American Cancer Society Study Research Articles

Afraid and tired: A longitudinal study of the relationship between cancer‐related fatigue and fear of cancer recurrence in long‐term cancer survivors

AbstractObjectiveCancer‐related fatigue (CRF) and fear of cancer recurrence (FCR) are two common concerns experienced by cancer survivors. However, the relationship between these two concerns is poorly understood, and whether CRF and FCR influence each other over time is unclear.MethodsData were from a national, prospective, longitudinal study, the American Cancer Society's Study of Cancer Survivors‐I (SCS‐I). Surveys were completed by 1395 survivors of 10 different cancer types at three time‐points, including assessment 1.3 years (T1), 2.2 years (T2) and 8.8 years (T3) following their cancer diagnosis. CRF was assessed using the fatigue‐inertia subscale of the Profile of Mood States, and FCR by the FCR subscale of the Cancer Problems in Living Scale. Multiple group random intercepts cross‐lagged panel models investigated prospective associations between CRF and FCR.ResultsFor younger participants (at or below median age of 55 years, n = 697), CRF at T1 and T2 marginally and significantly predicted FCR at T2 and T3, respectively, but no lagged effects of FCR on subsequent CRF were observed. Cross‐lagged effects were not observed for survivors over 55 years of age.ConclusionBoth CRF and FCR are debilitating side effects of cancer and its treatments. Given that CRF may be predictive of FCR, it possible that early detection and intervention for CRF could contribute to lowering FCR severity.

Assessing the impact of religious resources and struggle on well-being: a report from the American Cancer Society's Study of Cancer Survivors-I.

The current study examined the relationships between religious resources (i.e., certainty of belief in God and attendance at religious services), religious struggle (e.g., belief that cancer is evidence of God's punishment or abandonment), and physical and mental health-related quality of life (HRQoL), including fear of cancer recurrence (FCR), in a large, geographically and clinically diverse sample of long-term survivors of cancer. Participants were 2021 9-year survivors of cancer from the American Cancer Society's Study of Cancer Survivors - I. Religious resources included belief in God and attendance at religious services. Items from the Brief RCOPE and the PROMIS Psychosocial Impact of Illness were combined to assess religious struggle. Survivors also completed the Fear of Cancer Recurrence Inventory, SF-12, and Meaning and Peace subscales of the FACIT-Sp. Regression models were used to predict HRQoL and FCR from religious resources and struggle. In multivariable models, certain belief in God predicted greater mental HRQoL (B = 1.99, p < .01), and attendance at religious services was associated with greater FCR (B = .80, p < .05) as well as better mental (B = .34, p < .01) and physical (B = .29, p < .05) HRQoL. In addition, religious struggle predicted greater FCR (B = 1.32, p < .001) and poorer mental (B = - .59, p < .001) and physical (B = - .29, p < .001) HRQoL. Many of these relationships were mediated through Meaning. With the exception of FCR, religious resources predicted better HRQoL outcomes in these long-term survivors of cancer. Conversely, religious struggle consistently predicted poorer HRQoL, including greater FCR. Given the documented importance of its role in coping with the cancer experience, religion/spirituality should be a consideration in every survivorship care plan. Multidisciplinary assessment and support of religious resources and identification of and referral for religious struggle are needed to ensure the well-being of most long-term survivors of cancer.

Reflecting on Merck’s I-O biomarker development journey

Eric H Rubin has focused on cancer drug development for over 25 years, initially as a faculty member at the DanaFarber Cancer Institute, then as a senior leader of the Cancer Institute of New Jersey, where he served as the Director of the Investigational Therapeutics Division of that institution. His research efforts focused on mechanisms of resistance to DNA topoisomerase-targeting drugs and his laboratory cloned TOPORS, a novel topoisomerase I- and p53-interacting tumor suppressor gene. In 2008 he was recruited to Merck to lead the clinical oncology development team. Under his leadership, the clinical oncology group underwent a transformational change in an effort to realize the potential of cancer immunotherapy. He led the initial development of the anti-PD-1 antibody pembrolizumab, which was the first anti-PD-1 therapy approved in the USA, and in the identification of the significant activity of this breakthrough therapeutic across several cancer types. In 2014 Dr. Rubin was asked to head up Oncology Early Development for Merck, and in this role he oversees development of a promising and expansive early pipeline, as well as translational oncology research activities. Dr. Rubin has authored over 100 original, peer-reviewed publications and book chapters related to oncology translational research, clinical trials, and drug development. He has served frequently as a member of National Cancer Institute and American Cancer Society study sections, as well as on program committees for the American Association of Cancer Research (AACR) and the American Society of Clinical Oncology. He is a co-chair of the Cancer Steering Committee of the Biomarkers Consortium, Foundation of the National Institute of Health, a member of the Science Policy and Governmental Affairs Committee for AACR, and was a member of the National Cancer Moonshot Initiative/Blue Ribbon Panel Working Group on Expanding Clinical Trials.

Spirituality and depressive symptoms in a multiethnic sample of cancer survivors.

This study aimed to (a) examine the relationships of 3 facets of spirituality (i.e., meaning, peace, faith), and their interaction, with depressive symptoms among Black, Latino, and White cancer survivors; and (b) test fear of cancer recurrence (FCR) and social support (SS) as mediators of these relationships. Data were analyzed from the American Cancer Society's Study of Cancer Survivors-I, a longitudinal population-based study of cancer survivors' quality of life. A national sample of Black (n = 194), Latino (n = 90), and White (n = 2,775) survivors of the top 10 incident cancers completed measures 1 year (Time 1, T1), 2 years (Time 2, T2), and 9 years (Time 3, T3) postdiagnosis. After controlling for T1 depressed mood and demographic and medical characteristics, T1 lower meaning and lower peace, but not faith, predicted greater depressive symptoms at T3 in the total sample. A significant interaction showed that higher faith predicted greater depressive symptoms specifically in the context of lower meaning. Race/ethnicity did not affect these relationships. FCR at T2 partially mediated the relationships of T1 meaning and peace with T3 depressive symptoms, and SS partially mediated the relationship between T1 meaning and T3 depressive symptoms. Cancer survivors with greater meaning and peace appear better able to integrate the cancer experience into their lives. An interaction between T1 meaning and faith on T3 depressive symptoms replicated previous findings. Future research should treat spirituality as a multidimensional construct and focus on identifying and influencing malleable mechanisms of the associations between spirituality and mental health. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Examining the impact of cancer on survivors' religious faith: A report from the American Cancer Society study of cancer survivors-I.

The impact of religion/spirituality (R/S) on cancer outcomes, including health-related quality of life (HRQoL), has been the topic of much investigation. Reports of the opposite, that is, the impact of cancer on R/S and associations with HRQoL, are few. The current study sought to explore the positive and negative impacts of cancer on the religious faith of survivors as well as the associations of such impacts with HRQoL. Participants included 2309 9-year survivors of cancer from the American Cancer Society's Studies of Cancer Survivors-I. The impact of cancer on R/S was measured using items from the Patient-Reported Outcomes Measurement Information System (PROMIS) psychosocial impact of illness-faith, and HRQoL was measured with the 12-item short form (SF-12). Hierarchical regressions were used to examine the impact of cancer on R/S controlling for medical and demographic covariates. Consistent with hypotheses, the majority of survivors (70%) reported that cancer had a positive impact on religious faith, while the negative impact of cancer on religious faith was relatively rare (17%). In multivariable models, the negative impact of cancer on faith was associated with poorer HRQoL, both mental and physical, while the positive impact of cancer on faith was associated with greater mental well-being. Cancer has a negative impact on religious faith for a minority of survivors. However, when it is reported, such negative impact is indicative of poorer mental and physical well-being. As such, it is important to identify those survivors at risk early in survivorship and provide support and intervention as needed.

Cervical cancer subtype less detectable by Papanicolaou testing.

An increasingly common cervical cancer subtype is less detectable by Papanicolaou testing, and this makes human papillomavirus (HPV) testing and vaccination more important than ever according to an American Cancer Society study in Preventive Medicine.1 The squamous cell carcinoma subtype of cervical cancer, which accounts for 80% to 90% of cases, has been on the decline, as have cervical cancers overall. However, adenocarcinomas, the second most common type of the disease, which Papanicolaou testing is less likely to detect, have become more common over the past 20 to 30 years, researchers note. As a result of these findings, investigators emphasized the importance of increasing screening utilization and ensuring appropriate follow-up of positive results. Because HPV infection is the cause of most of these cancers, increasing screening uptake is essential, Dr. Islami says. He adds that at the same time, researchers need to explore strategies to reduce overdiagnosis, which frequently occurs with HPV testing.

Smoking versus quitting and fear of cancer recurrence 9years after diagnosis in the American Cancer Society's Longitudinal Study of Cancer Survivors-I (SCS-I).

Fear of cancer recurrence (FCR) adversely affects quality of life. Cigarette smoking increases the risk of recurrence and may exacerbate FCR among survivors who smoke. FCR also may motivate quitting, but research on whether quitting reduces long-term survivors' FCR is lacking. Among long-term survivors of various cancers, the authors investigated relationships between quitting (vs smoking) and FCR, controlling for sociodemographic, cancer-related, and health-related variables. Data from the American Cancer Society's Longitudinal Study of Cancer Survivors-I were used in generalized estimating equations to compare FCR at 3 waves (T1-T3) after diagnosis between 2 groups; survivors who reported current smoking (n=196) approximately 9years after diagnosis (at T3) or who, based on T3 recall of quitting age, had quit smoking after diagnosis (n=97). T3 cross-sectional analyses among current smokers examined associations of FCR with smoking level and intentions of quitting. A significant smoking status×time interaction (P=.003) indicated that only quitters experienced decreases in FCR from T1 to T3 (P=.007). At T3, FCR was significantly lower among quitters than among current smokers (P=.05), and current smokers reported that FCR caused more functioning impairments (eg, disruption of relationships, everyday activities, mood) than quitters (P=.001). Cross-sectional analyses (T3) among smokers found that heavier smoking predicted less attempts to cope with FCR (P=.04) and that reassurance behaviors (eg, self-examination for cancer) predicted stronger quitting intentions (P=.02). Quitting smoking lowers FCR, and FCR may disrupt functioning among continuing smokers. Interventions for FCR should be multimodal and should treat both psychological distress and health-related behaviors such as smoking.

The relationship between fear of cancer recurrence and health behaviors: A nationwide longitudinal study of cancer survivors.

The goal of this study was to examine fear of cancer recurrence (FCR) and 2 health behaviors, physical activity and fruit and vegetable intake, from early to long-term survivorship in a large cohort of mixed cancer survivors. Group-based trajectory analyses and repeated measures analysis of variance were conducted on data collected in the American Cancer Society's Studies of Cancer Survivorship-I. Two thousand three hundred thirty-seven survivors of 10 cancers completed the survey at 3 time points (M = 1.3, 2.2, and 8.8 years postdiagnosis). The current study found 3 FCR trajectories clustering cancer survivors by FCR severity: low (33.6%), moderate (58.1%), and high (8.3%). FCR significantly decreased over time and remained distinct for each trajectory group. Patient characteristics prevalent in the high FCR group were being female, of younger age, Hispanic ethnicity, having advanced cancer stage (II to III) and non-Hodgkin lymphoma, and low adherence to physical activity and fruit and vegetable intake recommendations. The high FCR group also reported significantly fewer of these health behaviors compared with the other groups, albeit the effect size was small. Across the survivorship trajectory, FCR severity decreased but remained distinct for the 3 trajectory groups. Future investigations should inquire about the specific needs of each FCR group to subsequently develop targeted interventions. A weak association between FCR and health behaviors was found, with individuals in the high FCR group reporting less health behaviors. Future research should assess the direction of this relationship over time to inform intervention targets within this subgroup. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Global Effect Factors for Exposure to Fine Particulate Matter.

We evaluate fine particulate matter (PM2.5) exposure–response models to propose a consistent set of global effect factors for product and policy assessments across spatial scales and across urban and rural environments. Relationships among exposure concentrations and PM2.5-attributable health effects largely depend on location, population density, and mortality rates. Existing effect factors build mostly on an essentially linear exposure–response function with coefficients from the American Cancer Society study. In contrast, the Global Burden of Disease analysis offers a nonlinear integrated exposure–response (IER) model with coefficients derived from numerous epidemiological studies covering a wide range of exposure concentrations. We explore the IER, additionally provide a simplified regression as a function of PM2.5 level, mortality rates, and severity, and compare results with effect factors derived from the recently published global exposure mortality model (GEMM). Uncertainty in effect factors is dominated by the exposure–response shape, background mortality, and geographic variability. Our central IER-based effect factor estimates for different regions do not differ substantially from previous estimates. However, IER estimates exhibit significant variability between locations as well as between urban and rural environments, driven primarily by variability in PM2.5 concentrations and mortality rates. Using the IER as the basis for effect factors presents a consistent picture of global PM2.5-related effects for use in product and policy assessment frameworks.

Use of complementary/integrative methods: cancer survivors' misconceptions about recurrence prevention.

Many cancer survivors use complementary and alternative health methods (CAM). Because we are unaware of high-level evidence supporting CAM for preventing cancer recurrence, we studied post-treatment survivors who use CAM to assess (1) the percentage who included preventing recurrence as a motive for using CAM, (2) characteristics of survivors who use CAM intended to prevent recurrence, and (3) CAM domains associated with use for recurrence prevention. We studied participants in the American Cancer Society's Study of Cancer Survivors-I (nationwide study of adult survivors) who used CAM (excluding osteopathy, yoga, tai chi, or qi gong users, as well as anyone whose only reported CAM was prayer/meditation). Multivariable logistic regression was used to examine associations of independent variables with CAM use for recurrence prevention. Among 1220 survivors using CAM, 14.8% reported recurrence prevention as a reason for CAM use (although only 0.4% indicated this was their only reason). The following were independently associated with odds of CAM use to prevent recurrence: not being married/in a marriage-like relationship (OR = 1.53, 95% confidence interval [CI] 1.05-2.23), using mind-body (OR = 1.65, 95% CI 1.08-2.51) or biologically based (OR = 4.11, 95% CI 1.96-8.59) CAM and clinically relevant fear of recurrence (OR = 1.96, 95% CI 1.38-2.78). Approximately 1/7 of survivors who use CAM have unrealistic expectations about CAM reducing recurrence risk. This expectation is strongly associated with the use of biologically based CAM. Patient education should support informed decisions and realistic expectations regarding any complementary/integrative or mainstream/conventional clinical intervention.

Correlates of light physical activity among cancer survivors.

Emerging evidence demonstrates the positive health benefits of light physical activity (LPA) for cancer survivors. Yet, little research has explored modifiable factors that facilitate or hinder LPA behavior in this population. Correlates of LPA among cancer survivors were examined, and stratified by moderate-to-vigorous physical activity (MVPA) status. A cross-sectional analysis using the American Cancer Society's Studies of Cancer Survivors-I (N=1751) was conducted. Correlates of interest were health-care provider support for physical activity, perceived health competence, perceived social support, unsupportive partner behaviors, and perceived susceptibility to cancer recurrence. The primary outcome was self-reported LPA categorized at 0, 1-59, 60-119, and 120+minutes per week. Multivariable ordinal regressions using forced entry were conducted, stratified by MVPA status. Adjusted multivariable models revealed that, among those reporting no MVPA (n=757), greater provider support for physical activity (adjusted odds ratio [aOR]=1.51; 95% CI, 1.05-2.17; P=0.03), greater perceived health competence (aOR=1.44; 95% CI, 1.10-1.88; P=0.01), and greater unsupportive partner behaviors (aOR=1.06; 95% CI, 1.01-1.12; P=0.03) were significantly correlated with higher LPA. No social cognitive constructs were correlated with LPA among those already engaging in MVPA (n=994). LPA interventions targeting cancer survivors not engaging in any MVPA are warranted and may optimize limited intervention resources. Furthermore, interventions may be more efficacious by applying behavior change techniques that incorporate health-care provider support and improves health competence and positive interpersonal skills.

Trajectories of spiritual well-being in long-term survivors of cancer: A report from the American Cancer Society's Studies of Cancer Survivors-I.

Existing research indicates that religion, spirituality, or both are important to the quality of life of patients with cancer. The current study is the first to characterize trajectories of spiritual well-being (SWB) over time and to identify their predictors in a large, diverse sample of long-term cancer survivors. The participants were 2365 cancer survivors representing 10 cancer diagnoses from the American Cancer Society's Studies of Cancer Survivors-I, and they were assessed at 3 time points: 1, 2, and 9 years after their diagnosis. SWB was assessed with the 3 subscales of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp; ie, Meaning, Peace, and Faith). Predictors included demographic, medical, and psychosocial variables. Latent growth mixture modeling was used to identify trajectories and test their predictors. Four distinct trajectories of SWB were identified for each of the FACIT-Sp subscales: stable-high (45%-61% of the sample, depending on the subscale), stable-moderate (23%-33%), stable-low (7%-16%), and declining (6%-10%). Significant predictors of these trajectories included age, sex, race, education, comorbidities, symptom burden, social support, and optimism, but not always in the hypothesized direction. For some of the subscale trajectories, a recurrence of cancer, multiple cancers, or metastatic cancer was associated with lower SWB. This is the first study to establish the existence and predictors of heterogeneous trajectories of SWB in long-term survivors of cancer. Because SWB is an important component of quality of life, the current results indicate characteristics of persons who could be at greater risk for a decline or consistently low scores in SWB and may warrant clinical attention.

Concordance of cancer registry and self-reported race, ethnicity, and cancer type: a report from the American Cancer Society's studies of cancer survivors.

To examine the concordance between cancer registry and self-reported data for race, Hispanic ethnicity, and cancer type in the American Cancer Society's Studies of Cancer Survivors (SCS) I and II. We calculated sensitivity, specificity, positive predictive value, and Kappa statistics for SCS-I and II. The gold standard for cancer type was registry data and for race and ethnicity was self-reported questionnaire data. Among 6,306 survivors in SCS-I and 9,170 in SCS-II, overall agreement (Kappa) for cancer type was 0.98 and 0.99, respectively. Concordance was strongest for breast and prostate cancer (Sensitivity ≥ 0.98 in SCS-I and II). For race, Kappa was 0.85 (SCS-I) and 0.93 (SCS-II), with strong concordance for white (Sensitivity = 0.95 in SCS-I and 0.99 in SCS-II) and black survivors (Sensitivity = 0.94 in SCS-I and 0.99 in SCS-II), but weak concordance for American Indian/Alaska Native (Sensitivity = 0.23 in SCS-I and 0.19 in SCS-II) and Asian/Pacific Islander survivors (Sensitivity = 0.43 in SCS-I and 0.87 in SCS-II). Agreement was moderate for Hispanic ethnicity (Kappa = 0.73 and 0.71; Sensitivity = 0.74 and 0.76, in SCS-I and SCS-II, respectively). We observed strong concordance between cancer registry data and self-report for cancer type in this national sample. For race and ethnicity, however, concordance varied significantly, with the poorest concordances observed for American Indian/Alaska Native and Asian/Pacific Islander survivors. Ensuring accurate recording of race/ethnicity data in registries is crucial for monitoring cancer trends and addressing cancer disparities among cancer survivors.

The impact of psychosocial characteristics in predicting smoking cessation in long-term cancer survivors: A time-to-event analysis.

Smoking poses significant health risks to cancer survivors. Cancer survivorship may heighten psychological distress and reduce social support and health-related quality of life (HRQOL) for years after diagnosis, which could inhibit long-term successful smoking cessation. Understanding longitudinal associations between these psychosocial characteristics and successful cessation could help clinicians tailor cessation interventions for their patients. Time-to-event analyses using data from the American Cancer Society Study of Cancer Survivors-I (SCS-I)-a longitudinal nationwide study-examined the relationship of psychosocial characteristics with cessation likelihood and amount of time from diagnosis to quitting in cancer survivors diagnosed 7 to 10years prior. Cancer survivors with high physical HRQOL were more likely to quit smoking within 10years from cancer diagnosis than survivors with low physical HRQOL, controlling for cancer type and number of comorbid conditions at baseline (HR=1.96; 95% CI: 1.10-2.70; P=.02). Survivors with high physical HRQOL also took less time to quit than survivors with low physical HRQOL. Survivors of tobacco-related cancers with low physical HRQOL were the least likely group to quit. No significant relationships between other psychosocial predictors and cessation outcomes were observed. Smoking cessation programs are needed for all cancer survivors who smoke, but survivors with low physical HRQOL 1year after diagnosis may need more intensive long-term smoking cessation interventions with multiple check-in points after smoking relapses. Cessation interventions that include strategies to mitigate physical symptoms in those with poor physical HRQOL deserve consideration in research and practice.

Examining the role of social support and spirituality on the general health perceptions of Hispanic cancer survivors.

Although cancer survival rates continue to improve, overall disparities persist for ethnic minority survivors, who have a disproportionately high risk of experiencing poor quality of life, despite documented higher levels of self-reported spirituality. Yet little is known about the relationship between spirituality and social support and health outcomes among Hispanic survivors. This study examined (1) differences between Hispanic and non-Hispanic white survivors on health, social support, and spirituality and (2) the potential mediating roles of mental health and emotional distress on general health perceptions. We analyzed data (N=7778) from the American Cancer Society's Study of Cancer Survivors-II, a national cross-sectional study of adult cancer survivors. Preliminary analysis compared sociodemographic and medical characteristics between the 2 groups to identify significant covariates. Structural equation modeling assessed whether mental health and emotional distress mediate the impact of social support and spirituality on Hispanics' general health perceptions. Overall, 693 survivors were Hispanic and 7085 were non-Hispanic whites. Hispanics reported poorer health and were more likely to have comorbid conditions such as diabetes and depression compared with non-Hispanic whites. Structural equation modeling indicated that the impact of spirituality on general health perceptions was fully mediated through mental health. Emotional distress did not have a direct effect on general health perceptions nor did it mediate effects of spirituality and social support and on general health perceptions. There was a mediated effect of social support on general health perceptions. Spirituality is an important factor in the health of Hispanic survivors. Future studies should explore the impact and effectiveness of spiritual interventions and the beneficial effect for mental health on general health perceptions.

Abstract C35: Examining the role of social support and spirituality on the health status of Hispanic cancer survivors

Abstract Purpose: Although overall survival rates continue to improve for many cancers, disparities persist for ethnic minorities who have a disproportionately high risk of experiencing poor mental health and quality of life. However, limited research has examined the role of social support and spirituality on the health status of Hispanic cancer survivors. This study examined differences between Hispanics and non-Hispanics on health status, emotional support, and spirituality. It also examined the role of social support and spirituality on health status of cancer survivors directly and mediated through emotional distress and mental health. Methods: We analyzed data (N=9,170) from the American Cancer Society's Study of Cancer Survivors-II (SCS-II), a national cross-sectional study of adult cancer survivors diagnosed at 2, 5, or 10 years prior to sampling. Preliminary analysis compared sociodemographic and medical characteristics between Hispanic and non-Hispanic cancer survivors to identify significant covariates of health status. We used structural equation modeling (SEM) to assess if the latent variables of mental health and emotional distress mediate the impact of social support and spirituality (also modeled as latent variables) on the health status of Hispanic cancer survivors. The final model included sociodemographic characteristics such as age and marital status, health insurance coverage, and cancer-related covariates such as time since diagnosis. Measurement models for social support, spirituality, emotional distress, and mental health were built based on literature and modified through adding meaningful error-covariances. SEM models were estimated in Mplus 7.4. Model fit was assessed using chi-square, RMSEA, TLI, and CFI. Results: Overall, 7.6% of survivors were Hispanics (n=693) and 92.4% were non-Hispanics (n=8,477). Compared to their non-Hispanic counterparts, Hispanics were significantly younger (M= 63.4 ±12.6 vs 67.7 ±11.8, p=0.002) and had lower levels of educational attainment (X2=347.7, p&amp;lt;0.001). The majority of participants reported currently having some form of health insurance coverage; however, Hispanic cancer survivors reported higher rates of being uninsured (6.0% vs 2.0%, p&amp;lt;0.001). Notable differences in cancer treatment were observed. Hispanics were more likely to undergo chemotherapy and immunotherapy and less likely to undergo surgery compared to non-Hispanics. Hispanic cancer survivors reported poorer health and were more likely to have comorbid conditions such as diabetes, depression, anxiety, and chronic back pain compared to non-Hispanics. Structural equation model (SEM) estimates indicated no direct effect of social support on health or any mediated effect of social support through neither emotional distress nor mental health on overall health among Hispanics. On the contrary, there was a small to medium total effect of spirituality on health. The impact of spirituality on health was fully mediated through mental health (total effect β=.26, p&amp;lt;.001) and neither the direct effect nor the mediated effect through emotional distress was statistically significant. The direct effect of spirituality on mental health was large (β=.60, p&amp;lt;.001). The model accounted for most of the variance in health (r-square = .71). SEM model fit indices other than chi-square were very good (RMSEA=.03, CFI=.98, TLI= .98). Conclusion: Hispanic cancer survivors were more likely to report poor health (general health, mental health, and emotional distress). Although data were cross-sectional, findings from this study suggest that the association between spirituality and health is mediated by mental health among Hispanic cancer survivors. Future studies are needed to determine if interventions to enhance spiritual well-being as a coping mechanism will have a direct impact on health of Hispanic cancer survivors. Citation Format: Carol Ochoa, Regine Haardörfer, Cam Escoffery, Kevin Stein, Kassandra I. Alcaraz. Examining the role of social support and spirituality on the health status of Hispanic cancer survivors [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C35.

608P - Variations in clinicopathological features, treatment patterns, and outcomes of young adults with colorectal cancer in the United States and Egypt

Background: A recent American Cancer Society study showed that the rate of colorectal cancer (CRC) in young American adults is rising. There are limited data on young Arabian adults with CRC. Herein we explore differences between American and Egyptian young adults with CRC. Methods: A retrospective review of young (≤46 years old) patients (pts) with CRC in the United States (US-pts) and Egypt (EGY-pts) was undertaken. T and Fisher’s exact tests were used for comparative analyses. Kaplan-Meier methodology estimated survival. Results: In total, 504 pts with CRC were studied, incorporating 62 US-pts (median age 38 yrs, range 20-46) and 442 EGY-pts (35 yrs, 15-46). US-pts were more commonly female (66% vs 41%, p < 0.001) and had more colon primaries (75% vs 50%, p = 0.001). EGY-pts had more left-sided tumors (78% vs 61%, p = 0.008), of which 49% were rectal primaries (vs 24% for US-pts, p < 0.001). US-pts had more well-differentiated tumors (25% vs 3%, p < 0.001), whereas EGY-pts had more mucin-producing tumors (40% vs 26%, p = 0.042). US-pts were more likely to have bowel obstruction (64% vs 17%, p < 0.001) and present with metastatic (met) disease (66% vs 28%, p < 0.001), particularly in the liver, lung, and peritoneum (56% vs 40%, p = 0.04; 35% vs 5%, p < 0.001; 48% vs 16%, p < 0.001). Comparing pts with met disease, EGY-pts tended to have rectal primaries (33% vs 22%), while US-pts had more right-sided tumors (38% vs 18%). US-pts were more likely to undergo palliative resection or metastatectomy (41% vs 26%, p = 0.039) and receive bevacizumab (69% vs 1%, p < 0.001). EGY-pts received more 5-FU alone (39% vs 2%, p < 0.001) or 5-FU + radiation (40% vs 0%, p < 0.001), whereas US-pts received more FOLFOX/FOLFIRI (64% vs 13%, p < 0.001). There was no statistically significant difference in median overall survival between US-pts (Not Reached) and EGY-pts (76 months (mos), p = 0.6), nor median progression free survival between US-pts (20 mos) and EGY-pts (13 mos, p = 0.202). Conclusions: Significant differences were observed among young US-pts and EGY-pts with CRC, particularly primary tumor location, patterns of metastasis, and treatment used. Further evaluation of the environmental and ethnic impact on disease biology and treatment outcomes is warranted. Legal entity responsible for the study: Georgetown University IRB Funding: None Disclosure: All authors have declared no conflicts of interest.

Positive aspects of having had cancer: A mixed-methods analysis of responses from the American Cancer Society Study of Cancer Survivors-II (SCS-II).

This study focused on understanding positive aspects of cancer among a large, national sample of survivors, 2, 5, and 10years' postcancer diagnosis, who responded to the American Cancer Society Study of Cancer Survivors - II (SCS-II) survey "Please tell us about any positive aspects of having cancer." A sequential mixed methods approach examined (1) thematic categories of positive aspects from cancer survivors (n=5149) and (2) variation in themes by sociodemographics, cancer type, stage of disease, and length of survivorship. Themes comprised 21 positive aspects within Thornton's typology of benefits that cancer survivors attribute to their illness: life perspectives, self, and relationships. New themes pertaining to gratitude and medical support during diagnosis and treatment, health-related changes, follow-up/surveillance, and helping others emerged that are not otherwise included in widely used existing benefit finding cancer scales. Gratitude and appreciation for life were the most frequently endorsed themes. Sociodemographics and stage of disease were associated with positive aspect themes. Themes were not associated with survivor cohorts. No differences in perceived positive aspects across survivor cohorts suggest that positive aspects of cancer may exist long after diagnosis for many survivors. However, variation across sociodemographics and clinical variables suggests cancer survivors differentially experience positive aspects from their cancer diagnosis. This analysis provides new information about cancer survivors' perceptions of positive aspects from their cancer and factors associated with benefit finding and personal growth. This information can be useful in further refining quality-of-life measures and interventions for cancer survivors.

The American Cancer Society's Cancer Prevention Study 3 (CPS‐3): Recruitment, study design, and baseline characteristics

Prospective cohort studies contribute importantly to understanding the role of lifestyle, genetic, and other factors in chronic disease etiology. The American Cancer Society (ACS) recruited a new prospective cohort study, Cancer Prevention Study 3 (CPS-3), between 2006 and 2013 from 35 states and Puerto Rico. Enrollment took place primarily at ACS community events and at community enrollment "drives." At enrollment sites, participants completed a brief survey that included an informed consent, identifying information necessary for follow-up, and key exposure information. They also provided a waist measure and a nonfasting blood sample. Most participants also completed a more comprehensive baseline survey at home that included extensive medical, lifestyle, and other information. Participants will be followed for incident cancers through linkage with state cancer registries and for cause-specific mortality through linkage with the National Death Index. In total, 303,682 participants were enrolled. Of these, 254,650 completed the baseline survey and are considered "fully" enrolled; they will be sent repeat surveys periodically for at least the next 20 years to update exposure information. The remaining participants (n = 49,032) will not be asked to update exposure information but will be followed for outcomes. Twenty-three percent of participants were men, 17.3% reported a race or ethnicity other than "white," and the median age at enrollment was 47 years. CPS-3 will be a valuable resource for studies of cancer and other outcomes because of its size; its diversity with respect to age, ethnicity, and geography; and the availability of blood samples and detailed questionnaire information collected over time. Cancer 2017;123:2014-2024. © 2017 American Cancer Society.

Exploring measurement invariance by gender in the profile of mood states depression subscale among cancer survivors.

The Profile of Mood States-Short Form (POMS-SF) is a well-validated tool commonly used in medical/clinical research. Less attention has been paid to the measurement invariance of the POMS-the degree to which the structure and items behave similarly for different groups (e.g., women and men). This study investigated the measurement invariance of the POMS Depression subscale across gender groups in a sample of cancer survivors. The POMS Depression subscale has 8 items (Unhappy, Sad, Blue, Hopeless, Discouraged, Miserable, Helpless, and Worthless). Invariance was measured using multigroup confirmatory factor analysis. This study used data from American Cancer Society Studies of Cancer Survivors-II, a population-based survey of adult cancer survivors (n=9170). We found factor structures and factor loadings were invariant for gender groups, but moderate differential item functioning (DIF) in the question containing the word blue. With regard to cancer survivors' gender, we found the Depression subscale of the POMS-SF had configural invariance, and partial metric and scalar invariance. This suggests that results should be interpreted with caution, especially when gender is considered important. More broadly, our finding suggests that questions with the word blue may introduce DIF into other measures of depressive mood. More research is needed to replicate these findings in other samples and with other instruments.