect of PN on four outcomes of African American breast cancer survivors (BCS): shared decision making (SDM) when undergoing diagnostic care; receipt of an early stage diagnosis; and, current quality of life. Methods: This study was a secondary analysis of the OASIS (Offering African American Survivors Increased Support) study, which followed African American BCS who obtained care at a Chicago-based hospital during or after the Patient Navigation in Medically Underserved Areas (PNMUA) study. Navigated women experienced largely phone- based navigation through screening, diagnostic care, and treatment. Eligibility criteria included: African American race; 18+ years old; receipt of breast healthcare in the study hospital during or after PN trial was implemented; and, receipt of a breast cancer diagnosis. We conducted multivariate logistic (SDM, early stage diagnosis) and linear regression models (quality of life measured with current mental and physical well-being using SF-12 scale) that were adjusted by age, socioeconomic status (income, education, insurance status) and year of diagnosis. Results: The average age of our sample was 66.28 (SD = 9.54). Approximately 26% of the sample had ≤ 12 years of education; 35% were married; 49% had an annual household income of ≤$50,000; and 64% had private insurance. Navigated women had greater odds of reporting shared decision making with their providers during diagnostic visits, non-nav: 26% vs. nav: 44%, OR = 3.48, 95%CI [1.08, 11.15], p = 0.04. There were no differences, however, between navigated and non-navigated women regarding odds of an early stage diagnosis and current quality of life (ps = 0.62-0.94). Conclusion: Navigated women’s greater propensity to engage in SDM compared with non-navigated women aligns with past research and suggests PN is effective for changing patients’ behaviors when actively engaged with navigators. However, we did not find that PN was associated with stage at diagnosis. Further, the absence of an association on current mental and physical well-being suggests that PN may have limited long-term effects. Limitations include use of self-report data and a small, convenience-based sample. Further research should assess how patient navigation can be adapted to have more sustained effects in the long term. Citation Format: Agnieszka M. Mynarska, Shaila M. Strayhorn, Tynetta Hill-Muhammad, Nyahne Q. Bergeron, Desmona C. Strahan, Stephanie L. Jara, Nancy Rayas, Anita Rong, Misael Villegas, Dana Villines, Karriem S. Watson, Aditya Khanna, Yamilé Molina. An exploration of patient navigation on various outcomes of African American breast cancer survivors [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-062.

Abstract B102: Body mass index, physical activity, and breast cancer subtype in European American, African American, and Sea Island breast cancer survivors

Abstract BACKGROUND: Breast cancer (BCa) is the second leading cause of cancer death among women in the United States and large racial/ethnic disparities are evident. Higher levels of body mass index (BMI), lower rates of physical activity (PA), and hormone receptor-negative BCa sub-type are associated with poorer BCa treatment outcomes. PURPOSE: To evaluate the prevalence of high BMI, low PA level, and BCa sub-type among three BCa survivor groups: European Americans (EAs), African Americans without Sea Island ancestry (AAs), and AAs with SI ancestry (SIs). METHODS: A state central cancer registry database was used to identify 137 (42 EAs, 66 AAs, and 29 SIs) women diagnosed with BCa between May 2012 and October 2013, who were within 6-21 months of diagnosis at the time of the study. RESULTS: Regardless of racial/ethnic group, most participants (82%) were overweight/obese (p=0.46). BMI was highest in younger AAs (p=0.02). The CDC PA guidelines (≥150 minutes/week) were met by only 28% of participants. In terms of BCa sub-type, among the 86 participants who provided saliva samples, the frequency of triple-negative BCa and estrogen-receptor-negative BCa was lower in EAs and SIs than in AAs (p&amp;lt; 0.05). CONCLUSIONS: This is the first study to identify differences in obesity rates, PA rates, and BCa sub-type in EAs, AAs, and SIs. Future research could explore dietary and PA behavioral interventions to reduce BCa recurrence risk, and could evaluate potential differential immune responses linked to the frequency of triple-negative BCa in AAs. Citation Format: Marvella E Ford, Colleen E Bauza, Victoria J Findlay, David P Turner, Latecia M Abraham-Hilaire, Leslie A Moore, Gayenell Magwood, Anthony J Alberg, Kadeidre Gaymon, Kendrea D Knight, Ebony Hilton, Angela M Malek, Rita M Kramer, Lindsay L Peterson, Susan Bolick, Deborah Hurley, Catishia Mosley, Tonya R Hazelton, Dana R Burshell, Lourdes Nogueira, Franshawn Mack, Erika T Brown, Judith D Salley, Keith E Whitfield, Joan E Cunningham. Body mass index, physical activity, and breast cancer subtype in European American, African American, and Sea Island breast 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 B102.

Abstract D058: Truth Talking Tour: Women’s sexuality after cancer

Abstract Background Due in part to advances in diagnosis, treatment, and early detection the number of cancer survivors in the United States is growing with an estimated 16.9 million cancer survivors and projected to increase to 21.7 million by 2029. Among the current survivor population, 8.8 million are female. Disparities in survivorship care exist, including poorer health outcomes related to sexual health impairment and stress from financial toxicity of cancer. A larger proportion of African American (AA) breast and colorectal cancer survivors experience issues related to lack of resources and information related to sexuality after cancer. The impact of breast cancer on sexuality among women is often examined, yet limited research has been conducted with AA survivors of other cancers such as colorectal cancer. Cultural considerations such as religion/spirituality and body image should be included in interventions addressing psychosocial needs of female AA cancer survivors. The Truth Talking Tour: Women’s Sexuality after Cancer was created by community stakeholders to give women a safe space to talk about sexuality and cancer. Methods The University of Illinois Patient Brigade convened a cohort of patient-centered outcomes research (PCOR) “ready” advocates to engage in desired training, guide center leadership activities and inform research tools/dissemination strategies that can inform PCOR. The Truth Talking Tour was developed by Patient Brigade cancer advocacy leaders for women in any stage of their cancer survivorship and included active participation from community members and health care providers. Results Thirty-nine women attended the workshop held in Spring 2019 at a community location on the Southside of Chicago. All survey respondents were AA, age range from 40 to 68, age at cancer diagnosis ranged from 25 to 63. Pre/post survey was conducted to explore impact of the convening on knowledge, priorities and needs of AA female cancer survivors. Results demonstrated that AA female cancer survivors see convening with other survivors and clinician experts as important and missing from current efforts. Results also showed that women with a cancer diagnosis are physically and psychologically challenged in their fight against cancer and face challenges with sexual identities currently unmet by survivorship care plans. Priority areas that emerged included lack of resources, lack of knowledge of providers, and lack of culturally tailored interventions for AA female cancer survivors. Conclusions The Truth Talking Tour survey data demonstrated additional research is needed to assess the needs of AA female cancer survivors impacted by lack of data on sexuality after cancer. Feasibility of the convening demonstrated that community-academic partnerships rooted in dialogue and data may be a great way to inform future interventions to improve sexuality after cancer among AA women. The community stakeholders leading the Truth Talking Tour have planned additional tours in the south, west and east coast. Citation Format: Candace Henley, Joanne Glenn, Vida Henderson, Jacqueline Kanoon, Melissa Simon, Susan Hong, Karriem S Watson. Truth Talking Tour: Women’s sexuality after cancer [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 D058.

Improve, a community-based exercise intervention versus support group to improve functional and health outcomes among older African American and non-hispanic white breast cancer survivors from diverse socioeconomic backgrounds: Recruitment strategies and baseline characteristics.

e24052 Background: We conducted an exercise study to IMPROVE health outcomes in older breast cancer survivors (BCS) from diverse racial and socioeconomic backgrounds. Here, we report cohort recruitment strategies and baseline characteristics. Methods: ‘IMPROVE’ is a randomized trial, designed to evaluate a group-based exercise intervention compared to support group. Participants were ≥ 65 years, had stage I-III breast cancer and within five years of treatment completion. Enrollment target was 220 participants, 25% in each of four strata defined by race (AA versus Non-Hispanic Whites [NHW]) and SES (low vs. high). Participants were recruited through hospital-based tumor registries, the state tumor registry or direct referrals. Results: Between October 2016 and November 2019, 7487 patients were screened, 4790 were potentially eligible, 230 were consented and 213 randomized into the study. The Eligible-to-Randomization rates were 4.4% overall, and 84%, 8%, and 2% for recruitment utilizing direct referrals, hospital and state registries, respectively. Median age of the randomized cohort was 70 years (range: 65-88 years) and included 25% AA/Low SES, 20% AA/High SES, 19% NHW/Low SES and 36% NHW/High SES Older BCS. Compared with registry-eligible patients, directly referred patients were more likely to be AA vs. NHW (41% vs. 19%, p = 0.003) and to accept study participation (88% vs. 16%, p &lt; 0.0001). Conclusions: Direct referrals resulted in the highest recruitment yield and was the most effective strategy for recruiting AA patients. Behavioral intervention studies seeking to target older BCS from racial minority and SES disadvantaged backgrounds should focus on strategies that foster direct referrals to study participation. Clinical trial information: NCT02763228 .

Expressive writing intervention for posttraumatic stress disorder among Chinese American breast cancer survivors: the moderating role of social constraints.

Posttraumatic stress disorder (PTSD) is a significant condition among breast cancer survivors (BCSs). However, few intervention studies for cancer-related PTSD were conducted among Asian cancer survivors. We evaluated a culturally sensitive expressive writing intervention, which combined cognitive reappraisal and emotional disclosure, in reducing PTSD among Chinese American BCSs. We also tested social constraints (defined as social conditions when individuals feel misunderstood or alienated when they desire to disclose their thoughts and feelings) as a moderator. Chinese American BCSs (n = 136) were randomly assigned to three groups with assigned writing topics for 3weeks: a self-regulation group, which wrote about the deepest feelings related to cancer in week 1, cognitive reappraisal about stress and coping in week 2, and benefit finding in week 3; an enhanced self-regulation group, with the same instructions, except weeks 1 and 2 were reversed; and a cancer-fact group, which wrote about cancer experiences objectively for 3weeks. PTSD symptoms were measured at baseline and 1-, 3-, and 6-month follow-ups. Social constraints were measured at baseline. Both the self-regulation and enhanced self-regulation groups showed reduced PTSD symptoms compared to the cancer-fact group. For reexperiencing and hyperarousal symptoms, expressive writing was more effective for BCSs who experienced high vs. low levels of social constraints; the opposite was found for avoidance symptoms. Findings demonstrated the effectiveness of expressive writing intervention in reducing PTSD for this minority population, and that the moderating role of survivors' social network varies among different PTSD symptom clusters. ClinicalTrials.gov Identifier: NCT02946619.

Changing Health Behaviors To Manage Chronic Conditions in Community-Dwelling African American Breast-Cancer Survivors (AABCS)

Abstract Date Presented 04/05/19 African American women diagnosed with breast cancer where this study was completed have significantly worse outcomes than Caucasian women. The purpose of this study was to prevent and manage chronic disease in AABCS. Partnering with the community to deliver interdisciplinary group intervention had a significant impact on changing health behaviors and risk factors to prevent and manage chronic conditions and reduce health disparities among AABCS. Primary Author and Speaker: Julie Hunley Contributing Authors: Phyllis Holder, Yvonne Greer

Self-perceived burden mediates the relationship between self-stigma and quality of life among Chinese American breast cancer survivors.

Cancer-related self-stigma (the internalized sense of shame about having cancer) has been found to associate with poorer quality of life (QoL) among cancer survivors. However, culturally salient illness beliefs (e.g., cancer is contagious; cancer is a result of karma; and cancer brings shame to the family) may make Chinese cancer survivors vulnerable to self-stigmatization. This study examined the association between self-stigma and QoL among Chinese American breast cancer survivors (BCS). To understand the potential mechanism, the mediating role of self-perceived burden to caregivers between self-stigma and QoL was also examined. Chinese American BCS (n = 136) were recruited through community-based cancer associations. Participants' self-stigma, self-perceived burden, and QoL were measured in a questionnaire package. Structural equation modeling results supported the proposed mediation model in predicting physical QoL (χ2(100) = 123.041, CFI = 0.982, TLI = 0.975, RMSEA = 0.041) and emotional QoL (χ2(84) = 137.277, CFI = 0.958, TLI = 0.940, RMSEA = 0.069), with satisfactory model fit indices. Both the indirect effects from self-stigma to QoL via self-perceived burden (physical: β = - 0.13; 95% CI = - 0.22, - 0.07 and emotional: β = - 0.11; 95% CI = - 0.22, - 0.04) and the direct effects from self-stigma to poorer QoL were significant (physical: β = - 0.22; 95% CI = -0.34, -0.10 and emotional: β = - 0.39; 95% CI = - 0.54, - 0.23), suggesting a partial mediation effect of self-perceived burden between self-stigma and QoL. Self-stigma could reduce physical and emotional QoL through increasing self-perceived burden. Interventions aiming to reduce Chinese American BCS' self-stigma and perceptions of burdensomeness may facilitate improvement in QoL, which in turn promotes better cancer survivorship.

Promoting Team-Based Exercise Among African American Breast Cancer Survivors.

Physical activity benefits the health and well-being of breast cancer survivors (BCS). Yet, many African American survivors do not routinely exercise and have increased risk of poor outcomes. The purpose of this mixed-method study was to identify motivational factors compelling African American BCS to participate in a 14-week team walking program and to intend to continue exercise after the intervention concluded. Focus groups were held with participants ( n = 12) before and after training. Content analysis discovered themes before the intervention: Not wanting to go at it alone, exercise not a life or treatment priority, cancer treatment affected activity, advocates to exercise, and can exercise really help? Four themes postintervention themes included: In the same boat, changed mind-set, improved weight and activity, and overcoming barriers. Physical data verified improvements. Results suggest that a team-based exercise training program may assist in overcoming a sedentary behavior tendency and subsequently improve health among survivors.

Cardiovascular risk and communication among early stage breast cancer survivors

ObjectiveAfrican American (AA) women have disproportionately high rates of cardiovascular (CV) risk factors that, coupled with potentially cardiotoxic breast cancer (BC) therapies, place them at risk of adverse CV outcomes. The purpose of this study was to assess CV risk factors among white and AA BC survivors and perceptions of patient-provider CV-related communication and post-treatment information needs. MethodsEarly-stage, English-speaking BC survivors were recruited through community-based survivorship organizations/clinics in New Jersey. Qualitative, semi-structured interviews and a brief survey of socio-demographics and comorbidities were conducted. ResultsBC survivors reported high rates of CV risk factors. Most reported their health as good/excellent despite their cancer history and CV risk profile. Approximately half of overweight/obese BC survivors reported no weight-related conversation with their health care team and, among those who reported discussion, 36% indicated it was self-initiated and dismissed. More than half of BC survivors’ reported a desire for lifestyle-related information and guidance. ConclusionBC survivors may not understand how their separate, yet cumulative, health issues can impact their CV risk. Practice implicationsPatient-provider communication on behavioral risk factor modification and CV risk is needed, particularly among at-risk subgroups such as AA and obese BC survivors, to improve BC and CV outcomes.

Abstract IA17: How does Cultural Equivalence Impact Asian American Cancer Survivors?

Abstract Introduction Over 1,500 studies are in Medline today on the psychosocial impact and quality of life (QOL) of breast cancer (BC) survivors. Only a small percentage of these studies have been conducted with women of color, yet most of these studies appear to use the same psycho-social theories for intervention and outcomes, developed and validated with non-Hispanic white women. This assumed universality of (EA) cultural beliefs and practices undermines the importance of cultural differences in cancer research. Often standardized questionnaires are tested for reliability in diverse groups with an α score, but many validated scales have rarely been tested for cross-cultural equivalence of concepts and metrics in diverse populations. The absence of research exploring and testing the cross cultural equivalence of EA developed concepts, such as, self-integrity and well-being of BC survivors thwarts our ability to effectively address the QOL of diverse populations, and hinders our ability to promote health equity. Therefore, this presentation will first briefly present a consensus definition of culture, second, discuss the general lack of attention to cross-cultural equivalence of concepts and measures used in cancer survivor research, last, present an example of a mixed paradigm and mixed method study designed to identify and test such potential cultural differences in among Asian American (AA) breast cancer (BC) survivors. AA BC survivors are reported to suffer significant emotional and social problems, but do not avail themselves of existing and available EA based services, even if they have been in the U.S. for multiple generations and/or are proficient in English. Yet, few studies have been conducted to identify why AA BC survivors do not use existing support services and how to better design high-quality programs that provide that needed support. Breast cancer support groups are designed to increase self-integrity, and well-being, but the cross-cultural equivalence of concepts of self-integrity and well-being have not been tested in breast cancer survivorship. Study Design This mixed paradigm and mixed method study was developed to 1) test the cultural equivalence and validity of standard measures of distress and well-being in order to investigate such potential cultural differences in the BC survivorship experience among three groups of Asian American women in three different geographic areas, 2) identify potential cultural differences in their perceptions of the cancer experience and degree of satisfaction with their strategies to manage the experience by providing context and meaning to our deductive findings, and 3) test if the cultural specific constructs and measures provide greater explanatory power to the QOL of the AA women than the set of standardized tools currently used. We conducted, in depth ethnographic interviews with 35 key informants, 118 BC survivors and 57 family members. We also surveyed 450 Chinese-, Japanese-, Vietnamese- and European American BC survivors. Implications for Health Disparities Research in Cancer The findings from this study will demonstrate how mixed-paradigms and methods are essential to develop a culturally informed understanding of the lives of women with cancer from diverse cultural backgrounds. Such study designs are crucial to inform the science and practice of BC survivorship in AA communities by mobilizing more culturally appropriate assessment tools built on culturally valid concepts and constructs. Such tools may aid in designing culturally grounded and congruent programs that more adequately meet the needs of those in underrepresented communities, and, thereby, improve the QOL of BC survivors from diverse populations as well as facilitate the elimination of health disparities. Citation Format: Marjorie Kagawa-Singer. How does Cultural Equivalence Impact Asian American Cancer Survivors? [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr IA17.

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

ABSTRACTObjective: Public health agencies encourage breast cancer survivors (BCSs) to follow their physical activity guidelines (PAGs). However, adherence to these guidelines is low. African American (AA) BCSs are more often overweight or obese and less likely than women of other races to report adherence to physical activity recommendations. This study examined socioeconomic, clinical, and psychosocial correlates with meeting PAGs.Design: AA women diagnosed and treated for breast cancer and participating in a breast cancer support group (N = 193) completed a lifestyle assessment tool capturing demographic characteristics; breast cancer diagnosis and treatment history; health-related quality of life; weight history, including body mass index and post-diagnosis weight gain; and physical activity. Logistic regressions were used to determine if these covariates were associated with meeting [>8.3 metabolic equivalent task (MET) hr/wk]; partially meeting (4.15–8.3 MET hr/wk); or not meeting (<4.15 MET hr/wk) PAGs.Results: Only 54% of AA BCSs reported meeting current PAGs. Participants reporting weight gain of ≤5 lbs post-diagnosis, and those who received surgical treatment for breast cancer were more likely to complete at least 8.3 MET hr/wk. Better physical functioning and lesser pain intensity were associated with meeting PAGs.Conclusion: Several factors influence physical activity behaviors and are likely to be important in developing effective interventions to assist AA survivors manage their weight. It is essential that providers and breast cancer support groups that assist survivors to remain physically active and to manage their weight should be aware of these factors. These findings may help generate hypotheses for future research to undergird efforts to increase physical activity among African American BCSs.

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.

Coping with breast cancer: Reflections from Chinese American, Korean American, and Mexican American women.

The present study identified and compared the coping strategies of Chinese American, Korean American, and Mexican American breast cancer survivors (BCS). Six focus groups were conducted with Chinese American (n = 21), Korean American (n = 11), and Mexican American (n = 9) BCS. Interviews were audio-recorded, transcribed, and translated for thematic content analysis of coping experiences and strategies. Women reported the use of 8 coping strategies (religious/spiritual, benefit finding, fatalism, optimism, fighting spirit, information seeking, denial, and self-distraction). Among Chinese American BCS, benefit finding was the most referenced coping strategy, whereas religious/spiritual coping was most frequently reported among Korean American and Mexican American BCS. Denial and self-distraction were the least cited strategies. Survivors draw upon new found inner strength to successfully integrate their cancer experience into their lives. Coping models must consider the diversity of cancer survivors and the variability in coping strategies among cultural ethnic minority BCS.

Abstract B14: Dietary patterns in Puerto Rican and Mexican-American breast cancer survivors: A pilot study

Abstract Breast cancer survivors comprise the largest group of cancer survivors in the US, with an estimated 2.8 million survivors. Breast cancer is the leading cause of cancer death among Hispanics, with greater mortality rates compared to non-Hispanic whites. Certain dietary factors have been associated with a decreased or increased risk of breast cancer recurrence; therefore, it is important to characterize the dietary patterns of the target population to develop effective dietary intervention prevention strategies. Objective: to examine the dietary patterns in two groups of Hispanic breast cancer survivors. Methods: Participants included Mexican American (MA) and Puerto Rican (PR) female breast cancer survivors, who participated in Project VIVA!, a randomized controlled trial to pilot test the effectiveness and feasibility of a 16-week culturally tailored exercise intervention. At the end of the trial, participants completed a culturally adapted and validated food frequency questionnaire. Daily dietary intake values were standardized for total energy (per 1,000 kcal) and compared to US Dietary Guidelines (1 cup/d fruits, 1 cup/d vegetables, ½ cup/wk beans, 2 cups/wk starchy vegetables, 2 cups/d dairy products, 50% of grains as whole grains, 12 g/d of added fat). Results: A total of 23 MA and 22 PR completed the FFQ. Mean age was 49±10 y in MA and 59±9 y in PR (p&amp;lt;0.05). Most women were overweight or obese (65% in MA and 91% in PR; p&amp;gt;0.05). Daily intake of fruits/100% fruit juices was 2.8 cups in MA and 1.2 cups in PR daily (p&amp;gt;0.05), which is higher than guidelines. Vegetable intake was higher in MA (2.6 cups) compared to PR (0.8 cups; p&amp;lt;0.05), and only MA met the guidelines. Intake of starchy vegetables (e.g., potatoes) was higher in PR than MA (0.6 vs. 0.4 cups, respectively; p&amp;lt;0.001) and it was higher than guidelines. Intake of beans was similar between groups (0.46 cups in MA and 0.44 cups in PR). Intake of whole grains was higher in MA (0.54 oz) than in PR (0.23 oz) and dairy products intake was higher in PR (1.2 cups) than in MA (0.7 cups; p&amp;lt;0.001), but both were below the guidelines. Estimated contribution of calories from solid fats and added sugars (SoFAs) was 30% in PR and 32% in MA, which is higher than guidelines (14%). Added sugar was higher in PR (9.2 tsp) compared to MA (5.2 tsp; p&amp;lt;0.01). Conclusion: PR met the recommendations for fruits, starchy vegetables, and beans while MA met the recommendations for fruits, vegetables, starchy vegetables and beans. Both groups had intakes below the recommendations for whole grains and dairy products but above for SoFAS. MA and PR female breast cancer survivors have different dietary patterns, but could benefit from similar targeted interventions to reduce consumption of SoFAS, and to increase the proportion of whole grains consumed. Larger studies are needed to confirm these results but these preliminary results could help design interventions specifically targeted to each group to improve diet quality, which could potentially prevent cancer recurrence in this group. This project was partially supported by the following NIH awards U54 CA 96297; P30 CA016672; NCR (2G12-RR003051), NIMHHD (8G12-MD007600), and the Center for Energy Balance in Cancer Prevention and Survivorship, Duncan Family Institute. Citation Format: Cristina Palacios, Carrie R. Daniel, Maribel Tirado-Gómez, Velda Gonzalez-Mercado, Liliana Liliana, Jose Lozada, Daniel C. Hughes, Sara Strom, Karen Basen-Engquist. Dietary patterns in Puerto Rican and Mexican-American breast cancer survivors: A pilot study. [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 B14.

Abstract B69: Mediated effects of social cognitive theory variables on physical activity in Hispanic breast cancer survivors

Abstract Purpose: The vast majority of long-term cancer survivors are insufficiently active, and breast cancer survivors are more likely to report being physically inactive and sedentary than prostate or colorectal cancer survivors. Social cognitive theory (SCT) has been used to understand physical activity adoption and maintenance in the general adult population and among breast cancer survivors, but no study to date has explored SCT influences on physical activity exclusively among Hispanic cancer survivors, who are at greater risk of not meeting leisure-time physical activity guidelines and disproportionately suffer from comorbidities, such as cardiovascular disease and diabetes. Thus, the purpose of this study was to determine the effect of a culturally-tailored exercise intervention on physical activity and sedentary behavior in Hispanic breast cancer survivors and to determine whether intervention effects were mediated by changes in SCT variables, including exercise self-efficacy, barriers self-efficacy, social modeling and social support. Method: Project VIVA! was a 16-week randomized controlled trial to test the effectiveness and feasibility of a culturally tailored exercise intervention for Mexican American and Puerto Rican breast cancer survivors in Houston, Texas and San Juan, Puerto Rico. Eligible women (N=93) who self-identified as Mexican American residing in Houston, TX or Puerto-Rican residing in San Juan, PR were randomized to a 16-week culturally-tailored (n=30) or standard (n=31) exercise intervention or a wait-list control (n=32) group. Women completed questionnaires on social cognitive influences, physical activity and sedentary behavior and completed a 7-day accelerometer protocol at baseline and post-intervention. Paired sample t-tests were used to assess changes in physical activity, sedentary behavior, and SCT variables over time across groups, and repeated measures analyses were used to assess changes over time by group. Mediation analyses were used to determine whether intervention effects on physical activity and sedentary behavior were mediated by changes in exercise self-efficacy, barriers self-efficacy, social modeling and social support after controlling for age and education. Results: On average, participants were middle-aged (M age=55.5 years, SD=9.9) and most (52.1%) had completed some college or more. At baseline, women reported doing roughly 11.6 minutes of physical activity and walking per day and were sedentary over 6 hours per day. Across groups, women reported increases in vigorous (t=2.7, p=.008), moderate (t=2.6, p=.011) and total (t=2.7, p=.008) physical activity and exercise self-efficacy (t=3.2, p=.002) from baseline to post-intervention. There were no significant differences in changes in physical activity or SCT variables over time by group. Although the intervention did not have a direct effect on physical activity or sedentary behavior, it had an indirect effect on sedentary behavior. Increases in social modeling significantly mediated the association between intervention group assignment and decreases in sedentary behavior (Indirect effect=4.5, 95% CI: 0.4, 12.4) among Hispanic breast cancer survivors, controlling for age and education. Conclusions: Results suggest that Hispanic survivors may benefit the most from exercise interventions that focus on increasing social norms for physical activity and social modeling from friends and family members. Future interventions should include friends and family members of Hispanic breast cancer survivors to support them to be active and less sedentary and to be physically active with them. Further research is needed to explore additional mediators of change in physical activity and sedentary behavior in Hispanic breast cancer survivors in an effort to reduce health disparities and decrease risk of cancer recurrence and comorbidities. Citation Format: Scherezade K. Mama, Lorna H. McNeill, Alexis Ortiz, Maribel Tirado-Gomez, Cristina Palacios, Daniel C. Hughes, Karen Basen-Engquist. Mediated effects of social cognitive theory variables on physical activity in Hispanic 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 B69.

1704 Lymphedema signs, symptoms, self-reported diagnosis and referral to physical therapy among African American and low-income breast cancer survivors

1704 Lymphedema signs, symptoms, self-reported diagnosis and referral to physical therapy among African American and low-income breast cancer survivors