Asian Survivors Research Articles

Personalized risk assessment of new onset depression in long-term cancer survivors.

e13798 Background: Advances in cancer detection and treatment have improved long-term survival. It is critical to understand the impact that experiencing cancer has on psychological health, given that the prevalence of depression in long-term survivors is higher than in the general population. Our aim was to develop a risk prediction model to identify long-term (5-year) survivors at high risk of developing depression. Methods: We conducted a retrospective study of the SEER-Medicare database beneficiaries with localized breast, prostate, colon, or rectal cancer diagnosed between 2003-2011 who had survived at least 5 years since diagnosis. We required Part D coverage in the breast cohort to account for adjuvant endocrine therapy. Our primary outcome was the cumulative incidence of depression between 5-10 years after diagnosis, which was defined using a claims-based algorithm as a single or recurrent episode of major depressive disorder, recent episode of bipolar I disorder, or dysthymic disorder. For each cancer site, we constructed restricted mean survival time models, a non-parametric method that yields time ratios; a time ratio (TR) < 1 indicates shorter mean time to event (TTE). Results: Our cohort consisted of 80,579 survivors. The cumulative incidence of depression occurring between 5-10 years after diagnosis was 16.9% for breast cancer, 7.8% for prostate cancer, 10.6% for colon cancer, and 8.6% for rectal cancer. The cumulative incidence of new onset depression increased over time and was 7.2% vs. 13.9% among survivors diagnosed before and after 2008, respectively. Compared with patients age < 70 at diagnosis, patients aged 75 and older exhibited 5-10% shorter mean TTE across breast, prostate, and colon cancer. There was no association between Non-Hispanic (NH) Black race or Hispanic ethnicity and depression compared with NH White survivors. Asian survivors were at lower risk of developing depression. Disease specific factors, including stage, grade, hormone receptor status (breast), or PSA (prostate), did not predict depression in long-term survivors. Receipt of treatment in the 3-5 years after initial diagnosis was associated with moderately greater risk for all survivors, with the shortest mean TTE among breast cancer survivors (TR=0.91, 95% CI=0.85-0.97). Across all cohorts, the greatest predictor of depression was a prior history of depression. The incidence of depression in long-term survivors was 42% in patients with a prior history of depression vs. 8% among survivors without a prior history of depression. Conclusions: Diagnoses of depression increased in cancer patients since 2008 and were associated with prior history of depression, advanced age, census tract poverty, and continued treatment 3 years after diagnosis. Treatment type and disease specific factors were not strong predictors of depression.

Socioeconomic Status and Chronic Health Conditions in Asian Survivors of Adolescent and Young Adult Cancers.

Purpose: While there are known disparities in socioeconomic status (SES) and health outcomes among racially and ethnically minoritized adolescent and young adult (AYA; ages 15-39 years at diagnosis) cancer survivors compared with White survivors, outcomes in the Asian survivor population are understudied. To better understand the association of an AYA cancer diagnosis with SES and health outcomes within a minoritized population, the current study makes comparisons between individuals of the same race or ethnicity with and without a history of AYA cancer. Methods: Non-Hispanic, Asian AYA cancer survivors and non-Hispanic, Asian age- and sex-matched controls were identified from self-reported data in the National Health Interview Survey (2009-2020). Prevalence of chronic health conditions and socioeconomic factors were compared between groups using chi-square tests. Odds of chronic conditions by SES factors were determined within and between survivors and controls using logistic regression methods. Results: One hundred and thirty-one survivors and 1310 controls were included. Survivors were less likely to be married compared with controls; however, there were no differences in other SES factors examined. Survivors had higher odds of at least one chronic condition diagnosis (odds ratio = 4.17, p < 0.001) compared with controls. Of the chronic conditions assessed, survivors had higher odds of arthritis, pulmonary disease, and hypertension compared with controls. Conclusions: Asian AYA cancer survivors are at increased risk of chronic health conditions compared with Asian individuals without a cancer history. Culturally adapted targeted interventions are needed to improve health outcomes for this population.

Racial differences in long-term social, physical, and psychological health among adolescent and young adult cancer survivors

BackgroundThe current guidelines for survivorship in adolescents and young adults (AYA) cancer are based on studies conducted in the United States and European AYA survivors. However, previous studies have shown that the health-related quality of life in cancer survivors can vary depending on race, yet the long-term health differences among AYA survivors by race/ethnicity have not been fully explored. Therefore, our aim is to compare the psychosocial and physical health of AYA survivors and their matched controls across different racial and ethnic groups.MethodsWe conducted a cross-sectional study using US National Health and Nutrition Examination Survey (NHANES) and the Korea NHANES from 2007 to 2018. We included AYA cancer survivors who were diagnosed with any type of cancer aged between 15 and 39 years, and who were adult with aged over 18 years old at survey year. We then stratified the study population by race/ethnicity with Non-Hispanic White (NHW, n = 310), African American (AA, n = 42), Hispanic (n = 81) from NHANES, and Asian (n = 389) from the Korea NHANES. We also selected 5 times age-, sex-, race-, and survey year-matched general population among participants who had never been diagnosed with cancer (N = 4110). Variables were defined using questionnaire data, physical exams, and laboratory tests.ResultsCompared to NHW, Hispanics (aOR 1.15, 95% CI 1.00–1.32) had poor or fair general health, lower education (aOR 1.23, 95% CI 1.07–1.40), and lower household income (aOR 1.16, 95% CI 1.01–1.33). AA survivors were more likely to be non-coupled (aOR 1.35, 95% 1.15–1.60) and have hypertension (aOR 1.18, 95% CI 1.03–1.36). Asians were more former/current drinkers (aOR 1.21, 95% CI 1.05–1.40). NHW are more likely to experience psychological limitation. Compared to matched general, NHW and Asian survivors had poor general health and psychological health.ConclusionsThis study provides evidence for future studies concerning long-term health after AYA cancer survivorship that may vary according to race.

Abstract A063: Multimorbidity and the association with patient reported access to care and physician relationships among racially and ethnically diverse patients with colorectal cancer

Abstract Background: Patient reported access to care and quality of physician relationships are influential determinants of outcomes following cancer diagnosis. Both poorer patient reported healthcare experiences and increased comorbidity loads are more common among racial and ethnic minority patients, contributing to disparities in cancer outcomes. We aimed to determine whether multimorbidity exacerbates racial and ethnic disparities in patient reported healthcare experiences. Methods: We used Surveillance, Epidemiology, and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) data to identify a cohort of patients diagnosed with non-metastatic colorectal cancer between 1999-2017 who were at least 65 at the time of diagnosis and who completed a CAHPS patient experience survey within two years after diagnosis. Main independent variables included CAHPS self-reported race/ethnicity and number of comorbidities. Patients with multimorbidity included those who reported at least one comorbidity, in addition to their colorectal cancer diagnosis. Dependent variables included validated CAHPS composite scores of getting needed care and physician communication (on a 0-100 scale). Multivariable linear regression was used to determine associations between patient race/ethnicity, multimorbidity status, and self-reported experiences with care controlling for sociodemographic and tumor prognostic factors. Models included a product interaction term between race/ethnicity and multimorbidity status to evaluate effect modification by multimorbidity. Results: We identified 4,201 SEER-CAHPS patients with colorectal cancer, consisting of 78.7% non-Hispanic white (NHW), 7.9% non-Hispanic Black (NHB), 7.6% Hispanic, and 5.9% non-Hispanic Asian (NHA) survivors. In addition, 41.2% self-reported having at least one comorbidity in addition to their diagnosis of colorectal cancer. The mean composite score of getting needed care was 88.2 out of 100 possible points and the mean composite score of physician communication was 89.0 out of 100. In multivariable analyses, NHA patients had a mean composite score of getting needed care that was 7.5 points lower than NHW patients (B=-7.45, 95% CI=-11.54- -3.55). Having multimorbidity (at least one self-reported comorbid condition in addition to colorectal cancer) did not affect mean composite scores of getting needed care or physician communication. However, NHB patients with multimorbidity had a mean composite score of getting needed care that was 7.7 points lower than NHW patients without multimorbidity (B=-7.73, 95% CI=-13.16- -2.30). Conclusions: Multimorbidity may substantially decrease the ability of Black colorectal cancer survivors to get needed care, which is an essential determinant of clinical cancer outcomes. Further research is needed to identify how cancer care can be targeted to racial and ethnic minority populations with multimorbidity to provide equitable cancer care for all patients. Citation Format: Stephanie Navarro, Mariana C. Stern, Afsaneh Barzi, Albert J. Farias. Multimorbidity and the association with patient reported access to care and physician relationships among racially and ethnically diverse patients with colorectal cancer [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 A063.

Factors Influencing Recovery and Well-Being Among Asian Survivors of International Criminal Sex Trafficking in an Urban U.S. City.

Sex trafficking is serious form of gender-based violence that results in profound adverse health outcomes, yet one that is poorly understood. New York City is a major hub for sex trafficking, with a significant but unquantified number of victims originating from East Asian countries and trafficked via illicit massage businesses. Peer-reviewed studies among Asian survivors of international criminal sex trafficking do not exist. The aim of this study is to qualitatively examine the factors at various levels of influence that impact the recovery and reintegration process of Asian criminal sex trafficking survivors in the United States from the perspective of survivors and front-line service providers. The study was guided by community-based participatory research and trauma-informed approaches, leveraging a collaboration with a well-established service provider organization. Ten in-depth interviews were conducted between 2018 and 2019 with three Korean survivors and seven key informants who were anti-trafficking service providers working with East Asian clients. Data were analyzed using a grounded theory approach. Survivors and service providers vocalized factors at multiple levels that either facilitate or impede recovery and well-being. Levels of influence included structural (e.g., poverty/debt bondage, immigration status, limited English proficiency), cultural (e.g., fatalism, collectivism), institutional (e.g., lack of culturally appropriate, trauma-informed care), interpersonal (e.g., exploitation, social support), and individual (e.g., resilience). Stigma was a crosscutting factor that spanned all levels of influence. This study highlights the voices of survivors and front-line service providers to understand the lives of an under-researched population of Asian sex trafficking survivors. Ultimately, the root, structural causes of survivor marginalization need to be addressed, which stem from the intersection of class-, gender-, and race-related inequities. While survivors continue to experience exploitation and marginalization post-trafficking, they also carry an enormous amount of resilience that must be leveraged in their path to recovery from trauma.

Assessment of appropriate body mass index cut-off points for long-term mortality among ST-elevation myocardial infarction survivors in Asian population using machine learning algorithm.

Low body mass index (BMI) is a predictor of adverse events in patients with ST-elevated myocardial infarction (STEMI) in Western countries. Because the average BMI of Asians is significantly lower than that of the Western population, the appropriate cut-off BMI value and its role in long-term mortality are unclear in Asian patients. Between January 2006 and December 2017, 1215 patients who underwent percutaneous coronary intervention (PCI) for acute STEMI and were alive at discharge (mean age, 67.7years; male, 75.4%) were evaluated. The cut-off BMI value, which could predict all-cause mortality within 10years, was detected using a survival classification and regression tree (CART) model. The causes of death according to the BMI value were evaluated in each group. Based on the CART model, the patients were divided into three groups (BMI < 18kg/m2: 54 patients, 18kg/m2 ≤ BMI ≤ 20kg/m2: 109 patients, and BMI > 20kg/m2: 1052 patients). The BMI decreased with age; with an increased BMI, patients with dyslipidemia, diabetes mellitus, and smoking habit increased. During the study period (median, 4.9years), 194 patients (26.8%) died (cardiac death, 59 patients; non-cardiac death, 135 patients). All-cause mortality was more frequent as the BMI decreased (BMI < 18kg/m2; 72.8%, 18kg/m2 ≤ BMI ≤ 20kg/m2; 40.5%, and BMI > 20kg/m2; 22.8%; log-rank p < 0.001). Non-cardiac deaths were more frequent than cardiac deaths in all groups, and the dominance of non-cardiac death was highest in the lowest BMI group. Cut-off BMI values of 18kg/m2 and 20kg/m2 can predict long-term mortality after PCI in Asian STEMI survivors, whose cut-off value is lower than that in the Western populations. The main causes of death in this cohort differed according to the BMI values.

Impact of Uncontrolled Hypertension at 3Months After Intracerebral Hemorrhage.

BackgroundSurvivors of intracerebral hemorrhage (ICH) are at high risk for recurrent stroke, which is associated with blood pressure control. Because most recurrent stroke events occur within 12 to 18 months of the index ICH, rapid blood pressure control is likely to be crucial. We investigated the frequency and prognostic impact of uncontrolled short‐term hypertension after ICH.Methods and ResultsWe analyzed data from Massachusetts General Hospital (n=1305) and the University of Hong Kong (n=523). We classified hypertension as controlled, undertreated, or treatment resistant at 3 months after ICH and determined the following: (1) the risk factors for uncontrolled hypertension and (2) whether hypertension control at 3 months is associated with stroke recurrence and mortality. We followed 1828 survivors of ICH for a median of 46.2 months. Only 9 of 234 (4%) recurrent strokes occurred before 3 months after ICH. At 3 months, 713 participants (39%) had controlled hypertension, 755 (41%) had undertreated hypertension, and 360 (20%) had treatment‐resistant hypertension. Black, Hispanic, and Asian race/ethnicity and higher blood pressure at time of ICH increased the risk of uncontrolled hypertension at 3 months (all P<0.05). Uncontrolled hypertension at 3 months was associated with recurrent stroke and mortality during long‐term follow‐up (all P<0.05).ConclusionsAmong survivors of ICH, >60% had uncontrolled hypertension at 3 months, with undertreatment accounting for the majority of cases. The 3‐month blood pressure measurements were associated with higher recurrent stroke risk and mortality. Black, Hispanic, and Asian survivors of ICH and those presenting with severe acute hypertensive response were at highest risk for uncontrolled hypertension.

“HONOUR”- BASED VIOLENCE AND THE POLITICS OF CULTURE IN CANADA: ADVANCING A CULTURAL ANALYSIS OF MULTI-SCALAR VIOLENCE

Since 2015, in Canada, political discourse on “honour”-based violence has shifted away from highly problematic understandings of “culture” as the cause of violence among racialized, Muslim, and immigrant communities. Instead, talk of culture has dropped out of the equation altogether in favour of more structural definitions of gender-based violence (GBV). In this article, we ask what gets lost when culture is not taken into account when talking about or trying to understand forms of GBV. Drawing from theoretical conceptualizations of culture — defined as “situated practices of meaning-making” that shape all experiences of violence, and societal responses to violence — we argue for a multiscalar approach to culture. To illustrate this framework, we first offer a critical analysis of Aruna Papp’s 2012 memoir Unworthy Creature as an exemplar of stigmatizing uses of culture and a key text promoted by the Conservative federal government at the time. We then turn to interviews we conducted with service providers serving South Asian survivors of GBV in Toronto from 2011 to 2013. Our analysis illustrates how to talk about culture as a key ingredient shaping multiscalar violence, regardless of whether that violence occurs in majority or minority communities. We conclude with three policy implications for addressing HBV moving forward.

Experiences of Asian Women Who Live in Urban Environments and Are Breast Cancer Survivors.

Despite expanding interest in cancer survivorship, little is known about urban Asian breast cancer survivors whose experience may differ from those in suburban and rural locations. This study explores survivors' challenges to maximize outcomes and identify common and unique themes among urban Asian survivors. Information was obtained from the survivors and outreach workers from their community. Descriptive qualitative methods including semistructured interview guides were used to plan, conduct, and analyze both individual interviews of Asian women (n = 6) and a focus group (n = 7) composed of community outreach workers. The interview and focus group findings, endorsed themes of communication/language, trust, and privacy, with generational differences. Poor health literacy in both survivors and providers was identified. Nurses are in a unique position to use the themes identified to both assist survivors expand their health literacy and lobby for resources for providers to promote culturally congruent care.

Health-Related Quality of Life in Asian Differentiated Thyroid Cancer Survivors.

Background:Health-related quality of life (HRQoL) is important for differentiated thyroid cancer survivors, but data for Asian survivors is lacking. This study aimed to have an overview of, and identify any disease-or treatment-related factors associated with, HRQoL in Asian differentiated thyroid cancer survivors.Patients and Methods:Thyroid cancer survivors were recruited from the thyroid clinics at Queen Mary Hospital, Hong Kong from February 2016 to December 2016. All adult differentiated thyroid cancer patients with stable disease more than or equal to 1 year received a survey on HRQoL using the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and Thyroid cancer specific quality of life (THYCA-QoL) questionnaire. Clinical information was collected retrospectively from the computerized clinical management system. To identify factors associated with poor HRQoL, univariable and stepwise multivariable regression analysis were performed.Results:A total of 613 survivors completed the questionnaires (response rate: 82.1%; female: 80.1%; median survivorship: 7.4 years (range: 1.0-48.2 years)). The QLQ-C30 summary score mean was 84.4 (standard deviation (SD): 12.7) while the THYCA-QoL summary score mean was 39.9 (SD: 9.7). The 2 highest symptom subscales were fatigue (mean: 26.4, SD: 20.6) and insomnia (mean: 26.2, SD: 27.6). Factors associated with worse HRQoL included serum thyrotropin (TSH) greater than 1.0 mIU/L, unemployment, and concomitant psychiatric disorders. Concomitant psychiatric illness (n = 40/613, 6.5%) also showed significant association with most of the symptom and functional subscales.Conclusions:Fatigue and insomnia were the 2 most common symptoms experienced by our differentiated thyroid cancer survivors. Long-term survivorship care with monitoring serum TSH level, supporting return-to-work and screening for concomitant psychiatric disorders should be offered.

‘I Am Talking About It Because I Want to Stop It’: Child Sexual Abuse and Sexual Violence Against Women in British South Asian Communities

This article explores the role of socio-cultural factors in violence against women and girls, focusing on child sexual abuse (CSA) and sexual violence (SV) in British South Asian communities. Using examples from 13 in-depth interviews with survivors, the researchers examine (1) how abusers gain access to their victims, (2) family and community responses and (3) the role of cultural factors in concealing CSA/SV. The interviews demonstrate that British South Asian survivors are extremely reluctant to disclose SV/CSA due to factors that other groups of victims usually do not face, including a general taboo about discussing sex and strong cultural norms around notions of shame. These findings are contextualized in relation to a larger study that also involved community focus groups and interviews with professionals in relevant fields. Moving forward, new culturally specific support pathways for British South Asian victims must be developed that take account of the role that victims and their communities must play if CSA and SV are to be effectively combatted.

Risk and protective factors of intimate partner violence among South Asian immigrant women and perceived need for services.

Limited research exists on multilevel influences of intimate partner violence (IPV) among immigrant groups in the United States, particularly South Asians. Using a socioecological framework, this study examined risk and protective factors of IPV among a diverse group of South Asian immigrant survivors of IPV and identified their perceived need for services. Sixteen South Asian immigrant survivors were recruited from New York; Maryland; Virginia; and Washington, DC, using a snowball sampling method. Participants were 1st-generation and 2nd-generation immigrants born in India (n = 4), Bangladesh (n = 4), Pakistan (n = 5), the United States (n = 2), and Sri Lanka (n = 1). Data were collected using in-depth interviews (n = 16) and a focus group (n = 1). A thematic analysis procedure was used to analyze the data and to identify themes across different ecological levels. IPV was related to factors at multiple levels, such as cultural normalization of abuse, gender role expectations, need to protect family honor, arranged marriage system, abusive partner characteristics, and women's fear of losing children and being on own. Protective factors included supportive family and friends, religion, safety strategies, education, and empowerment. Women highlighted the need for community education and empowerment efforts and culturally responsive services for addressing IPV in South Asian communities. South Asian survivors of IPV have experienced, and some continue to experience, abuse due to factors operating at multiple levels of the ecological framework. Consideration of culturally specific risk and protective factors for IPV at multiple contexts in women's lives could inform culturally responsive IPV prevention and intervention strategies for South Asian communities in the United States. (PsycINFO Database Record

Healthcare experience among older cancer survivors: Analysis of the SEER-CAHPS dataset.

Little is known about factors affecting medical care experiences of cancer survivors. This study examined experience of care among cancer survivors and assessed associations of survivors' characteristics with their experience. We used a newly-developed, unique data resource, SEER-CAHPS (NCI's Surveillance Epidemiology and End Results [SEER] data linked to Medicare Consumer Assessment of Healthcare Providers and Systems [CAHPS] survey responses), to examine experiences of care among breast, colorectal, lung, and prostate cancer survivors age >66years who completed CAHPS >1year after cancer diagnosis and survived ≥1year after survey completion. Experience of care was assessed by survivor-provided scores for overall care, health plan, physicians, customer service, doctor communication, and aspects of care. Multivariable logistic regression models assessed associations of survivors' sociodemographic and clinical characteristics with care experience. Among 19,455 cancer survivors with SEER-CAHPS data, higher self-reported general-health status was significantly associated with better care experiences for breast, colorectal, and prostate cancer survivors. In contrast, better mental-health status was associated with better care experience for lung cancer survivors. College-educated and Asian survivors were less likely to indicate high scores for care experiences. Few differences in survivors' experiences were observed by sex or years since diagnosis. The SEER-CAHPS data resources allows assessment of factors influencing experience of cancer among U.S. cancer survivors. Higher self-reported health status was associated with better experiences of care; other survivors' characteristics also predicted care experience. Interventions to improve cancer survivors' health status, such as increased access to supportive care services, may improve experience of care.

Racial and ethnic disparities in patient-provider communication, quality-of-care ratings, and patient activation among long-term cancer survivors.

We examined racial and ethnic disparities in patient-provider communication (PPC), perceived care quality, and patient activation among long-term cancer survivors. In 2005 to 2006, survivors of breast, prostate, colorectal, ovarian, and endometrial cancers completed a mailed survey on cancer follow-up care. African American, Asian/Pacific Islander (Asian), Hispanic, and non-Hispanic white (white) survivors who had seen a physician for follow-up care in the past 2 years (n = 1,196) composed the analytic sample. We conducted linear and logistic regression analyses to identify racial and ethnic differences in PPC (overall communication and medical test communication), perceived care quality, and patient activation in clinical care (self-efficacy in medical decisions and perceived control). We further examined the potential contribution of PPC to racial and ethnic differences in perceived care quality and patient activation. Compared with white survivors (mean score, 85.16), Hispanic (mean score, 79.95) and Asian (mean score, 76.55) survivors reported poorer overall communication (P = .04 and P < .001, respectively), and Asian survivors (mean score, 79.97) reported poorer medical test communication (P = .001). Asian survivors were less likely to report high care quality (odds ratio, 0.47; 95% CI, 0.30 to 0.72) and reported lower self-efficacy in medical decisions (mean score, 74.71; P < .001) compared with white survivors (mean score, 84.22). No disparity was found in perceived control. PPC was positively associated with care quality (P < .001) and self-efficacy (P < .001). After adjusting for PPC and other covariates, when compared with whites, Asian disparities remained significant. Asian survivors report poorer follow-up care communication and care quality. More research is needed to identify contributing factors beyond PPC, such as cultural influences and medical system factors.

Abstract PR07: Racial-ethnic disparities in patient-provider communication and overall perceptions of follow-up care quality among adult cancer survivors.

Abstract Purpose: Poor patient-provider communication (PPC) may contribute to racial-ethnic disparities in healthcare, and is critical to quality cancer survivorship care. Racial-ethnic differences in PPC have been noted among cancer survivors; however, previous studies have focused primarily on comparing White and African American patients and survivors recently diagnosed or treated for cancer. This study examined racial-ethnic differences in PPC and its association with perceived follow-up care quality among a diverse sample of long-term cancer survivors. Methods: Survivors of breast, prostate, colorectal, ovarian and endometrial cancers were recruited from Surveillance Epidemiology and End Results cancer registries in California to complete a mailed survey on cancer follow-up care. African American, Asian/Pacific Islander (Asian), Hispanic, and non-Hispanic White (White) cancer survivors were selected for this analysis if they had seen a doctor for cancer-related follow-up care in the past two years (n=1215). We conducted linear regression analyses to identify racial-ethnic differences in PPC (general follow-up care communication and explanation of medical tests). We used logistic regression models to examine the association between race-ethnicity and dichotomized perceived follow-up care quality outcomes: overall rating (very good/excellent vs. poor/fair/good) and receipt of desired help with symptoms/side effects (usually/always vs. never/sometimes). Finally, we added PPC to the adjusted logistic regression models to assess the effect of PPC on racial-ethnic differences in perceived follow-up care quality, adjusting for covariates (age, gender, education, insurance, comorbidities, cancer treatment modalities, cancer site, stage at diagnosis, number of provider visits for follow-up care, time since most recent follow-up care visit, duration of relationship with follow-up care provider, and whether it was the same provider seen for cancer treatment). Results: Of the 1215 survivors, 24% were African American, 22% were Asian, 13% were Hispanic, and 39% were White. Compared to White survivors, all minority survivors reported poorer explanation of medical tests (F=4.69, p=0.003), and Asian and Hispanic survivors reported poorer follow-up care communication (F=11.42, p&amp;lt;0.001). Asian survivors were also less likely to report receipt of desired help with symptoms/side effects (OR=0.46, 95%CI: 0.27-0.79), and both African American and Asian survivors were less likely to report high overall ratings of follow-up care quality (OR= 0.55, 95%CI: 0.38-0.79 and OR=0.43, 95%CI: 0.30-0.62, respectively) compared to White survivors. In fully adjusted models, including PPC, Asian survivors remained less likely to rate overall follow-up care quality as good/excellent (OR: 0.51, 95%CI: 0.28-0.93) compared to White survivors. No other significant racial-ethnic differences persisted. Conclusions: Both Asian and Hispanic survivors reported poorer PPC. For some survivors, PPC may help to explain disparities in perceived follow-up care quality; however, Asian survivors reported poorer overall ratings of follow-up care, despite controlling for covariates and PPC. Addressing PPC is important as poor communication may also affect survivors' ability to actively participate in follow-up care. This abstract is also presented as Poster A12. Citation Format: Nynikka R.A. Palmer, Neeraj K. Arora, Erin Kent, Laura Forsythe, Julia H. Rowland, Noreen Aziz, Kathryn E. Weaver. Racial-ethnic disparities in patient-provider communication and overall perceptions of follow-up care quality among adult cancer survivors. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr PR07.

Multiplicities of Violence: Responses to September 11 from South Asian Women's Organizations

On September 11, 2001, and the period that followed, the author was a full-time staff member at a community-based organization dedicated to ending violence against South Asian1 women. She was also involved in immigrant rights, racial justice, and queer/trans justice work. Being simultaneously positioned in these sometimes overlapping, sometimes distinct, spheres produced unexpected insights into the alliances and fractures that emerged through South Asian community-based responses to September 11 and its impacts on the communities. In this paper, the author explores the limitations South Asian women’s organizations (SAWOs) experienced in holding the complexities of the myriad forms of state, institutional, and interpersonal violence that faced South Asian survivors in the post–September 11 period. These limitations were rooted in the obscurity of the role of structural violence in the everyday lives of South Asian communities, which was made possible through 1) a general emphasis on criminal legal solutions to respond to violence in the interpersonal realm; and 2) the location of SAWOs’ work in discourses of culture and the consequent advocacy for culturally specific needs of survivors.

Assessment of Quality of Cancer-Related Follow-Up Care From the Cancer Survivor's Perspective

We assessed cancer survivors' perceptions of the quality of their follow-up care. We surveyed a population-based cohort of leukemia, bladder, and colorectal cancer survivors diagnosed 2 to 5 years previously in northern California (N = 623; participation rate, 69.2%; overall response rate, 49.2%). Data were collected between April 2003 and November 2004. Ten scales assessed survivors' perceptions of different aspects of care in the last 12 months, and an eleventh scale measured their overall ratings of care. On nine of the 11 scales, mean scores ranged from 88 to 97 on a 0 to 100 response format, indicating very positive experiences. The two areas where quality perceptions were lower were discussions about health promotion and the physician's knowledge of the whole patient. In adjusted analyses, those without private health insurance (P = .02) and Hispanic and Asian survivors compared with whites (P < .001) reported worse timeliness of care. Survivors who had multiple comorbidities reported better scores on timeliness of care (P < .01) and physicians' knowledge (P = .05) than survivors without any comorbidity. Length of the patient-physician relationship was the variable most consistently found to be significantly associated with survivors' quality assessments. Physicians' information exchange had the strongest relationship with overall ratings of care, followed by physicians' affective behavior, their knowledge of the survivor, and survivors' perceptions of coordination of care (P < .001 for all). Delivery of quality follow-up care to cancer survivors may require efforts to improve patient-centered communication and coordination. Special emphasis may need to be placed on health promotion discussions and adoption of a whole-person orientation.

Study Protocol to Investigate the Efficacy of Participation in Qi-Gong by Breast Cancer Survivors

Background: Physical activity improves quality of life and reduces the risks of breast cancer up to 30 - 40 percent. Qi-Gong is a form of exercise widely acknowledged by Asian survivors as health promoting, despite a lack of research evidence. This study aimed to investigate the efficacy of Qi-Gong on the Quality of Life (QOL) of survivors. Methods/ Design: A total of 114 women who had been treated for stage I or II breast cancer at least 12 months previously were randomly assigned to supervised aerobic exercise (n = 38), Qi-Gong exercise (n = 38), or usual care (n = 38). Supervised 1.5 hour exercise sessions took place three times per week for 8 weeks (face to face—once a week and home follow up twice a week). Outcomes included QoL (FACT-G), Functional Assessment of Cancer Therapy-Breast (FACT-B)], distress [Depression Anxiety Stress Scale (DASS)] assessed at baseline and at the 8-week follow-up. Secondary measures included exercise Self Efficacy Scale (ESS), Functional Assessment of Cancer Therapy-Fatigue (FACT-F) and exercise behavior (log) Two way (group × time) repeated measures ANOVA will examine differences between groups over time. Discussion: This research will provide insights on the efficacy of a 8 weeks structured Qi-Gong program designed for quality of life. The details of the Qi-Gong and the placebo (line dancing) over 8 weeks are delineated, with the study protocol for researcher’s replication. The result of the study can contribute towards understanding how Qi-Gong over other physical activity can be used for self managing physical health for people with breast cancer, an increasingly acknowledged chronic condition. Conclusion: Women with breast cancer need to start engaging in physically healthyactive living on a day-to-day basis for prevention of recurrence, mortality and wellbeing. However, many requires professional support with a structured intervention. This design of this study provides a protocol for 8 weeks Qi-Gong with implications on healthy survivorship, and a possible reduction on healthcare costs related to long-term effects and co morbidities that can be prevented via physical activity.

Comprehensive clinical follow-up of late effects in childhood cancer survivors shows the need for early and well-timed intervention

Background: Due to recent advances in treatment, nearly 80% of childhood cancer patients become long-term survivors. Studies on the late effects of survivors are under way worldwide. However, data on Asian survivors remain limited.Methods: Data on 241 survivors at the Long-term Follow-up Clinic in Severance Hospital, South Korea, were collected and late effects were confirmed by oncologists.Results: The median follow-up from diagnosis was 7.8 years. Late effects were identified in 59.8% of survivors and 23.2% had two or more late effects. Grade 3 or higher late effects were present in 10.8%. The most common late effects involved endocrine system (29.0%). Late effects were present in 95.7% of brain tumor survivors and 36.0% of Wilms' tumor survivors. Chemotherapy, hematopoietic stem-cell transplantation and radiotherapy were significant factors associated with the number and severity of late effects (P<0.05). Brain tumor survivors had more severe late effects (P<0.001), whereas Wilms' tumor survivors had fewer and milder late effects (P<0.05).Conclusion: The observation that over 50% of cancer survivors suffered from late effects during the short follow-up period and that a high frequency of endocrine late effects was present indicates the need for early and well-timed intervention of the survivors.

Mental health and the psychosocial consequences of natural disasters in Asia

This article presents an overview of natural disasters in Asia, as well as mental disorders and psychosocial interventions related to disasters. Although most of the top ten worst natural disasters occurred in Asia over the past century, little is known about the mental health and psychosocial aspects. After the tsunami incident in 2004, research reports in international journals related to Asian disasters have been growing. The prevalence rate of post-traumatic stress disorder related to natural disasters is currently between 8.6% and 57.3% depending on assessment methodologies, instruments and timing. Cognitive behaviour therapy has been found to be effective with Asian survivors but needs to be adapted for cultural and local sensitivities. Further research is needed in the areas of epidemiology for mental disorders and suitable psychosocial interventions for disaster survivors in Asia.