Rural Breast Cancer Survivors Research Articles

Abstract A024: Mind Your BEAT: A culturally adapted intervention to increase physical activity and reduce psychosocial distress among rural breast cancer survivors

Abstract Purpose: Rural cancer survivors are less likely to meet physical activity recommendations than urban cancer survivors, contributing to physical inactivity-related cancer health disparities. Evidence-based interventions to reduce psychosocial distress and increase physical activity in cancer survivors were developed in urban or clinical settings and often fail when implemented in rural community settings. The purpose of this study was to use a community-engaged approach to develop and evaluate an intervention to reduce psychosocial stress and increase physical activity in rural breast cancer survivors in Northeast Texas. Method: We conducted interviews with community partners and rural breast cancer survivors to adapt an evidence-based program for rural cancer survivors and for implementation in a rural community setting. The Mind Your BEAT (MYB) intervention combined aerobic exercise, group education, and mind-body strategies to increase physical activity and reduce psychosocial distress in rural breast cancer survivors. Participants were recruited through FitSteps for Life, an existing evidence-based exercise program, and randomized to participate in MYB or FitSteps as usual (control group). Self-reported weekly leisure time physical activity (WLA) was assessed using the Godin Leisure-Time Exercise Questionnaire, and psychosocial distress was assessed using the NCCN distress thermometer. All measures were completed at baseline and following the 3-month intervention. Participants were categorized as meeting physical activity recommendations or not (WLA score ≥24 or <24) and reporting high or low psychosocial distress (NCCN score ≥4 or <4). Results: To date, 29 rural breast cancer survivors (M age=65.8±10.3 years) have enrolled in the study, and 24 (83%) were retained at post-intervention. Most participants completed a bachelor degree or more (62%), reported an annual household income >$40,000 (80%), reported their cancer stage at diagnosis was 0-II (95.9%), and were over 5 years post-treatment (M=5.9±8.4 years). In the MYB intervention, the percent of rural breast cancer survivors who met physical activity recommendations increased from 53.3 to 90.9% compared to the control group, which decreased from 64.3 to 50%. The percent of rural cancer survivors who reported high psychosocial distress decreased from 66.7 to 27.3% in the MYB group and from 57.1 to 41.7% in the control group. Conclusions: MYB integrates physical and psychological health and wellbeing and is feasible among rural breast cancer survivors who are insufficiently active. Furthermore, MYB improved physical activity and reduced psychosocial distress among rural cancer survivors who experience poorer cancer survivorship outcomes and are at greater risk of recurrence, comorbidity and death. Findings from this study fill a critical gap in the literature on the translation of evidence-based interventions into sustained practice in rural community settings. Citation Format: Scherezade K. Mama, Lily Ju, Brandy Friendly, Ian Leavitt, Laura Q. Rogers, Kathryn H. Schmitz, Lorna H. McNeill. Mind Your BEAT: A culturally adapted intervention to increase physical activity and reduce psychosocial distress among rural breast cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A024.

Quality of life assessment of breast cancer survivors in Northern Morocco: Rural-urban disparity.

This article is a cross-sectional study of 216 women undergoing adjuvant hormone therapy for breast cancer in two oncology centers in northern Morocco. Quality of life (QoL) was assessed using the Functional Assessment of Cancer Therapy (FACT) questionnaire and its endocrine subscale (ES). The relationship between rural-urban status in our sample and QoL was assessed by linear regression analysis using sociodemographic and clinical variables as covariates. Our results show that physical and functional well-being are significantly (p <0.001) higher in rural areas (24 and 29, respectively) than in urban areas (16 and 19, respectively), while social and emotional well-being are significantly (p <0.001) higher in urban areas (22 and 21, respectively) than in rural areas (15 and 16, respectively). However, there was no significant difference (p =0.097) between rural and urban breast cancer survivors regarding endocrine symptom burden. Regarding the effect of sociodemographic and clinical factors on overall HRQOL of breast cancer survivors, hormone type was shown to have a significant effect on overall HRQOL (FACT-ES) of rural and urban breast cancer survivors (𝛽 = +0.849 and 𝛽 = +0.678, respectively). A similar effect was observed for ES (𝛽 = +0.896 and 𝛽 = +0.180, respectively).In contrast, other factors (age, marital status, economic status, menopausal status, type of surgery) did not have a significant effect on HRQOL (FACT-ES) or ES.The study highlighted the need for increased psychosocial supportive care efforts for rural breast cancer survivors to improve their QoL.

Adverse Health Outcomes among Rural and Urban Breast Cancer Survivors: A Population-Based Cohort Study.

Limited population-based studies have focused on breast cancer survivors in rural populations. We sought to evaluate the risk of adverse health outcomes among rural and urban breast cancer survivors and to evaluate potential predictors for the highest risk outcomes. A population-based cohort of rural and urban breast cancer survivors diagnosed between 1997 and 2017 was identified in the Utah Cancer Registry (UCR). Rural breast cancer survivors were matched on year (±1 year) and age at cancer diagnosis (±1 year) with up to 5 urban breast cancer survivors (2,359 rural breast cancer survivors; 11,748 urban breast cancer survivors). Cox proportional hazards models were used to calculate HRs with 99% confidence intervals (CI) for adverse health outcomes overall, within 5 years, and >5 years after cancer diagnosis. Compared with urban breast cancer survivors, rural breast cancer survivors had a 39% (HR, 1.39; 95% CI, 1.02-1.65) higher risk of heart failure (HF) within the 5 years of follow-up. Overall, there was no increase in the risk of other evaluated adverse health outcomes. A higher baseline body mass index and Charlson Comorbidity Index, family history of cardiovascular diseases, family history of breast cancer, and advanced cancer stage were risk factors for HF for rural and urban breast cancer survivors, with similar levels of HF risk. Rural residence was associated with an increased risk of HF among breast cancer survivors. Our study highlights the need for primary preventive strategies for rural cancer survivors at risk of heart failure.

Physical activity and cognitive function: A comparison of rural and urban breast cancer survivors.

Increasing evidence suggests rural breast cancer survivors (BCS) may experience greater burden in symptoms known to be associated with cancer-associated cognitive decline (CACD). Yet, little is known about CACD in rural BCS. This study (1) examined differences in cognitive function, moderate-to-vigorous physical activity (MVPA), and other CACD correlates and (2) tested the effects of MVPA on cognitive function in rural versus urban BCS. Rural and urban BCS (N = 80), matched on age, education, and time since diagnosis from a larger study, completed cognitive tasks assessing processing speed (Trails-B, Mazes, Task-Switch) and working memory (spatial working memory) and questionnaires assessing subjective memory impairment (SMI), MVPA, and CACD correlates (i.e., sleep quality, fatigue, anxiety/depression). Some participants (n = 62) wore an accelerometer to objectively estimate MVPA. Multiple linear regression and multivariate analysis of covariance were used to test study aims. Rural BCS (n = 40, M = 61.1±8.4 years-old) performed significantly slower on Trails-B (p<0.01) compared with urban BCS (n = 40, M = 61.0±8.2 years-old) and engaged in less objectively-estimated daily MVPA (mean difference = 13.83±4.73 minutes; p = 0.01). No significant differences in SMI, self-reported MVPA, or CACD correlates were observed (all p>0.28). Regression models did not reveal a significant interaction between MVPA and cognitive performance (all p>0.1); however, estimated marginal means models indicated that the effect of MVPA on processing speed was evident only among rural BCS (Trails-B, p = 0.04; Mazes, p = 0.03). Findings suggest rural BCS may suffer greater CACD and engage in less MVPA. Additional research is warranted to further examine CACD and more effectively promote MVPA in rural BCS.

Assessing the relationship between body image and quality of life among rural and urban breast cancer survivors in China

BackgroundBreast cancer survivors experience altered body image and quality of life (QoL) due to the disease and its treatment. The multidimensional nature of body image and QoL makes their relationships complex. This study aimed to examine the associations between the two concepts in Chinese breast cancer survivors and test whether these associations are moderated by rural–urban residence.MethodsA cross-sectional design was adopted. Breast cancer survivors were recruited via a convenience sampling method. Two validated questionnaires (the Body Image Self-Rating Questionnaire for Breast Cancer and 36-item Short-Form Health Survey) and questions assessing demographic and clinical covariates were administered. Multiple linear regressions were used to assess the relationship between body image and QoL domains and to examine the moderating effect of rural–urban residence.ResultsIn our sample of 354 breast cancer survivors, half (50.28%) lived in rural areas. After adjusting for demographic and clinical variables, better perception of body image-related sexual activity change, role change, and psychological change was significantly associated with better physical (β ranged from − 0.15 to − 0.11, p < 0.05) and mental (β ranged from − 0.46 to − 0.34, p < 0.001) well-being. Better perception of body image-related social and behavior change was significantly associated only with better mental well-being (β ranged from − 0.40 to − 0.33, p < 0.001). The association between body image and mental well-being was much stronger in urban subjects (b = − 0.38, p < 0.001) than in rural subjects (b = − 0.20, p < 0.001).ConclusionsOur findings suggest that multidimensional body image is associated with physical and mental well-being in Chinese breast cancer survivors. Body image appears to play a larger role in urban breast cancer survivors’ mental well-being. Our results indicate that incorporating interventions that address body image issues would be advantageous for survivorship care to enhance QoL in breast cancer survivors. Furthermore, rural–urban differences should be considered in the strategic design of survivorship care programs in rural and urban settings.

The importance of patient engagement to quality of breast cancer care and health-related quality of life: a cross-sectional study among Latina breast cancer survivors in rural and urban communities

BackgroundCompared to their white counterparts, Latina breast cancer survivors experience poorer quality of care and worse health-related quality of life. Limited English proficiency (LEP) and patient engagement in cancer care could help explain these disparities. We assessed associations between LEP status and difficulty engaging with physicians, with self-reported quality of breast cancer care and health-related quality of life (physical and emotional well-being) among rural and urban Latina breast cancer survivors.MethodsAnalyses used cross-sectional baseline survey data from two studies that tested a stress management program among rural and urban Latina breast cancer survivors in California. Medical information was collected through medical records review. Linear regression models examined bivariate and multivariable associations of LEP status (yes or no), difficulty engaging with doctors (asking questions and participating in treatment decisions) (1–4; higher score = greater difficulty), and rural versus urban site, with three outcomes: (1) quality of breast cancer care and information; (2) physical well-being; and (3) and emotional well-being, controlling for demographic and medical factors.ResultsThe total sample included 304 women (151 from urban and 153 from rural sites). Mean age was 52.7 years (SD 10.9). Most were limited English proficient (84.5%) and had less than a high school education (67.8%). Difficulty engaging with doctors was inversely associated with patient ratings of quality of breast cancer care and information (B = − 0.190, p = 0.014), emotional well-being (B = − 1.866, p < 0.001), and physical well-being (B = − 1.272, p = 0.002), controlling for demographic and treatment factors. LEP (vs. not; B = 1.987, p = 0.040) was independently associated with physical well-being only. Rural/urban status was not related independently to any outcome.ConclusionsRural and urban Latina breast cancer survivors who report greater difficulty engaging with physicians experienced worse quality of breast cancer care and health-related quality of life. Promoting greater engagement of Latina breast cancer survivors in cancer care and providing medical interpreters when needed could improve patient outcomes among this vulnerable group.Trial registration: http://www.ClinicalTrials.gov identifier NCT02931552 and NCT01383174.

Rural breast cancer survivors are able to maintain diet quality improvements during a weight loss maintenance intervention.

Obesity and poor diet quality (DQ) are associated with increased risk of morbidity/mortality among breast cancer survivors. This study explored DQ changes during a weight loss maintenance intervention in a cohort of rural female breast cancer survivors (n = 131) who lost ≥ 5% body weight in a weight loss intervention. Previous analyses demonstrated significant DQ improvements during weight loss. DQ was calculated using the alternate Healthy Eating Index (aHEI)-2010. Differences in scores across time for the cohort and between those that maintained weight loss within 5% (low regainers) and those that regained > 5% (high regainers) were analyzed by linear mixed models. Significant improvements in aHEI total score were observed from baseline (M = 52.3 ± 11) to 6months (M = 60.7 ± 8; p < 0.001); these improvements were sustained from 6 to 18months (M = 58.4 ± 11; p = 0.16). Total aHEI-2010 score at 18months was higher in low regainers, compared with high regainers (60.7 vs. 56.0, p = 0.03), with healthier component scores for red meat (p = 0.01) and fruit (p = 0.04), and a trend for a healthier score for sugar-sweetened beverages (p = 0.08). Overall DQ improvements made during a weight loss intervention for rural breast cancer survivors were sustained during a weight loss maintenance intervention; this intervention was effective in helping low regainers maintain healthier scores in fruit, red meat, and sugar-sweetened beverage components. Maintaining higher DQ may help breast cancer survivors maintain weight loss, thereby reducing risk of breast cancer recurrence and premature death from comorbidities.

A systematic review of behavioral interventions for rural breast cancer survivors.

Rural breast cancer survivors (RBCS) are at greater risk for poorer health outcomes and face greater treatment barriers compared to their urban counterparts, necessitating behavioral interventions tailored for the unique needs of RBCS. A systematic review of studies examining behavioral interventions delivered to RBCS living in the United States from 2000 to 2020 was conducted following PRIMSA guidelines. Nineteen unique studies were included: eight randomized controlled trials, two matched-control studies, six pre-post intervention feasibility studies, and three post-intervention satisfaction studies. Thirteen interventions aimed to improve psychosocial support, three to improve weight management, and three to improve education. Results indicate interventions' feasibility and acceptability. Six out of eight intervention conditions reported favorable outcomes compared to control conditions, suggesting promise for efficacy. However, variability in intervention objective, duration, delivery, and follow-up timing, and small sample sizes prevent overarching conclusions. Research involving larger sample sizes, higher quality control groups, and longer follow-up data is needed.

Abstract A043: Baseline characteristics of rural Spanish-speaking Latina breast cancer survivors enrolled in a community-based RCT of a peer-delivered cognitive-behavioral stress management intervention: The Nuevo Amanecer rural trial

Abstract Introduction: Effective interventions tailored for rural Spanish-speaking Latina breast cancer survivors are needed to address their psychosocial health disparities. Purpose: Describe development of a rural community-based cognitive-behavioral stress management program, Nuevo Amanecer-R (NA-R) (New Dawn-R) and baseline characteristics of rural Latina breast cancer survivors enrolled in the RCT testing the program. Methods: Using community-based participatory research (CBPR) strategies, we applied a translational model appropriate for underserved populations that integrated an evidence-based intervention, a community best-practices program, and formative research to develop a program that could be delivered by trained breast cancer survivors (peers) in rural settings. We trained community recruiters to enroll, and collect hair and saliva biospecimens from, Spanish-speaking Latinas with nonmetastatic breast cancer in 3 rural California communities. Women were randomized to receive the program immediately or in 6 months. Primary outcomes include the Functional Assessment of Cancer Therapy-Breast Quality of Life (FACT-B) Total Score and its Physical, Social, Emotional, Functional Well-being, and Additional Concerns about Breast Cancer subscale scores (higher scores=better quality of life), with assessments at baseline, 3 months, and 6 months. Results: Based on input from survivors, advocates, and clinicians, modifications to the initial program for rural Latina survivors included further simplification of language, more visuals, developing stress management videos in Spanish and English, and expansion from 8 to 10 sessions to increase skills practice and healthy lifestyles information. Trained peers are delivering the 10-week NA-R program through weekly in-person 90-minute sessions in participants' homes. Components include managing the initial impact of cancer, finding cancer information and support, thoughts and mood management skills, behavioral stress management skills, and goal-setting. Of 231 women approached, 54 (24%) refused, 24 (10%) were ineligible, and 153 (66%) were randomized (76 to intervention, 77 to control group). To date, all baseline, 90% of 3-month, and 92% of 6-month assessments are completed. Participant characteristics are: mean age of 54.8 years (range, 28 to 88); 69% have &amp;lt; high school education; 66% are married; 80% have public/no health insurance; and 48% experienced financial hardship in the past year. Baseline FACT-B mean scores are: Total Score, 96.7 (possible range 0-144); Emotional Well-being, 17.3 (possible range 0-24); Functional Well-being, 18.2 (possible range 0-28); Social/Family Well-being, 18.2 (possible range 0-28); Physical Well-being, 20.4 (possible range 0-28); and Breast Cancer Concerns, 22.7 (possible range 0-36). Conclusions: Using CBPR principles in the design and implementation of community-based RCTs enhances cultural appropriateness, congruence with community contexts, and recruitment and retention. Citation Format: Jasmine Santoyo-Olsson, Anita L. Stewart, Carmen Ortiz, Steven Gregorich, Anna Maria Napoles. Baseline characteristics of rural Spanish-speaking Latina breast cancer survivors enrolled in a community-based RCT of a peer-delivered cognitive-behavioral stress management intervention: The Nuevo Amanecer rural trial [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A043.

Abstract A103: How do coping resources and financial hardship affect rural Latina breast cancer survivors' stress and depressive symptoms: The Nuevo Amanecer Rural Trial

Abstract Introduction: Compared to their white counterparts, Latina breast cancer survivors suffer from greater distress and poorer health-related quality of life. Yet little is known about the determinants of such distress. Purpose: Examine the independent associations of coping self-efficacy, social support, neighborhood cohesion, engagement with physicians, and financial hardship with depressive symptoms and perceived stress using baseline data from a randomized controlled trial of a stress management intervention among Spanish-speaking rural Latina breast cancer survivors. Methods: All data were self-reported and collected via in-person interviews in Spanish, except for medical information, which was obtained from medical records review. Bivariate linear models regressed either depressive symptoms (Patient Health Questionnaire-8) or stress (Perceived Stress Scale) on coping self-efficacy, social support, neighborhood cohesion, difficulty engaging with physicians, and financial hardship, controlling for demographic, medical factors, and study site. Hypothesized predictors that were statistically significant at p &amp;lt;0.20 in bivariate analyses were included in multivariate linear models. Higher scores on all measures signify more of the construct. Results: In bivariate analyses, coping confidence (b = -2.50; p &amp;lt;0.0001) and social support (b = -1.14; p &amp;lt;0.01) were negatively associated with depressive symptoms; difficulty engaging with physicians (b = 1.51; p &amp;lt;0.01) and financial hardship (b = 2.30; p &amp;lt;0.01) were positively associated with depressive symptoms. In multivariate analyses, only coping confidence (b = -2.35; p &amp;lt;0.0001) was negatively and independently associated with depressive symptoms, controlling for covariates. In bivariate analyses, coping confidence (b = -4.10; p &amp;lt;0.0001), social support (b = -2.66; p &amp;lt;0.0001), and neighborhood cohesion (b = -1.83; p &amp;lt;0.01) were negatively associated with stress; difficulty engaging with physicians (b=1.51; p =0.05) and financial hardship (b=4.58; p &amp;lt;0.0001) were positively associated with stress. In multivariate analyses, coping confidence (b = -3.65; p &amp;lt;0.0001) and neighborhood cohesion (b = -1.03; p &amp;lt;0.05) were negatively and independently associated with stress; financial hardship was positively and independently associated with stress (b = 3.44; p&amp;lt;0.01). Conclusions: Interventions that focus on increasing women's coping confidence and sense of neighborhood cohesion, and services to reduce their financial hardship, could help alleviate psychosocial health disparities among rural Latina cancer survivors. Citation Format: Anna M. Napoles, Jasmine Santoyo-Olsson, Anita L. Stewart, Carmen Ortiz, Steven Gregorich. How do coping resources and financial hardship affect rural Latina breast cancer survivors' stress and depressive symptoms: The Nuevo Amanecer Rural Trial [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A103.

Abstract C111: Biologic and self-reported stress levels among Latina breast cancer survivors: The Nuevo Amanecer Rural Trial

Abstract Among Latinas, breast cancer is the primary cause of cancer-associated mortality. Latinas experience breast cancer health disparities in disease-free survival, health-related quality of life, pain, fatigue, and anxiety, which may be a result of experiences of chronic stress. Chronic stress can impact the hypothalamic pituitary adrenal (HPA) axis, leading to changes in the tumor microenvironment and subsequently facilitate cancer progression. Little is known about the role of stress in cancer health disparities among Latinas. Our aim was to assess the feasibility of biospecimen collection and describe biologic and self-reported levels of stress using baseline data from a randomized controlled trial of a stress-management intervention among Spanish-speaking rural Latina breast cancer survivors (LBCS). We used community-based participatory research (CBPR) methods to recruit women, conduct interviews, and obtain saliva and hair samples. Recruiters were bilingual-bicultural women from local communities working in the community organizations that were research partners. Videos and print materials with graphics were developed in low-literacy Spanish to demonstrate biospecimen collection procedures. Recruiters provided instruction and demonstrations on sample collection and collected self-reported stress and depressive symptoms via in-person interviews in Spanish. Self-reported measures of stress and depressive symptoms consisted of the Perceived Stress Scale (PSS-10) and Personal Health Questionnaire (PHQ-8). Biologic stress was measured using hair (1 sample) and salivary cortisol (3 samples/day for 3 days). Mean hair cortisol concentration (HCC) in pc/mg units was used to assess chronic stress. The cortisol awakening response (CAR) measure assessed the activity of the HPA axis; curves that demonstrate a cortisol peak 30 minutes after awakening and a cortisol dip bedtime were considered normal. We recruited 103 participants from the Central Valley and Imperial County, California. Eighty-six percent provided saliva samples for CAR analysis, and 53% provided hair samples for HCC. Participants' mean age was 56 years (SD=10.6) and mean time since breast cancer diagnosis was 3.2 years (SD=3.2). Participants reported moderate (PSS mean score = 14.5; SD 7.5) stress levels and mild depression (PHQ-8 mean score = 6.3; SD 5.5). Biologic stress measurements demonstrated that 37% of participants had an abnormal CAR at baseline, and elevated HCC (mean HCC = 362.9 pg/mg). Bivariate models showed no relationship between self-reported and biologic markers of stress. Using CBPR methods leads to successful recruitment of Latinas to clinical research involving biospecimen collection. Although self-reported stress and depression were moderate or mild, biologic stress levels were high and abnormal in over 1/3 of participants, suggesting that chronic stress, and its subsequent integration into the biologic stress pathways, may help explain ethnic disparities in cancer outcomes of LBCS. Citation Format: Cathy Samayoa, Jasmine Santoyo-Olsson, Leticia Márquez-Magaña, Anna M. Nápoles. Biologic and self-reported stress levels among Latina breast cancer survivors: The Nuevo Amanecer Rural Trial [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C111.

A telephone-based education and support intervention for Rural Breast Cancer Survivors: a randomized controlled trial comparing two implementation strategies in rural Florida.

To compare two implementation telephone-based strategies of an evidence-based educational and support intervention to Rural Breast Cancer Survivors (RBCS) in which education was delivered early or after the support component. Florida RBCS participated in a 12-month randomized clinical trial (RCT) with two arms: Early Education and Support (EE-S) and Support and Delayed Education (S-DE). Arms differed in the timing of 6 support and 3 education sessions. Main outcome was quality of life (QOL, SF-36 physical and mental composite scores [PCS, MCS]). Secondary outcomes were depressive symptoms (Centers for Epidemiologic Studies Depression Scale, CES-D), mood (Profile of Mood States, POMS), and social support (Medical Outcomes Study Social Support Survey, MOS-SSS). Outcomes were analyzed longitudinally using repeated measures models fitted with linear mixed methods. Of 432 RBCS (mean 25.6months from diagnosis), about 48% were 65+, 73% married/partnered, and 28% with ≤high school education. There were no differences between EE-S and S-DE in demographics or outcomes at baseline (mean (standard deviation): SF-36 PCS, 44.88 (10.6) vs. 45.08 (10.6); MCS, 49.45 (11.1) vs. 48.1 (11.9); CES-D, 10.11 (9.8) vs. 10.86 (10.5); POMS-SF, 23.95 (38.6) vs. 26.35 (38.8); MOS-SSS, 79.2 (21.2) vs. 78.66 (21.2)) or over time. One exception was slightly worse mean scores at month 9 in MCS (Cohen's d, - 0.22; 95% CI, - 0.38, - 0.06) and POMS (Cohen's d, 0.23; 95% CI, 0.07, 0.39) for EE-S vs. S-DE. The implementation strategies were equivalent. Enhancing support may be considered before delivering not-in-person interventions to RBCS.

Breast cancer survivorship in rural settings: a systematic review

Rural breast cancer survivors (BCS) in the United States face unique challenges during survivorship, related to knowledge and accessibility of resources. Survivorship care plans should address five key areas that include surveillance and screening for new/reoccurring cancer; management of long-term effects of cancer treatment; health promotion; and care coordination/practice implications. To maximize the benefit of survivorship care for rural BCS, it is necessary to better understand their experiences and preferences. A systematic review of the extant literature addressing the survivorship needs and interventions for rural BCS was conducted. The following databases were searched for reports published between January, 2007, and December, 2018: PubMed, CINAHL, SCOPUS, PsycINFO (EBSCO), CAB Direct, and Sociological Abstracts. Reports published after 2007 with samples including and comprised of rural BCS in the United States were included. Screening of the search results followed PRISMA guidelines using Covidence systematic review software. Findings were extracted from 30 reports disseminating findings of 14 research studies. The five areas of a survivorship care were counted/accounted for during data extraction. The included reports concentrated on health promotion (e.g., weight loss and exercise) and the management of long-term effects of cancer treatment as key outcomes. There is a gap in the literature addressing care coordination, surveillance, and screening. Additional research including interventions for rural BCS that address more survivorship care areas would benefit this population and improve survivorship quality of life for rural BCS.

Reducing Metabolic Syndrome (MetS) and Unmet Needs Among Rural Breast-Cancer Survivors (BCS) During the Survivorship Transition

Abstract Date Presented 04/05/19 Metabolic syndrome (MetS) is a leading risk factor for cardiovascular-disease-related death among breast-cancer survivors (BCS). Adhering to dietary and physical activity recommendations can help reduce MetS, but many women face challenges with lifestyle behavior change after cancer treatment, and few programs exist to support such efforts. Evidence-based habit development strategies in combination with OT intervention could reduce MetS risk factors among rural BCS. Primary Author and Speaker: Heather Fritz Contributing Authors: Wassim Tarraf

Post-Treatment Symptoms of Pain, Anxiety, Sleep Disturbance, and Fatigue in Breast Cancer Survivors

BackgroundIn part because of improvements in early detection and treatment, the number of breast cancer survivors is increasing. After treatment, however, breast cancer survivors often experience distressing symptoms, including pain, sleep disturbance, anxiety, and fatigue; at the same time, they have less frequent contact with health care providers. Pain commonly co-occurs with other symptoms and the combination of symptoms contribute to the amount of distress experienced by survivors. Previous studies of post-treatment symptoms include primarily urban and white women. AimsThe purpose of this study was to describe the post-treatment cluster of symptoms, to examine the correlations among these symptoms, and to examine the role pain intensity may play in understanding the variation in sleep disturbance, fatigue, and anxiety in a racially diverse sample of rural breast cancer survivors. DesignThe theoretical framework for this descriptive correlational study was the theory of unpleasant symptoms. SettingsOutpatient university-affiliated cancer clinic. Participants/SubjectsForty women who were between 6 months and 5 years post breast cancer diagnosis. MethodsParticipants completed the following self-report instruments: Patient Reported Outcomes Measurement Information System of pain intensity, pain interference, anxiety, and sleep disturbance and the Piper Fatigue Short Form 12. ResultsThe average age of participants was 58 years, and 57.5% were black. Most women reported sleep disturbance (78%), pain interference (68%), and pain intensity (63%) above the national average for an American adult. Black women reported higher pain intensity than whites. There were moderate to strong correlations among the symptoms (range r = 0.35-0.89). ConclusionsNurses and health care providers in primary care settings need to screen for symptoms, and nursing interventions are needed to assist breast cancer survivors to manage distressing symptoms.

Feasibility of Synchronous Online Focus Groups of Rural Breast Cancer Survivors on Web-Based Distress Self-Management.

To obtain rural breast cancer survivors' perceptions of CaringGuidance™ After Breast Cancer Diagnosis, a web-based, psychoeducational, distress self-management program, and explore the feasibility of gathering survivors' perceptions about CaringGuidance using online focus groups (OFGs). 23 survivors of early-stage breast cancer, a mean of 2.5 years postdiagnosis, living in rural Nebraska. Participants reviewed the CaringGuidance program independently for an average of 12 days prior to their designated OFG. The extent of participants' pre-OFG review was verified electronically. Four synchronous, moderated OFGs were conducted. Demographic and OFG participation data were used to assess feasibility. Transcripts of OFGs were analyzed using directed content analysis. All enrolled women participated in their designated OFG. Five themes of the quality and usability of CaringGuidance were identified. Recommendations were used to modify CaringGuidance prior to the pilot efficacy trial. The findings contribute to nurses' knowledge and guide assessment and interventions pertaining to psychosocial needs of rural women with breast cancer, OFGs, and qualities rural women seek in web-based psychological interventions.

Feasibility of a Telemedicine-Delivered Cognitive Behavioral Therapy for Insomnia in Rural Breast Cancer Survivors.

To evaluate a nurse-led, telemedicine-delivered cognitive behavioral therapy for insomnia (CBTI) in rural breast cancer survivors (BCSs). 18 BCSs diagnosed with stage I-III breast cancer in the rural western United States. In this prospective, pre-/post-test, quasiexperimental feasibility pilot trial, BCSs attended six weekly sessions of CBTI via Internet videoconference. Feasibility was assessed using recruitment and acceptability of the intervention. Primary outcomes were diary-based sleep efficiency (SE), sleep latency (SL), total sleep time, wake after sleep onset, and number of nightly awakenings; secondary outcomes included quality of life (QOL), mental health, and daily functioning. Following the intervention, participants reported improvements in sleep outcomes, including SE and SL. QOL and daily functioning improved, but anxiety and depression did not. Nurse-led, telemedicine-delivered CBTI for rural BCSs is feasible and may be effective in managing insomnia. Additional research is needed to determine widespread effectiveness and best practices for dissemination and implementation.

Change in Physical Activity During a Weight Management Intervention for Breast Cancer Survivors: Association with Weight Outcomes.

ObjectiveThe study examined the effects of a group-phone based weight management intervention on change in physical activity as measured via accelerometer and self-report in rural breast cancer survivors. The study also evaluated the role of physical activity on clinically meaningful cut-points for weight loss (baseline to 6 months) and weight loss maintenance (6 to 18 months).MethodsParticipants were breast cancer survivors in a weight management intervention who provided valid weight and accelerometer data (N=142). We categorized participants into four groups based on weight loss ≥10% and weight regain ≥5% at 18 months.ResultsAccelerometer-measured moderate-to-vigorous physical activity (MVPA) significantly increased from baseline to 6 months (+46.9 minutes). MVPA declined during maintenance; however remained significantly greater than baseline. Self-reported MVPA followed a similar pattern as accelerometer MVPA, but estimates were significantly higher. Participants in the high loss, low regain group had significantly higher MVPA at all points.ConclusionsA distance-based weight management intervention for survivors improved physical activity outcomes over 18 months. Self-reported physical activity was substantially higher than accelerometer-measured. Findings highlight the importance of device-based measurement for characterizing the magnitude of physical activity change, as well as the role of physical activity in weight management outcomes.

Diet Quality During Weight Maintenance in Rural Breast Cancer Survivors

Diet Quality During Weight Maintenance in Rural Breast Cancer Survivors

0379 EFFECTS OF AN INTERNET-BASED VIDEOCONFERENCE COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA INTERVENTION

Insomnia is a prevalent condition affecting 30–50% of breast cancer survivors (BCS). Insomnia can originate during primary cancer treatment and persist for years, affecting long-term health and wellness throughout survivorship. Cognitive Behavioral Therapy for Insomnia (CBTI) is an effective treatment, but a dearth of trained providers requires the exploration of creative methods of CBTI delivery. Rural BCS, already vulnerable due to a lack of healthcare providers, have little access to specialty care such as CBTI. The aim of this study was to examine the results of an internet-based videoconference CBTI in a rural BCS population. Eighteen rural BCS were enrolled in a 6-week CBTI intervention, using a pre/post study design. The individualized CBTI was provided via an internet-based videoconference using Adobe Connect. Participants completed sleep diaries daily throughout the 6-week CBTI, and symptom and quality of life surveys before and after the intervention. Dependent t-tests were used to compare changes in primary sleep outcomes, symptom burden, and quality of life. All primary sleep measures improved significantly after the CBTI intervention, including sleep efficiency (p < .001), sleep latency (p < .001), wake after sleep onset (p = .001) and total sleep time (p = .001). Symptoms including fatigue (p < .001), pain (p < .001), and menopausal symptoms (p < .001) decreased significantly after treatment. Global quality of life increased significantly (p < .001), as well as the subscales of emotion (p < .001) and cognition (p < .001). CBTI is an established treatment for insomnia in BCS, but many rural survivors lack access to CBTI as a face to face intervention. This study contributes to the evidence that an online, videoconference CBTI intervention can be an effective method to help treat insomnia in rural BCS. NINR 1F31NR012097-01A1.