Spanish-speaking Latina Breast Cancer Survivors Research Articles

Evaluating the implementation of Nuevo Amanecer-II in rural community settings using mixed methods and equity frameworks

BackgroundThe 10-week Nuevo Amanecer-II intervention, tested through a randomized controlled trial, reduced anxiety and improved stress management skills among Spanish-speaking Latina breast cancer survivors. This paper describes the implementation and equity evaluation outcomes of the Nuevo Amanecer-II intervention delivered in three California rural communities.MethodsUsing implementation and equity frameworks, concurrent convergent mixed methods were applied to evaluate implementation (feasibility, fidelity, acceptability, adoption, appropriateness, and sustainability) and equity (shared power and capacity building) outcomes. Quantitative data were collected using tracking forms, fidelity rating forms, and program evaluation surveys; qualitative data were collected using semi-structured in-depth interviews. Respondents included community-based organization (CBO) administrators, recruiters, compañeras (interventionists), and program participants.ResultsOf 76 women randomized to the intervention, 65 (86%) completed at least 7 of 10 sessions. Participants’ knowledge (85% correct of 7 questions) and skills mastery were high (85% able to correctly perform 14 skills). Mean fidelity ratings across compañeras ranged from 3.8 (modeled skills) to 5.0 (used supportive/caring communication); 1–5 scale. The program was rated as very good/excellent by 90% of participants. Participants and compañeras suggested including family members; compañeras suggested expanding content on managing thoughts and mood and healthy living and having access to participant’s survivorship care plan to tailor breast cancer information. CBOs adopted the program because it aligned with their priority populations and mission. Building on CBOs’ knowledge, resources, and infrastructure, implementation success was due to shared power, learning, responsibility, and co-ownership, resulting in a co-created tailored program for community and organizational contexts. Building intervention capacity prior to implementation, providing funding, and ongoing technical support to CBOs were vital for fidelity and enhancement of recruiter and compañera professional skills. Two of three CBOs created plans for program sustainability beyond the clinical trial; all administrators discussed the need for new funding sources to sustain the program as delivered.ConclusionsBuilding on community assets and using equitable participatory research processes were central to the successful implementation of a peer-delivered psychosocial intervention in three rural communities among Spanish-speaking Latinas with breast cancer.

Navigating norms and expectations: the influence of culture on Latino couples and their interpersonal communication and coping post-breast cancer diagnosis

ABSTRACT Objectives Cultural norms shape expectations, care, and communication. Effective interpersonal communication is a prominent predictor of patient-partner cancer management, improving the overall quality of life for the dyad by increasing their ability to cope with cancer. However, couples-based cancer interventions often do not consider cultural factors. Additionally, although Latinas have a high incidence of breast cancer, few studies focus on Latino couples and the influence of culture in cancer care interventions. This study focuses on understanding how Latino culture’s norms and expectations influence how couples communicate and cope post-breast cancer diagnosis. Design This study conducted interviews and focus groups with a purposive sample of Spanish-speaking Latina breast cancer survivors (N = 21) and intimate partners (N = 5). In the focus group and interviews, participants were asked about the influence cancer had on their relationship, with specific questions focusing on communication within the dyad. The study team used CARV: Community-Engaged Adaptation with Rapid Analysis and Visualization framework to identify cultural considerations and recurring themes. Results The cross-cutting cultural considerations and themes found were: the negative influence of gendered and social norms on managing emotions and coping; the silent struggle with physical intimacy; and the inability to discuss the topic – or even say the word ‘cancer.’ Conclusion Understanding the role of Latino culture in how couples cope with and communicate about cancer post-diagnosis is essential. This understanding will help strengthen the dyad by assisting with positive interpersonal support, which contributes to a better quality of life. These findings will also help providers assist dyads in navigating the cancer diagnosis and journey, helping to lessen the interpersonal stress and tensions that can occur after diagnosis.

Financial strain, neighborhood cohesion, and health-related quality of life among rural and urban Spanish-speaking Latina breast cancer survivors.

Among Latina breast cancer survivors, explore associations between rural/urban residence and health-related quality of life (HRQL), and whether associations are moderated by financial strain and low neighborhood cohesion. We combined baseline data from two randomized controlled trials of a stress management intervention conducted among 151 urban and 153 rural dwelling Latinas with nonmetastatic breast cancer. Generalized linear models estimated associations between rural/urban status and HRQL (overall, emotional, social-family, physical, and functional well-being), and we examined moderation effects of financial strain and low neighborhood cohesion, controlling for age, marital status, and breast cancer characteristics. Rural women reported better emotional (β = 1.85; 95% CI = 0.37, 3.33), functional (β = 2.23; 95% CI = 0.69, 3.77), and overall (β = 5.68; 95% CI = 1.12, 10.25) well-being than urban women, regardless of degree of financial strain or neighborhood cohesion; moderation effects were not statistically significant. Financial strain was inversely associated with emotional (β = -2.34; 95% CI = 3.63, -1.05), physical (β = -2.56; 95% CI = -4.12, -1.01), functional (β = -1.61; 95% CI = -2.96, -0.26), and overall (β = -6.67; 95% CI = -10.96, -2.98) well-being. Low neighborhood cohesion was inversely associated with emotional (β = -1.27; 95% CI = -2.50, -0.04), social-family (β = -1.72; 95% CI = -3.02, -0.42), functional (β = -1.63; 95% CI = -2.92, -0.34), and overall (β = -5.95; 95% CI = 9.76, -2.14) well-being. Rural Latina breast cancer survivors reported better emotional, functional and overall well-being than their urban counterparts. Greater financial strain and less neighborhood cohesion were associated with worse HRQL on most domains regardless of rural/urban context. Interventions that focus on increasing perceived neighborhood cohesion and reducing or better managing financial strain, could help improve Latina cancer survivors' well-being.

Cortisol levels in rural Latina breast cancer survivors participating in a peer-delivered cognitive-behavioral stress management intervention: The Nuevo Amanecer-II RCT

BackgroundCompared to their White counterparts, Latina breast cancer survivors have poorer survival rates and health-related quality of life, and higher rates of depression and anxiety which may be a result of chronic stress. Chronic stress impacts the hypothalamic-pituitary-adrenal (HPA) axis, resulting in cortisol dysregulation which may be associated with breast cancer survival. However, cortisol levels and cortisol profiles of Latina breast cancer survivors are poorly characterized due to their underrepresentation in biomedical research. ObjectiveThe objective of this study was to describe cortisol levels and patterns of cortisol secretions in rural Latina breast cancer survivors participating in an RCT study of Nuevo Amanecer-II, an evidence-based peer-delivered cognitive behavioral stress management intervention. MethodsParticipant-centered recruitment and collection strategies were used to obtain biospecimens for cortisol analysis. Nine saliva samples (3/day for 3 days) and a hair sample were obtained at baseline and 6-months (3-months post-intervention). We describe cortisol levels and profiles, explore correlations of biomarkers with self-report measures of stress and psychological distress, and compare women who received the intervention with a delayed intervention group on biomarkers of stress. Mean hair cortisol concentration (HCC) was used to assess chronic stress. Based on daily measures of cortisol (awakening, 30 min post-awakening, and bedtime), we calculated three summary measures of the dynamic nature of the cortisol awakening response (CAR): 1) the CAR slope, 2) whether CAR demonstrates a percent change ≥40, and 3) total daily cortisol output (AUCg). Linear and log-binomial regression, accounting for multiple samples per participant, were used to compare cortisol measures at 6-month follow-up by treatment arm. ResultsParticipants (n = 103) were from two rural California communities; 76 provided at least one saliva sample at baseline and follow-up and were included in the analysis. At baseline, mean age was 57 years, mean years since diagnosis was 2 years, 76% had a high school education or less, and 34% reported financial hardship. The overall median CAR slope was 0.10, and median cortisol AUCg (in thousands) was 11.34 (range = 0.93, 36.66). Mean hair cortisol concentration was 1751.6 pg/mg (SD = 1148.6). Forty-two percent of samples had a ≥40% change in CAR. We found no statistically significant correlations between the cortisol measures and self-reported measures of stress and psychological distress. At follow-up, no differences were seen in HCC (mean difference between intervention and control: −0.11, 95% CI -0.48, 0.25), CAR slope (0.001, 95% CI -0.005, 0.008), cortisol AUCg (−0.15, 95% CI -0.42, 0.13), or ≥40% change in CAR (prevalence ratio 0.87, 95% CI 0.42, 1.77) between treatment arms. ConclusionOur findings of flattened cortisol profiles among more than half of the sample suggest potential HPA-axis dysregulation among rural Spanish-speaking Latina breast cancer survivors that merits further study due to its implications for long-term survival. Trial registrationhttp://www.ClinicalTrials.gov identifier NCT02931552.

Sharing research results with Latina breast cancer survivors who participated in a community-engaged behavioral RCT study: a descriptive cross-sectional survey study

BackgroundAn often heard and justifiable concern of ethnic minorities is related to researchers’ lack of attention to sharing the results of a study with participants after the study has concluded. Few studies have examined the effects of returning overall study results on participants’ attitudes, especially among populations underrepresented in research. Among Latina research participants, providing a summary of study results could enhance participation in research. We assess Latina breast cancer survivors’ reactions to receiving study results and their attitudes about participating in future studies.MethodsFor this cross-sectional survey study, all women who had participated in two behavioral randomized controlled trials (RCTs) were mailed a letter summarizing the study results (using written and graphic formats) and a questionnaire assessing problems and understanding the results, importance of sharing results, willingness to participate in future studies, and format preferences for receiving the results. A postage-paid envelope for returning the completed questionnaire was included. Logistic regression examined the associations of age, education, and rural/urban residence on format preferences and willingness to participate. The survey sample consisted of 304 low-income, predominantly Spanish-speaking Latina breast cancer survivors (151 from urban and 153 from rural communities) who had participated in two RCTs testing a stress management program designed for Latina breast cancer survivors.ResultsNinety-two women returned the questionnaires (30.3%). Most of the women (91.1%) indicated that they had no trouble understanding the results of the study, and 97% agreed that it is very/extremely important for researchers to share the study result with the participants. The majority (60.2%) reported that receiving the results increased their willingness to participate in future studies. About half (51.7%) did not have a format preference, 37.4% preferred written summaries, and 10.9% preferred graphs.ConclusionsThis study is an important first step to understanding the impact of returning study results among a population that is underrepresented in research. Returning the results of studies and understanding the impact of doing so is consistent with maintaining community involvement in all phases of research. The findings suggest that sharing aggregate research results in simple language yields few problems in participants’ understanding of the results and is viewed as important by participants.Trial registrationClinicalTrials.govNCT02931552 Date registered: October 13, 2016 and NCT01383174 Date registered: June 28, 2011.

Abstract IA29: Applying the Transcreation Framework to Address Psychosocial Health Disparities among Latina Breast Cancer Survivors

Abstract PURPOSE: Latina breast cancer survivors, especially those who primarily speak Spanish, experience worse symptoms and quality of life than non-Latina survivors. This presentation will describe a new framework, the Transcreation Framework for Community-Engaged Behavioral Interventions to Reduce Health Disparities, and how it was applied to develop a translational research program to address psychosocial health disparities among Spanish-speaking Latina breast cancer survivors (SSBCS). METHODS: Applying the Transcreation Framework (TF), the research program uses community-engaged interventions to equip SSBCS with information and skills to manage their disease. We focus on community-based self-care approaches because many underserved communities have limited access to cancer support services and oncology specialists. Applying the framework, we used rigorous scientific methods in community settings to develop, implement and evaluate the effectiveness of behavioral interventions in reducing psychosocial distress and symptoms among urban and rural SSBCS. RESULTS: We define transcreation as the process of planning, delivering, and evaluating interventions so that they resonate with the community experiencing health disparities, while achieving intended health outcomes. Following the TF’s seven iterative steps, we: 1) engaged community partners; 2) selected a theory to guide intervention development; 3) identified candidate evidence-based interventions and community best practices; 4) designed a new transcreated program prototype; 5) designed studies to test the intervention in community settings; 6) built community capacity to deliver the interventions; and 7) delivered and evaluated intervention implementation processes and outcomes. Formative research identified four general areas of need among SSBCS: fear; loss of control over cancer and life; lack of social support; lack of culturally appropriate care; and lack of cancer information in Spanish that they could understand. Population-based research identified cancer self-efficacy and social support as promising mechanisms to improve quality of life of SSBCS, thus we selected social-cognitive theory as the basis for the intervention prototype. With extensive community involvement, we identified an evidence-based stress management program and a community-based program and incorporated them with our prior research to develop Nuevo Amanecer, a new transcreated 8-week cognitive-behavioral stress management program for delivery by peers (trained SSBCS). Two sequential randomized controlled trials were conducted with urban SSBCS first, then rural SSBCS. The program improved several quality of life domains and decreased breast cancer concerns and depressive and bodily symptoms in the first RCT, and reduced anxiety and improved self-efficacy in performing several stress management skills in the 2nd RCT. Subsequently, we used the TF to develop a survivorship care planning and physical activity intervention (health coach plus mobile app and activity tracker) and tested it in a 2-month pilot study among SSBCS that resulted in reduced fatigue and health distress, improved emotional well-being, increased knowledge of needed follow-up care and resources, and an average increase of 1,313 daily steps. CONCLUSIONS: Engaging underserved communities in the design and implementation of behavioral interventions for cancer survivors leads to programs that are more likely to be effective and sustained because they are embedded and delivered in the communities experiencing cancer health disparities. Peer- and community health worker-delivered cancer support programs could be a low-cost, effective method for meeting the psychosocial needs of and increasing inclusion of underrepresented groups in cancer research. Research Implications: The TF can guide development and testing of behavioral interventions for communities experiencing cancer health disparities. The TF results in interventions that balance fidelity to evidence with fit to the setting because they are designed with community. Citation Format: Anna Maria Nápoles. Applying the Transcreation Framework to Address Psychosocial Health Disparities among Latina Breast Cancer Survivors [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr IA29.

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 < 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.

Participant-Centered Strategies for Overcoming Barriers to Biospecimen Collection among Spanish-Speaking Latina Breast Cancer Survivors.

Latinos are underrepresented in biomedical research, particularly biomarker research, yet they constitute the nation's largest ethnic/racial minority. Optimal methods for obtaining biospecimens for biomarker research among Latinos need to be identified. To minimize barriers and enhance participation, this study developed and tested tailored strategies for collecting biomarkers of chronic stress and premature aging among Spanish-speaking Latina breast cancer survivors. This study used a community-based participatory approach and selected hair and saliva as noninvasive biospecimens to assess telomere length, the cortisol awakening response (CAR), and hair cortisol concentration. We developed bilingual multimedia instructional materials, and community health workers assisted in collections. Telephone surveys assessed willingness to participate in future studies, barriers to sample collection, and recommendations for improving the strategies. A total of 103 participants were recruited over 18 months from two rural sites in California, and 88 were retained at 6-month follow-up. At baseline, rates of donating salivary DNA for telomere length measurement, saliva for CAR analysis, and hair for cortisol concentration were 98%, 89%, and 52%, respectively. At follow-up, rates were 83%, 76%, and 55%, respectively. The majority of participants reported being very willing to provide hair (72%) or saliva (74%) for future studies. Our results support the feasibility of including minorities in biomedical research. We report excellent rates of saliva collection when community partners are engaged in the process, and when patient-centered and culturally tailored recruitment methods are implemented. The development of methods to facilitate the inclusion of minorities in biomedical research is critical to eliminate racial/ethnic health disparities.

Feasibility of a Mobile Phone App and Telephone Coaching Survivorship Care Planning Program Among Spanish-Speaking Breast Cancer Survivors.

BackgroundSpanish-speaking Latina breast cancer survivors experience disparities in knowledge of breast cancer survivorship care, psychosocial health, lifestyle risk factors, and symptoms compared with their white counterparts. Survivorship care planning programs (SCPPs) could help these women receive optimal follow-up care and manage their condition.ObjectiveThis study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of a culturally and linguistically suitable SCPP called the Nuevo Amanecer (New Dawn) Survivorship Care Planning Program for Spanish-speaking breast cancer patients in public hospital settings, approaching the end of active treatment.MethodsThe 2-month intervention was delivered via a written bilingual survivorship care plan and booklet, Spanish-language mobile phone app with integrated activity tracker, and telephone coaching. This single-arm feasibility study used mixed methods to evaluate the intervention. Acceptability and feasibility were examined via tracking of implementation processes, debriefing interviews, and postintervention satisfaction surveys. Preliminary efficacy was assessed via baseline and 2-month interviews using structured surveys and pre- and postintervention average daily steps count based on activity tracker data. Primary outcomes were self-reported fatigue, health distress, knowledge of cancer survivorship care, and self-efficacy for managing cancer follow-up health care and self-care. Secondary outcomes were emotional well-being, depressive and somatic symptoms, and average daily steps.ResultsAll women (n=23) were foreign-born with limited English proficiency; 13 (57%) had an elementary school education or less, 16 (70%) were of Mexican origin, and all had public health insurance. Coaching calls lasted on average 15 min each (SD 3.4). A total of 19 of 23 participants (83%) completed all 5 coaching calls. The majority (n=17; 81%) rated the overall quality of the app as “very good” or “excellent” (all rated it as at least “good”). Women checked their daily steps graph on the app between 4.2 to 5.9 times per week. Compared with baseline, postintervention fatigue (B=–.26; P=.02; Cohen d=0.4) and health distress levels (B=–.36; P=.01; Cohen d=0.3) were significantly lower and knowledge of recommended follow-up care and resources (B=.41; P=.03; Cohen d=0.5) and emotional well-being improved significantly (B=1.42; P=.02; Cohen d=0.3); self-efficacy for managing cancer follow-up care did not change. Average daily steps increased significantly from 6157 to 7469 (B=1311.8; P=.02; Cohen d=0.5).ConclusionsWe found preliminary evidence of program feasibility, acceptability, and efficacy, with significant 2-month improvements in fatigue, health distress, and emotional well-being and increased knowledge of recommended follow-up care and average daily steps. Tailored mobile phone and health coaching SCPPs could help to ensure equitable access to these services and improve symptoms and physical activity levels among Spanish-speaking Latina breast cancer survivors.

Abstract 2429: Social Support as a Moderator in the Relationship between Intrusive Thoughts and Psychological Symptoms among Spanish-speaking Latinas with Breast Cancer

Abstract Background: Intrusive thoughts are associated with higher levels of psychological symptoms and impaired quality of life in the year after breast cancer treatment. To our knowledge, no studies have examined social support as a potential moderator between intrusive thoughts about breast cancer and psychological symptoms among Latinas. This study aims to assess the moderating effects of different dimensions of social support on the association between intrusive thoughts and psychological symptoms among Spanish-speaking Latina breast cancer survivors. Methods: Analyses were performed using baseline data from a randomized control trial of a stress management intervention delivered to 151 Spanish-speaking Latinas with non-metastatic breast cancer. Survey measures on intrusive thoughts, four dimensions of social support (emotional/information, tangible, affectionate, and positive social interaction), and psychological symptoms (depression, anxiety, and somatization) were obtained at baseline via a structured survey. Information on age, time since diagnosis, breast cancer treatment, surgery type, breast cancer stage, history of depression and marital status was obtained via medical records review and served as covariates. Generalized linear models were used to investigate bivariate and multivariate associations and to explore moderation effects of the four dimensions of social support. Results: In the bivariate models, intrusive thoughts were associated with more depressive (β=0.024, p=0.0014), anxiety (β=0.047, p<.0001) and somatization symptoms (β=0.019, p = 0.0036). In multivariable models, intrusive thoughts remained strongly associated with anxiety symptoms (β=0.132, p=0.0001). In contrast, the effects of intrusive thoughts on depressive and somatization symptoms was attenuated in the multivariate models. Receiving affectionate social support was found to moderate the relationship between intrusive thoughts and anxiety symptoms (β=-0.022, p=0.0055). No dimension of social support was found to have a moderating effect in the relationship between intrusive thoughts and either depressive or somatization symptoms. Conclusions: Our findings indicate that social support, particularly affectionate support, had a protective effect on anxiety symptoms among Spanish-speaking Latinas with breast cancer experiencing intrusive thoughts. Affectionate social support is a possible protective factor that can be developed and encouraged in socio-behavioral interventions for this vulnerable population. Citation Format: Cristian Escalera, Anna Maria Napoles, Jasmine Santoyo-Olsson, Carmen Ortiz. Social Support as a Moderator in the Relationship between Intrusive Thoughts and Psychological Symptoms among Spanish-speaking Latinas with Breast Cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2429.

Do coping strategies mediate the effects of emotional support on emotional well-being among Spanish-speaking Latina breast cancer survivors?

This study aimed to assess the relationship between emotional social support and emotional well-being among Latina immigrants with breast cancer and test whether two culturally relevant coping strategies, fatalism and acceptance, mediate this relationship. One hundred fifty Spanish-speaking Latinas within 1year of breast cancer diagnosis participating in a randomized trial of a stress management intervention were assessed in person at baseline and via telephone 6months later. Survey measures included baseline emotional support, fatalism, and acceptance and emotional well-being 6months later. Generalized linear models estimated direct effects of emotional support on emotional well-being and indirect effects through fatalism and acceptance. Mean age was 50.1 (SD = 10.9) years; most women had low education and acculturation levels. Emotional support was negatively associated with fatalism (r = -0.24, p < 0.01) and positively associated with acceptance (r = 0.30, p < 0.001). Emotional support (r = 0.23, p = 0.005) and acceptance (r = 0.28, p = 0.001) were positively associated with emotional well-being, whereas fatalism (r = -0.36, p < 0.0001) was negatively associated with emotional well-being. In multivariable models, emotional support was associated with emotional well-being (b = 0.88, 95% CI: 0.24, 1.52). This direct effect remained significant when additionally controlling for fatalism (b = 0.66, 95% CI: 0.03, 1.30) and acceptance (b = 0.73, 95% CI: 0.09, 1.37) in separate models. There was a significant indirect effect of emotional support on emotional well-being through fatalism (b = 0.21, 95% CI: 0.04, 0.51) as well as a marginally significant effect through acceptance (b = 0.15, 95% CI: 0.001, 0.43). Emotional support may increase well-being among Spanish-speaking Latina cancer survivors by reducing cancer fatalism.Copyright © 2015 John Wiley & Sons, Ltd.