Low-income Breast Cancer Survivors Research Articles

Physical activity in association with mortality among Black women diagnosed with breast cancer in the Southern Community Cohort Study.

Physical activity (PA) is associated with many health benefits. While PA has been associated with reduced mortality after breast cancer diagnosis in many studies, few studies have examined the role of PA in breast cancer survival among underserved and minority populations, including Black women. We investigated PA in association with mortality among Black predominantly low-income breast cancer survivors in the Southern Community Cohort Study (SCCS). Study participants were women diagnosed with incident breast cancer (n = 949) in the SCCS, which is a prospective cohort study of predominantly low-income adults aged 40-79years recruited from 12 Southeastern states between 2002 and 2009. Participants completed a detailed baseline questionnaire, with annual follow-up for mortality via registry linkages. Cox regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for associations of pre-diagnosis PA (measured via a validated questionnaire) with all-cause and breast cancer-specific mortality. Breast cancer survivors had a mean age of 61.1years and most (79.3%) had a household income of < $25,000. In adjusted models, higher levels of total PA (MET-hours/day) were inversely associated with all-cause mortality with HRs (95% CIs): 0.79 (0.59-1.06), 0.66 (0.49-0.90), and 0.60 (0.43-0.84), for Q2, Q3, and Q4 (reference: Q1), respectively, ptrend ≤ 0.01. A similar inverse association was found for breast cancer-specific mortality. Higher levels of pre-diagnosis PA were associated with improved survival among low-income Black breast cancer survivors. Resources to reduce barriers to PA participation and increase support for education and intervention efforts to promote PA among Black women are needed.

Abstract P4-11-19: Utilization of the RE-AIM frameworkfor evaluating the implementation of group medical visit for low-income breast cancer survivors

Abstract Introduction: Providing cost effective comprehensive survivorship care (SC) remains a major challenge for which optimal delivery models are needed. Group medical visits (GMV) are commonly used in chronic diseases to deliver medical care, education, and empower patients. Pilot GMV studies for breast cancer survivors (BCS) have shown increases in peer support and patient education. This pilot study uses the RE-AIM framework for evaluation of the GMV intervention to support breast cancer survivors. RE-AIM is an efficient framework for systematic evaluation of health care interventions. RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) is the evaluation methodology based on the framework developed by a working team of scholars from health care, public health, and implementation science. Methods: The study was conducted at a public hospital in California. GMV consisted of 4, 2-hour, weekly sessions focused on therapy side effects and prevention, emotional health, sexual health, physical activity, and diet. Patient navigator (PN) recruited 3 consecutive GMV groups of 6 English-speaking BCS (n=18). Results: The Reach was determined by the number and proportion of participants in this study. Our participants were primarily English-speaking and were within 1-5 years of completing active breast cancer treatment. Participants of the GMV were from diverse backgrounds and low-income neighborhoods in San Francisco and were representative of breast cancer survivors in our population. Effectiveness of GMV were assessed through self-reported changes with increased knowledge of survivorship care plans, recognition, and management of long-term side effects of cancer treatments and knowledge of community-based resources. There was an increase from baseline in all these domains and in confidence communicating with their primary care provider. Adoption involved initial stakeholder engagement in the intervention and Implementation was assessed by the consistent content and delivery of the intervention. We did not evaluate Maintenance as it was out of the scope of this study. We found that ongoing need for services is extremely high in our BCS, suggesting that this intervention has the potential to be widely adopted by cancer survivors and survivorship programs. Overall, consistent attendance and active participation indicated that GMV are feasible in this setting. 94% of BCS reported GMV increased their awareness and confidence of SC. Participants reported high satisfaction, felt well-informed, and supported through the availability of GMV. BCS highlighted the benefits of integrating treatment, services, emotional support, and education. BCS suggested GMV should be implemented at time of cancer diagnosis and emphasized the key role of PN in GMV and supporting SC. Conclusions: GMVs were specifically designed to address unmet needs for services that are necessary for SC but not readily available. Our pilot data suggests PN facilitated GMV are a feasible and acceptable model to integrate SC in public hospitals. The evaluation of our intervention using the RE-AIM framework can aid potential adopters in developing and implementing GMV intervention to support BCS. Citation Format: Evelin Trejo, Ana I. Velazquez, Elizabeth Castillo, Barbara Cicerelli, Robin McBride, Nancy J. Burke, Niharika Dixit. Utilization of the RE-AIM frameworkfor evaluating the implementation of group medical visit for low-income breast cancer survivors [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-19.

Predictors of health-related quality of life among Hispanic and non-Hispanic White breast cancer survivors in New Jersey

Purpose To examine predictors of health-related quality of life (HRQoL) in Hispanic and non-Hispanic White (NHW) breast cancer (BC) survivors. Design Cross-sectional study using survey data. Participants Women diagnosed with BC at ages 21-79 years, between 2012-2014, recruited from the New Jersey State Cancer Registry. Methods HRQoL was assessed using the Functional Assessment Cancer Therapy (FACT-G) instrument. Descriptive statistics compared Hispanics and NHWs, and multivariate regression analyses identified predictors of HRQoL. Results HRQoL was significantly higher scores among NHW (85.7 ± 18.5) than Hispanics (79.4 ± 20.1) (p < 0.05). In multivariate analyses, comorbidities (β: −13.3, 95%CI: −20.6, −5.92), late-stage diagnosis (β: −5.67, 95%CI: −10.7, −0.62), lower income (β: −13.9, 95%CI: −19.8, −7.97) and younger age at diagnosis were associated with lower HRQoL. Conclusion Socio-demographic and clinic characteristics were significant predictors of HRQoL among diverse BC survivors. Implications for Psychosocial Oncology Supportive psychosocial care interventions tailored to the needs of young, low-income BC survivors with comorbidities are needed.

Physical impairments and physical therapy services for minority and low-income breast cancer survivors.

PurposeWe describe impairments after breast cancer and its treatment for African American (AA), non-Hispanic white and low-income breast cancer survivors (BCS) and whether physical therapy (PT) was utilized to address these impairments.MethodsBCS from the Southern Community Cohort Study (SCCS) were surveyed about self-reported BC treatment-related impairments (shoulder impairment, muscle weakness, pain, fatigue, skin numbness, abnormal posture) and referral to PT for impairments. We compared impairments by race, income and PT utilization. We used a cross-sectional design.ResultsAmong 528 BCS interviewed (266 whites; 262 AA), mean age 64, those with low incomes were more likely to report muscle weakness, pain and postural abnormalities, and a greater total number of impairments than those with higher incomes. Racial differences were few. PT utilization tended to be low, with AAs more likely than whites to utilize PT if they had shoulder impairment or pain, whereas no monotonic trends across income levels were seen in PT utilization.ConclusionsLow-income level was associated with greater prevalence of BC-related physical impairments, but not higher PT utilization. There appears to be a possible under-utilization of PT, particularly for those with low incomes.

Changes in Lower Body Functional Strength after Physical Activity Intervention in Sedentary Low Income Breast Cancer Survivors

Studies show physically active breast cancer survivors (BCS) can reduce risk of breast cancer (BC) recurrence and BC-related mortality. Physical activity (PA) can help reduce many quality of life (QOL) concerns reported by BCS. Reviews of PA for cancer survivors report interventions improved aerobic fitness, body strength, BMI, and QOL. PURPOSE: Examine changes in lower body functional strength (LBFS) after a 16 week PA intervention in inactive, low-income BCS. Consideration of LBFS is imperative in establishing an active lifestyle which can lead to greater QOL and reduce risk of cancer recurrence. METHODS: Participants (PTS) were low-income, underinsured BCS from the Houston, TX area with less than 150 minutes of moderate PA a week. An in-person PA program was delivered in 12 group sessions over 16 weeks. This included 10 minutes of PA to instruct on intensity, resistance tubes use, and PA safety. PTS were asked to complete 30 minutes of moderate or greater intensity PA 5 or more days a week, and include 2 days resistance training weekly. The short International Physical Activity Questionnaire (IPAQ) (baseline (BL), follow up (F/U)) was used to measure if PTS met PA criteria. The 6 minute walk test (6MWT) and 30 second sit-to-stand (Rikli and Jones Senior Fitness test Manual) were used at BL and F/U to assess lower body physical function (LBPF). RESULTS: We examined 35 PTS, mean age 59, median education some college. IPAQ results show significant increase in PA between BL and F/U in all categories of intensity: walk (p = .018), moderate (p = .007), vigorous (p = .009). We observed significant increase in 30 second sit-to-stand count (p = .045) but not 6MWT (p = .141). Paired t-tests were used between BL and F/U. CONCLUSION: Results suggest PA including guidance in increasing PA can produce positive changes in PA on all intensity levels. Initial gains LBFS may be attributed to newly introduced resistance activity and resulting muscle adaptation. While no significant results were seen in 6MW, gains in LBFS show potential for gains in overall (LBPF) with a well-planned PA program involving progressive overload for aerobic conditioning leading to more PA and better QOL. Funded by the Cancer Research Institute of Texas (CPRIT). Acknowledgements: Center for Energy Balance in Cancer Prevention and Survivorship, Kelsey Research Foundation

Abstract A88: Medicaid expansion and access to care among breast cancer survivors

Abstract Background: Breast cancer survival is improving due to early detection of the disease and advances in treatment. In the United States, there are more than 3 million breast cancer survivors and approximately 240 thousand women diagnosed with the disease every year. To receive effective treatment, breast cancer survivors need to follow a treatment plan prescribed by their physicians. However, access to healthcare services remains a barrier to completing needed treatment. Medicaid expansion under the Affordable Care Act improves access to care among vulnerable populations, but almost half of the states opted out of the expansion. Research Objective: We shed light on the potential effect of Medicaid expansion on access to care among breast cancer survivors by assessing inability to see a doctor due to cost before Medicaid expansion in non-expansion states versus expansion states. Study Design: We use a logistic model (accounting for the weighted sample) and control for demographics, insurance status, and general health. We calculate the odd ratios of inability of survivors of breast cancer to see a doctor in the past year due to cost. Population Studied: We use data from the Behavioral Risk Factor Surveillance (BRFSS) for the years 2009, 2010, and 2012, which are the only years containing data on cancer survivorship. The BRFSS is a nationally representative survey that collects information on self-reported preventive health practices and risk behaviors. The sample used for this study consists of women ages 40 to 64, in all 50 states and Washington D.C., and who were diagnosed with breast cancer (n = 3,223). Results: Preliminary results suggest that breast cancer survivors in non-expansion states had significantly higher odds of being unable to see a doctor due to cost (OR = 1.63, 95% CI =1.10, 2.42). Conclusions: Living in a state that expands Medicaid will be an advantage for low-income breast cancer survivors because it will improve their access to healthcare services. Existing disparities in access to care are likely to widen between survivors of breast cancer in non-expansion states and expansion states as a result of lack of affordable insurance coverage for low-income cancer survivors in non-expansion states. Citation Format: Wafa W. Tarazi. Medicaid expansion and access to care among 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 A88.

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

저소득층 유방암 생존자의 건강증진 행위 경험 연구

Abstract This study explores the health behaviors and related situations of Korean low-income breast cancer survivors using in-depth interview. The study derives 95 concepts, 23 sub-categories and 12 categories in open coding.Illness experiences were categorized by behavioral, psychological, and social domains, cognitive were categorized bycausal and destiny thought, emotions were categorized by negative, positive emotion, reserve capacity were categorized by internal and external domains and health behaviors were categorized by behavioral, psychological, andsocial domains. Understanding illness experience, cognitive, emotion, reserve capacity and health behaviors for Korean low-income breast cancer survivors will be useful in developing social welfare interventions and for enhancing healthpromotion. Key Words : Breast cancer survivors, Health behaviors, Low-income 이 논문은 2012년도 정부재원(교육부) 으로 한국연구재단의 지원을 받아 연구되었음(NRF- 2012S1A5A8022329) * Corresponding Author : Young-Sun Rhee (Chosun University)Tel: +82-62-230-6708 email: claudia@chosun.ac.krReceived March 27, 2015 Accepted May 7, 2015Revised (1st April 27, 2015, 2nd May 6, 2015)Published May 31, 2015

Early predictors of not returning to work in low-income breast cancer survivors: a 5-year longitudinal study

Low-income women may be especially vulnerable to job loss after a breast cancer diagnosis. The identification of early risk factors for not returning to work in the long term could inform interventions to help survivors avoid this outcome. A consecutive sample of low-income, employed, underinsured/uninsured women treated for stage 0-III breast cancer was surveyed 6, 18, 36, and 60months after diagnosis. Participants were classified according to the survey in which they first reported return to work. If they were not working in every survey they were classified as not returning to work. Correlates of not returning to work were identified. Of 274 participants, 36% returned to work by 6months, an additional 21% by 18, 10% by 36, and 5% by 60months. 27% never returned to work. Of those not working at 6months, 43% never returned. Independent predictors of never returning to work included lowest annual income (<$10,000), Latina ethnicity, high comorbidity burden, and receipt of chemotherapy. Very poor women who stop working during chemotherapy for breast cancer are at risk of not returning to work months and years following treatment. These findings may have clinical and policy implications. Conversely, radiation therapy, axillary node dissection, age, and job type do not appear to be associated with return to work. Clinicians should discuss work-related concerns with patients and facilitate early return to work when desired by the patient. Additional research is needed to develop interventions to optimize return to work.

Is Medical Home Enrollment Associated With Receipt of Guideline-Concordant Follow-up Care Among Low-Income Breast Cancer Survivors?

Community Care of North Carolina (CCNC) initiated an innovative medical home program in the 1990 s to improve primary care in Medicaid-insured populations. CCNC has been successful in improving asthma, diabetes, and cardiovascular outcomes but has not been evaluated in the context of cancer care. We explored whether CCNC enrollment was associated with guideline-concordant follow-up care among breast cancer survivors. Using state cancer registry records matched to Medicaid claims, we identified women 18 to 64 years old who were diagnosed with stage 0, I, II, or unstaged breast cancer from 2003 to 2007 and tracked their monthly CCNC enrollment. Using published American Society for Clinical Oncology guidelines to define our outcomes, we employed multivariate logistic regressions to examine, as a function of CCNC enrollment, receipt of mammogram and at least 2 physical examinations/history-taking visits within observational windows consistent with the guidelines. Of the 840 women, approximately half were enrolled into the CCNC for some time during the study period. Between 40% and 85% received follow-up mammogram in accordance with guidelines, with significant variation by CCNC status, and 95% of women received at least 2 physical examinations/history-taking visits. In multivariate models, increasing months of CCNC enrollment was significantly positively associated with receipt of follow-up mammogram but not with physical examinations/history-taking visits. Results suggest that CCNC enrollment is associated with guideline-concordant follow-up care for Medicaid-insured survivors. Given the growing population of cancer survivors and increased emphasis on primary care medical homes, future studies should explore what factors are associated with medical home participation and whether similar findings are observed with extended follow-up.

Five-year trajectories of financial recovery in low-income breast cancer survivors.

9597 Background: Breast cancer may have devastating consequences on the financial stability of low-income families due to its impact on employment and limited duration of emergency Medicaid coverage. Methods: A consecutive sample of 921 low-income, uninsured/underinsured, English/Spanish-speaking women diagnosed with breast cancer through the California Breast and Cervical Cancer Treatment Program was surveyed 6 months after diagnosis. Previously uninsured women were enrolled in MediCal. Follow-up surveys were administered at 18, 36, and 60 months. Our primary outcome was self-reported adequacy of financial resources. Trajectories of financial adequacy were compared by ethnicity and by trajectories of employment and insurance status. Results: 6 months after diagnosis, 38% said they had adequate financial resources to meet their needs, compared to 39%, 49%, and 55% at 18, 36, and 60 months, respectively. Trajectories of financial adequacy varied by ethnicity and by trajectories of employment and insurance status (Table). Of 549 who reported on financial resources in all 4 surveys the most common trajectory was inadequate resources in all surveys (n=120) followed by adequate resources in all surveys (n=83). Of 208 who had adequate resources at 6 months, 60% reported inadequate resources in ≥1 subsequent survey. Of 341 who had inadequate resources at 6 months, 87% reported inadequate resources in ≥1 subsequent survey. Conclusions: Low-income breast cancer survivors are at risk of long-term financial instability. Latinas and survivors who are not working and/or are uninsured are at highest risk. Additional research is needed to better understand the factors that impact financial recovery after treatment. [Table: see text]

Depression and sexual adjustment following breast cancer in low-income Hispanic and non-Hispanic White women.

Hispanics are the largest and fastest growing ethnic minority group in the United States and breast cancer is the most commonly diagnosed cancer in Hispanic women. However, Hispanics are underrepresented in the psychosocial breast cancer literature. This study included 677 low-income women (425 Hispanic, 252 non-Hispanic White) enrolled in the Medi-Cal Breast and Cervical Cancer Treatment Program. Data were gathered through phone interviews conducted in English or Spanish 6 and 18 months following breast cancer diagnosis. We focus on three variables that the literature indicates are salient for breast cancer survivors: sexual function, body image and depression. Results of an ANCOVA indicated worse sexual function for Hispanic women, even after controlling for significant covariates. Hispanics reported significantly less sexual desire, greater difficulty relaxing and enjoying sex, and greater difficulty becoming sexually aroused and having orgasms than non-Hispanic White women. Both Hispanic and non-Hispanic White women endorsed a lack of sexual desire more frequently than problems with sexual function. Body image did not differ between Hispanic and non-Hispanic White women. In all, 38% of Hispanic and 48% of non-Hispanic White women scored above cut-off scores for depressive symptoms. While there was no ethnic difference in depressive symptoms, single women reported more depressive symptoms than partnered women. Findings suggest that low-income breast cancer survivors may experience symptoms of depression more than a year following diagnosis, and that sexual dysfunction may be particularly salient for low-income Hispanic women.