White Survivors Research Articles

Abstract B032: Which forms of financial hardship predict financial distress among African American and white cancer survivors?

Abstract Background: Financial hardship (FH) is common among cancer survivors and prevalence is often higher in non-white survivors. It is not known whether specific forms of FH are stronger predictors of financial distress than others, or if predictors of distress differ by race. Methods: We utilized data from 500 (196 white, 304 African American) participants in the Detroit Research on Cancer Survivors pilot cohort. Adults ages 20-79 were eligible if they were diagnosed with a first primary breast, colorectal, lung, or prostate cancer since January 1, 2013; identified through the Metropolitan Detroit Cancer Surveillance System; and diagnosed/treated at the Karmanos Cancer Institute. Measures of financial hardship included decreased income, cancer-related debt, utilizing assets or borrowing money to pay for cancer care, refusing treatment or not seeing a doctor when needed due to cost, and skipping doses of prescribed medication to save money. Financial distress was measured using the validated Comprehensive Score for Financial Toxicity (COST), coded so that lower scores indicate higher distress (lower financial quality of life). We used backward selection models including demographic and socioeconomic factors to identify predictors of financial distress overall and separately for white and African American survivors. Results: COST scores were 27.3 on average (SD: 10.9; 95% CI: 26.2, 28.3; range: 0-44), and were lower (more financial distress) in African American (24.5, 95% CI: 23.1, 25.8) than white survivors (31.0, 95% CI: 29.4, 32.5; p<0.001). Younger age, being unmarried, lower income, not being employed, and having Medicaid coverage were all associated with higher financial distress. Debt, decreased income, utilizing assets, skipping doses of prescribed medication, and needing a doctor but not going were each independently associated with more financial distress overall (all p=0.013). Debt was associated with distress among both white and African American survivors in race-specific models (p=0.005) and decreased income was associated with distress in white (p=0.013) and marginally associated (p=0.06) in African American survivors. Not going to the doctor when needed and utilizing assets (both p<0.001) predicted distress among white survivors, while refusing treatment due to cost (p=0.007) and skipping doses of prescribed medication to save money (p=0.007) predicted distress in African American survivors. Not going to a doctor when needed was more common in African American survivors, but more strongly associated with distress in white survivors (p-interaction=0.024). A similar pattern was observed for utilizing assets but was only marginally significant (p=0.08). Conclusions: Several forms of financial hardship were strongly associated with financial distress after cancer, but their association with distress differed by race. Some forms of financial hardship that are more common in African American survivors are more strongly associated with financial distress among white survivors. Citation Format: Theresa A. Hastert, Amanda R. Reed, Jennifer L. Beebe-Dimmer, Terrance L. Albrecht, Julia Mantey, Tara Baird, Ann G. Schwartz. Which forms of financial hardship predict financial distress among African American and white cancer survivors? [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 B032.

Abstract C015: Cardiovascular disease and health-related quality of life among African American and white cancer survivors

Abstract Background: Cardiovascular disease (CVD) is common among cancer survivors and is a leading cause of death among survivors of several forms of cancer. Race disparities exist in the prevalence of several forms of CVD, and these may have implications for the health-related quality of life (HRQOL) of cancer survivors. The current study estimates the association between several forms of CVD and HRQOL among a diverse cohort of cancer survivors. Methods: This analysis was conducted using data from 979 participants (574 African American, 405 white) with female breast, colorectal, lung, or prostate cancer in the Detroit Research On Cancer Survivors (ROCS) pilot study who were diagnosed and/or treated at the Karmanos Cancer Center in Detroit, Michigan. The analyses were conducted using linear regression with binary measurements of five different forms of CVD included in the ROCS pilot survey (self-reported history of congestive heart failure (CHF), myocardial infarction (MI), hypertension, peripheral vascular disease (PVD), and stroke) as predictors of HRQOL measured using the Functional Assessment of Cancer Therapy – General (FACT-G), controlling for demographic, socioeconomic, and cancer-related characteristics. We also tested for effect modification by race. Results: FACT-G scores were 2.2 (95% CI: -4.3, 0.0) points lower among cancer survivors who were diagnosed with any type of CVD compared to those who were not. This association did not differ by race (Pinteraction=0.25). FACT-G scores were somewhat lower among survivors diagnosed with hypertension [-1.9; 95% confidence interval (CI): -4.1, 0.1], MI (-4.1; 95% CI: -8.4, 0.2), CHF (-3.7; 95% CI: -8.2, 0.9), or stroke (-4.0; 95% CI: -8.5, 0.5); however, the magnitude of these differences was not clinically meaningful and the findings did not reach statistical significance. History of MI was associated with clinically meaningful differences in HRQOL among African American (-6.1; 95% CI: -11.3, -0.8) but not white survivors (-0.4, 95% CI: -7.9, 7.2; Pinteraction=0.15). Conclusions: Overall, any type of CVD was not associated with meaningful differences in HRQOL among cancer survivors. Our finding that history of MI was associated with clinically meaningful differences in HRQOL among African American survivors, but not white, could represent an opportunity for future efforts to improve survivors’ HRQOL. Citation Format: Jaclyn M. Kyko, Jennifer L. Beebe-Dimmer, Tara E. Baird, Ann G. Schwartz, Theresa A. Hastert. Cardiovascular disease and health-related quality of life among African American and white cancer survivors [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C015.

Abstract B006: Developing Men Moving Forward, a lifestyle intervention for African American prostate cancer survivors

Abstract African American men are disproportionally affected by high prostate cancer incidence and mortality, and also comorbidities. African American prostate cancer survivors (AAPCS) report lower quality of life (QOL) relative to Non-Hispanic white (NHW) survivors. Many factors drive these differences, including weight status and health behaviors. The American Cancer Society has nutrition and physical activity guidelines to help cancer survivors achieve optimal health and QOL. AAPCS are more likely than NHW survivors to be non-adherent. Poor diet and physical inactivity often result in adverse body composition (high adiposity, low lean muscle) leading to hormonal changes, increased systemic inflammation and insulin resistance theorized to promote carcinogenesis and chronic diseases. Studies document positive results for lifestyle interventions focusing on NHW prostate cancer survivors, but inclusion of AAPCS is limited. We conducted an exploratory mixed methods study with AAPCS to inform the development and implementation of Men Moving Forward, a lifestyle intervention currently being tested in a randomized efficacy trial. Methods: 22 AAPCS completed a focus group and validated questionnaires on diet, physical activity patterns, QOL, and unmet needs related to lifestyle changes. Results: 75% of the participants were overweight/obese, 82% were considered insufficiently active, only 10% engaged in resistance training. Diets were high in saturated fat and sugar, low in fiber, fruits and vegetables. Compared to other prostate cancer survivors, AAPCS reported lower rankings on all QOL domains. Compared to the general population, men had worse physical functioning, pain interference, and sexual functioning. Qualitative data reflected high interest in a lifestyle intervention that would provide opportunities to build strength, learn about healthy eating, and bring men together to talk about relevant survivorship issues. Conclusions: Interventions are needed to address the lifestyle and QOL needs of AAPCS. The community-based Men Moving Forward trial will examine the feasibility and effects of a 4-month lifestyle program with 200 AAPCS. Outcomes include body composition (adiposity, lean muscle mass), behavior (diet, physical activity), strength, biomarkers of general health (lipids, blood pressure, glucose, and insulin) and prostate cancer recurrence (inflammation, insulin resistance, hormones) and QOL. This study is being conducted in partnership with the Milwaukee Public Recreation system which increases the potential for program sustainability. Citation Format: Jamal A. Jarrett, Lauren Matthews, Patricia Sheean, Kathryn Flynn, Kathryn Bylow, Deepak Kilari, Paula Papanek, Tina Johnson, Melinda Stolley. Developing Men Moving Forward, a lifestyle intervention for African American prostate cancer survivors [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B006.

Abstract IA11: Cancer disparities and survivorship challenges facing young Latina women (<50 years) on the U.S.-Mexico border

Abstract Disparities in the incidence of specific cancers are prevalent among young Latinas (i.e., < 50 years). Although research focusing exclusively on Latina cancer survivors is limited, mixed-sample research suggests that Latina cancer survivors experience greater distress relative to non-Latina white (NLW) survivors, predisposing them toward poorer cancer outcomes. Young Latina survivors who are parenting school-age children may be at even higher risk of poor cancer survivorship, given research demonstrating that young NLW women experience worse physical and psychological well-being and greater illness intrusiveness compared to older NLW women (i.e., >50 years). This presentation describes the cancer disparities and survivorship challenges encountered by young Latina women living along the Paso del Norte U.S.-Mexico border region. Methodology: Cancer registries were used to identify cancer disparities in the U.S.-Mexico border counties. Elicitation and focus group interviews conducted with diagnosed child-rearing Latina mothers explored their challenges in coping with cancer while parenting school-age children. Findings from the qualitative research informed the cultural adaptation of an evidence-based program, Enhancing Connections, to help Latina cancer survivors and their children cope with cancer. A subsequent study examined the feasibility and short-term efficacy of the culturally adapted Conexiones program. Results: Based on research conducted exclusively with Latina women along the U.S.-Mexico border, this presentation will demonstrate (1) how cancer disparities worsen as the focus shifts from the national level to the U.S.-Mexico border region, (2) the challenges in cancer survivorship along the Paso del Norte U.S.-Mexico border region, and (3) research efforts designed to improve the quality of survivorship among young Hispanic mothers diagnosed with cancer. Citation Format: Rebecca Palacios. Cancer disparities and survivorship challenges facing young Latina women (<50 years) on the U.S.-Mexico border [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr IA11.

Abstract TP308: Fatalism or Realism? Racial Differences in the Beliefs of Stroke Survivors

Introduction: Fatalistic beliefs which contribute to worse health outcomes are believed to be more common in African Americans (AA). Hypothesis: AA stroke survivors exhibit more fatalistic beliefs about stroke and stroke recovery than White stroke survivors. Methods: A 20-item fatalism scale was administered to 63 AA and 22 white stroke survivors within 30 days of their stroke. The fatalism scale measured predetermination, luck and pessimism. Responses to the 20 questions included: strongly disagree, disagree, neutral, agree and strongly agree. Results: The mean age for the sample was 58 years and 58% were female and there were no racial differences in either age or sex. More Whites (77 vs 35%) reported being college educated than AAs (p=.006). There were no racial differences in the mean total fatalism score or the predetermination, luck and pessimism subtest scores. When the responses were examined in categorical fashion utilizing their combined responses of: strongly disagree/ disagree, neutral and agree/strongly agree racial differences were present on select questions. Predetermination: AAs were more likely to agree or strongly agree (52% vs 40%) that if someone is meant to get a serious disease they will (p=.04). In contrast, AAs were more likely to strongly disagree or disagree (43% vs 22%) that how long you live is predetermined (p=.03). Luck: AAs were more likely to strongly disagree or disagree (86% vs 77%) or to be neutral (0% vs 14%) that they will get diseases if they are unlucky (p=.011). Pessimism: AAs were more likely strongly disagree or disagree (77% vs 50%) and less likely to agree or strongly agree (16% vs 41%) that they often feel helpless dealing with the problems of life (p=.043). AAs were also more likely to strongly disagree or disagree (81% vs 64%) and were less likely to be neutral (2% vs 18%) that there is really no way they can solve the problems they have (p=.017). Conclusions: The general health literature suggests AAs exhibit more fatalistic beliefs. AAs in this stroke sample were less fatalistic on select questions and did not differ on others. Fatalism is a complex construct and questions designed to examine fatalism should be carefully examined particularly when race comparisons are being considered.

Sexual Assault Survivors' Post-Traumatic Growth: Individual and Community-Level Differences.

Past research has focused on individual differences in post-traumatic growth (PTG) among survivors, but no studies to date have examined differences at the neighborhood level. This exploratory study uses data from a 3-year longitudinal study of women sexual assault survivors (N = 1,863) living in a segregated city. We tested random intercept models of individuals nested within neighborhoods. Disrupted core beliefs, greater perceived control over recovery, less post-traumatic stress disorder (PTSD), religious coping, and positive social coping predicted more PTG. White survivors had lower PTG scores than the women of color in this study. Neighborhood-level differences in PTG scores persisted even though violent crime rate and neighborhood poverty did not emerge as significant in our model.

Assessing Physical Activity Behavior of Cancer Survivors by Race and Social Determinants of Health.

Introduction Black cancer survivors remain at a higher risk for secondary cancers, cancer recurrence, and comorbid conditions than non-Hispanic White survivors. Physical activity may help improve health outcomes and overall quality of life. We assessed cancer survivors’ physical activity by race/ethnicity and the effect of social determinants of health (SDH) constructs (i.e., economic stability, education, and access to health care) on physical activity. Methods This was a cross-sectional analysis of data from the 2016 Behavioral Risk Factor Surveillance System. The outcome variable was physical activity after cancer diagnosis and the predictor variables were SDH and race. Multivariable logistic regressions were used to examine associations between race and physical activity and the effect of SDH on physical activity. Results Among 3,787 cancer survivors, 91.6% self-identified as White and 8.4% as Black. Blacks were more likely than Whites to report low economic stability, low access to health care, and low health literacy (all ps < .01). Blacks were less likely than Whites to engage in physical activity after controlling for demographic and clinical factors (adjusted odds ratio [ORAdj] = 0.71; 95% confidence interval [CI] = 0.56–0.91; p = .01) and after additional adjustment of SDH (ORAdj = 0.77; 95% CI = 0.60–0.99; p = .04). Conclusions The findings suggest that though Black cancer survivors are less than White to engage in physical activity, and SDH partially explained the racial difference in physical activity behaviors. These findings highlight the need to address barriers to health-care access, economic stability, and educational attainment.

Racial and socioeconomic disparities in adherence to preventive health services for ovarian cancer survivors.

To examine ovarian cancer survivors' adherence to evidence-based guidelines for preventive health care. A case-control, retrospective study of Medicare fee-for-service beneficiaries diagnosed with stage I, II, or III epithelial ovarian cancer from 2001 to 2010 using the Surveillance, Epidemiology, and End Results-Medicare database. Survivors were matched 1:1 to non-cancer controls from the 5% Medicare Beneficiary file on age, race, state of residence, and follow-up time. Receipt of flu vaccination, mammography, and bone density tests were examined in accordance with national guidelines. Adherence was assessed starting 1year after cancer diagnosis, across 2years of claims. Interaction with the health care system, including outpatient and cancer surveillance visits, was tested as a potential mechanism for receipt of services. 2437 survivors met the eligibility criteria (mean age, 75; 90% white). Ovarian cancer survivors were more likely to be adherent to flu vaccination (5 percentage points (pp); < 0.001) and mammography guidelines (10pp.; < 0.001) compared to non-cancer controls, but no differences were found for bone density test guidelines (- 1pp.; NS). Black women were less likely to be adherent to flu vaccination and bone density tests compared with white women. Women dually eligible for Medicare and Medicaid were less likely to be adherent compared to those without such support. Adherence was not influenced by measures of outpatient visits. Ovarian cancer survivors are receiving preventive services with the same or better adherence than their matched counterparts. Minority and dual-eligible survivors received preventive services at a lower rate than white survivors and those with higher income. The number of outpatient visits was not associated with increased preventive health visits. Ovarian cancer survivors are receiving adequate follow-up care to be adherent to preventive health measures. Efforts to improve care coordination post-treatment may help reduce minority and low SES disparities.

Discrepancy Between Perceived Diet Quality and Actual Diet Quality Among US Adult Cancer Survivors (OR14-05-19)

ObjectivesPostdiagnosis diet and food choices are essential for survivorship management. However, diet quality of cancer survivors is generally low. This study aimed to examine he temporal trends of diet quality of cancer survivors, assess the discrepancy between perceived diet quality and actual diet quality among cancer survivors, and its impact on their actual diet quality. MethodsThe National Health and Nutrition Examination Survey (NHANES) data 2005 -2014 were used in this study. Logistic regression models were fit to examine the influence of misperception of eating healthiness on diet quality measured by healthy eating index (HEI). Multinomial logistic regression models were fit to examine the factors that may influence the likelihood of diet quality misperception. ResultsBetween 2005 and 2014, there was an increasing trend in HEI in cancer survivors, with a small but significant increase of 0.7 per year. Non-Hispanic white survivors had a consistent higher total HEI score compared to other race/ethnic groups during this period. There were 11.66%, 29.67% and 38.02% cancer survivors who rated their overall diet quality as excellent, very good, or good, while 16.96% and 3.69% perceived their overall diet as fair and poor respectively. Kappa statistic indicated a low agreement between the self-perceived diet quality and the actual diet quality measured by HEI among cancer survivors (0.06, 95% CI: 0.02, 0.09). with adjustment of age, gender, race/ethnicity, and SES status, over-rate misperception was associated with a 5.39 lower total HEI score P < 0.0001), 1.00 lower HEI score of empty calorie intake (P = 0.0028), 0.15 lower score of vegetable intake (P = 0.108) and 0.29 lower score of fruit intake. On the other hand, under-rate misperception was associated with a 7.12 higher total HEI score P < 0.0001), 2.57 higher HEI score of empty calorie intake (P < 0.0001), 0.02 higher score of vegetable intake (P = 0.904) and 0.84 higher score of fruit intake (P = 0.001). Multinomial logistic regression suggested that higher income was also associated with higher odds of being an over-rater. Individuals with college education or above were more likely to over-rate their diet quality compared to those with high school or under education (OR: 1.32, 95% CI: 1.005 1.732). Moreover, Hispanics were more likely than Non-Hispanic Whites to over-rate their diet quality (OR: 1.792, 95% CI: 1.062, 3.024). ConclusionsThe divergence between self-assessed eating health and the HEI measured diet quality was an important factor that may have influenced cancer survivors’ diet behavior and diet quality. Funding SourcesNA.

Race, financial hardship, and limiting care due to cost in a diverse cohort of cancer survivors.

Estimate prevalence of types of cancer-related financial hardship by race and test whether they are associated with limiting care due to cost. We used data from 994 participants (411 white, 583 African American) in a hospital-based cohort study of survivors diagnosed with breast, colorectal, lung, or prostate cancer since January 1, 2013. Financial hardship included decreased income, borrowing money, cancer-related debt, and accessing assets to pay for cancer care. Limiting care included skipping doses of prescribed medication, refusing treatment, or not seeing a doctor when needed due to cost. Logistic regression models controlled for sociodemographic factors. More African American than white survivors reported financial hardship (50.3% vs. 41.0%, p = 0.005) and limiting care (20.0% vs. 14.2%, p = 0.019). More white than African American survivors reported utilizing assets (9.3% vs. 4.8%, p = 0.006), while more African American survivors reported cancer-related debt (30.5% vs. 18.5%, p < 0.001). Survivors who experienced financial hardship were 4.4 (95% CI: 2.9, 6.6) times as likely to limit care as those who did not. Borrowing money, cancer-related debt, and decreased income were each independently associated with limiting care, while accessing assets was not. The prevalence of some forms of financial hardship differed by race, and these were differentially associated with limiting care due to cost. The ability to use assets to pay for cancer care may protect survivors from limiting care due to cost. This has differential impacts on white and African American survivors.

EHealth Activity among African American and White Cancer Survivors: A New Application of Theory

ABSTRACTeHealth is a promising resource for cancer survivors and may contribute to reducing racial disparities in cancer survivorship. This research applies the Unified Theory of Acceptance and Use of Technology (UTAUT) to examine eHealth activity among African American (AfAm) and White cancer survivors. In a population-based sample of AfAm and White survivors (n = 300), a Poisson regression tested whether UTAUT constructs (facilitating conditions, social influence, perceived ease of use, perceived usefulness) and beliefs about security/trustworthiness of eHealth were associated with the number of eHealth activities respondents had used. To test whether the effects varied across racial groups, interactions between each of these five facets and survivor race were included in the model. The model adjusted for demographic characteristics, cancer history, and internet access and use. Across racial groups, facilitating conditions (IRR = 1.44, 95%CI [1.17, 1.77]) and perceived usefulness (IRR = 1.16, 95%CI [1.08, 1.24]) were associated with increased eHealth activity. A marginally significant interaction between race and perceived ease of use (IRR = 1.17, 95%CI [0.99, 1.39]) indicated this perception was associated with decreased eHealth activity for White but not AfAm survivors. A significant interaction between race and perceived security/trustworthiness (IRR = 1.16, 95%CI [1.02, 1.32]) indicated this perception was associated with increased eHealth activity for AfAm but not White survivors. Social influence was not associated with eHealth use for either group (IRR = 1.07, 95%CI [0.98, 1.16]). Interventions targeting attitudes about eHealth may encourage its adoption and use. Furthermore, eHealth tools intended for use among AfAm cancer survivors should ensure they are secure and emphasize trustworthiness to intended users.

Supplemental Material for Factors Associated With Chinese American and White Cancer Survivors’ Physical and Psychological Functioning

Supplemental Material for Factors Associated With Chinese American and White Cancer Survivors’ Physical and Psychological Functioning

Prediction of Low and Very Low Bone Mineral Density Among Adult Survivors of Childhood Cancer.

To develop and validate prediction models for low and very low bone mineral density (BMD) on the basis of clinical and treatment characteristics that identify adult survivors of childhood cancer who require screening by dual-energy x-ray absorptiometry. White survivors of childhood cancer (n = 2,032; median attained age, 29.3 years [range, 18.1 to 40.9 years]) enrolled in the St Jude Lifetime Cohort (SJLIFE; development) and survivors treated at the Erasmus Medical Center (validation) in the Netherlands (n = 403; median age, 24.2 years [range, 18.0 to 40.9 years]) were evaluated with dual-energy x-ray absorptiometry to determine lumbar spine BMD and total-body BMD. Low and very low BMD were defined as lumbar spine BMD and/or total-body BMD z scores of -1 or lower or -2 or lower, respectively. Multivariable logistic regression was used to build prediction models; performance was assessed using receiver operating characteristic curves. Diagnostic values were calculated at different probabilities. Low BMD was present in 51% and 45% of SJLIFE and Dutch participants, respectively, and very low BMD was present in 20% and 10%, respectively. The model for low BMD included male sex (odds ratio [OR], 3.07), height (OR, 0.95), weight (OR, 0.98), attained age (OR, 0.97), current smoking status (OR, 1.48), and cranial irradiation (OR, 2.11). Areas under the curve were 0.72 (95% CI, 0.70 to 0.75) in the SJLIFE cohort and 0.69 (95% CI, 0.64 to 0.75) in the Dutch cohort. The sum of the sensitivity (69.0%) and specificity (64.0%) was maximal at the predicted probability of 50%. The model for very low BMD included male sex (OR, 3.28), height (OR, 0.95), weight (OR, 0.97), attained age (OR, 0.98), cranial irradiation (OR, 2.07), and abdominal irradiation (OR, 1.61), yielding areas under the curve of 0.76 (95% CI, 0.73 to 0.78; SJLIFE cohort) and 0.75 (95% CI, 0.67 to 0.83; Dutch cohort). Validated prediction models for low and very low BMD, using easily measured patient and treatment characteristics, correctly identified BMD status in most white adult survivors through age 40 years.

Lay navigation across the cancer continuum for older cancer survivors: Equally beneficial for Black and White survivors?

The Patient Care Connect Program (PCCP), through lay navigators' distress assessments and assistance, was shown to lower healthcare utilization and costs in older cancer survivors. PCCP benefits and assistance needs for disadvantaged minorities (e.g., Black) vs. Whites are unknown. We examined the PCCP impact with retrospective analyses of Medicare claims (2012-2015). Outcomes were quarterly costs and utilization (emergency room (ER), hospitalizations) for navigated and matched survivors. Repeated measures generalized linear models with normal (costs), and Poisson (utilization) distributions assessed differences in trends overall and separately for Blacks and Whites. With distress data for navigated survivors, we assessed high distress (score > 3), ≥1 distress cause (overall, by domain), and ≥ 1 assistance request by minority group. Beneficiaries were: 772 Black and 5350 White navigated, and 770 Black and 5348 White matched survivors. Impact was: i) costs: -$557.5 Blacks (p < .001), -$813.4 Whites (p < .001); ii) ER: Incidence Rate Ratio (IRR) 0.97 Blacks (NS), 0.93 Whites (p < .001); iii) hospitalizations: IRR 0.97 Blacks (NS), 0.91 Whites (p < .001). There was no significant difference in impact across minority groups. No significant differences were found in high distress (29% Black, 25.1% White), ≥1 distress cause (61.6% Black, 57.8% White), or ≥ 1 assistance request (64.5% Black, 59.1% White). Blacks were more likely to have ≥1 distress cause in the Practical domain. The PCCP may benefit both Black and White older cancer survivors. Programs should consider the proportion of older survivors with high distress, and the specific needs of minorities.

Exercise in African American and White Colorectal Cancer Survivors: A Mixed Methods Approach.

African-American (AA) colorectal cancer (CRC) survivors tend to be more obese and less physically active compared to white survivors. To test the feasibility of an aerobic exercise program as well as explore perceptions about supervised exercise among AA CRC survivors. A prospective supervised exercise intervention performed on a cycle ergometer 2 days/week for 12 weeks. Peak (VO2peak) and sub-maximal exercise (6MWT) along with questionnaires (SF-36, Memorial Sloan Kettering Cancer Center Bowel Function Instrument (BFI), Functional Assessment of Cancer Therapy Scale-Colorectal (FACT-C) and Fatigue (FACIT-F), Brief Symptom Inventory (BSI). A second group of survivors participated in an interview evaluating perceptions regarding exercise. Prospective case series and qualitative interview. Research university and academic medical center. African American and white colorectal cancer survivors. Quantitative: A total of 237 letters were mailed to CRC survivors (112 white, 126 AAs). From the letters, 25 white and 15 AAs expressed interest; only five white (4.5%) and four AAs (3.2%) enrolled. Two AAs and five white survivors (7/9) finished the program. There was an improvement in peak exercise (p=0.011) and quality of life (QoL) (SF-36 total, p=0.035) post-training. Qualitative: 30 CRC survivors (12 AA and 18 white) participated in qualitative interviews and selected co-morbidity, motivation and location as primary barriers to exercise. Small sample size. Recruiting CRC survivors (regardless of race) into an exercise program is challenging, however, there are exercise and QoL benefits associated with participation. Barriers to exercise are similar between AA and white CRC survivors.

Mediating Role of Pain on Functional Recovery in White, Black, and Hispanic Stroke Survivors

Mediating Role of Pain on Functional Recovery in White, Black, and Hispanic Stroke Survivors

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

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

Abstract C37: Racial and ethnic disparities in comorbidities and behavioral risk factors among prostate cancer survivors, NHIS 2015

Abstract Background: Despite the growing number of prostate cancer survivors, little is known about the health status and health behaviors of this population. Prostate cancer survivors are at increased risk for recurrence and second primary cancers. Improved health behaviors and health status could lower the risk of recurrence and second primary cancers, as well as provide opportunities for better quality of life and physical health outcomes in survivorship. Furthermore, an understanding of the racial/ethnic differences in health status and behavioral risk factors is necessary to enhance health outcomes and quality of life of diverse survivors. Purpose: To examine health status, comorbidity status, and health behaviors among prostate cancer survivors and explore any racial/ethnic disparities among these survivors. Methods: Analysis was conducted using cross-sectional data from the 2015 National Health Interview Survey. Demographic frequencies and percentages were calculated among White, African American, and Hispanic men 50 years of age and older diagnosed with prostate cancer (n=398) with no report of other cancer diagnoses. Self-rated health, comorbidities, and selected health behaviors (physical activity, smoking, and alcohol use) were stratified by race/ethnicity. Results: The average age of survivors was 73 years (range 50-85 years). Survivors were more likely to be married, college graduates, and be publicly insured. Twenty-five percent of respondents reported a family history of prostate cancer. Sixty percent of survivors reported “good/very good” self-rated health. Overall, 40% of prostate cancer survivors reported no physical activity. Fifty-seven percent of respondents reported being current drinkers, of whom 25% characterized their drinking as heavy/moderate. Forty-nine percent reported being former smokers, although only 6% were current smokers. Thirty-one percent of survivors were obese (BMI ≥ 30) and 20% had 3+ comorbidities. There were no significant differences for physical activity, self-rated health, or obesity by race/ethnicity. More White survivors (29%) were moderate/heavy drinkers compared to African American (11%) and Hispanic (14%) survivors (p=0.04). African Americans (17%) were more likely to be current smokers than White (5%) or Hispanic (6%) survivors (p=0.04). African American (30%) and Hispanic (22%) survivors were more likely to report having 3 or more comorbidities compared to White (18%) survivors (p=0.03). Conclusions: The overall health status of prostate cancer survivors is suboptimal. Many health behaviors need to be improved in this higher-risk group. There are significant racial/ethnic differences in health behaviors including alcohol use, smoking status, and comorbidity status among prostate cancer survivors. The findings present opportunities to improve health behaviors among prostate cancer survivors. As many prostate cancer survivors are living longer, public health efforts to improve health behaviors are imperative to prevent a recurrence or second cancer diagnosis and improve quality of life. Evidence-based interventions are needed to promote healthy behaviors among prostate cancer survivors. Citation Format: Joelle Atere-Roberts, Ingrid J. Hall, Judith Lee Smith. Racial and ethnic disparities in comorbidities and behavioral risk factors among prostate cancer survivors, NHIS 2015 [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C37.

Abstract C55: Understanding the financial consequences of cancer: A qualitative study of racially and geographically diverse survivors

Abstract Background: Cancer survivors commonly face serious financial hardships that can impact their physical and financial health. African-American survivors, who are at greater risk of experiencing financial hardship than whites, and survivors in rural areas are often under-represented in this research, and ways in which financial hardship might differ by race and geography are not well understood. The purpose of this study is to gain a deeper understanding of the experiences of financial hardship of racially and geographically diverse cancer survivors using qualitative research methods. Study Design: We conducted a total of 7 focus groups, 5 in Detroit (2 among white and 3 among African-American survivors) and 2 among white survivors in rural communities in Michigan's Lower Peninsula. Detroit survivors were recruited from participants in the Cancer Survivorship in Metropolitan Detroit cohort study and included white and African-American adults diagnosed with breast, colorectal, lung, or prostate cancer since January 1, 2013. Rural survivors were recruited from community hospitals using the same criteria with regard to cancer site and dates of diagnosis. Each group included 3-6 survivors for a total of 32 participants across all groups. A semistructured discussion guide was developed based on a review of the literature related to financial hardship among cancer survivors. Topics included the types of financial costs experienced, strategies used to address those costs, the care-related and emotional impact of those costs, and the impact of those costs on future financial health and decision-making. All focus groups were audio- and video-recorded and verbatim transcripts were created from those recordings. Coding was conducted by 3 members of the study team. At least 2 individuals coded each transcript. Inter-rater reliability was tested and found to be satisfactory (Cohen's kappa = 0.70 for both LM and TF relative to TH). Coding and inter-rater reliability testing was conducted using Dedoose. Results: Overall, 6 main themes emerged related to the financial consequences of cancer: care-related costs, access to/paying for care, practical considerations, social support, knowledge and advocacy, and survivors' outlook. Participants in each group emphasized the impact of care-related costs, of insurance in paying for care, and the lack of knowledge of what their costs would be until bills began arriving after treatment. The importance of both individual and institutional social support in navigating the financial impact of cancer was emphasized, and several participants also discussed having to balance their care with caregiving responsibilities for others (e.g., disabled adult children) and the further financial and emotional toll that their treatment presented to their families. Although each group discussed each of the main themes, within those themes, survivors in the African-American focus groups further emphasized difficulty accessing timely and appropriate care due to cost and insurance coverage issues, difficulty in maintaining employment and the subsequent effects on their financial situation, and the centrality of faith and their relationship with God in their approach to handling financial stresses related to cancer. Rural survivors particularly emphasized the importance of logistical considerations with regard to traveling to and from treatment appointments and the impact of both monetary and time costs on their treatment decisions. Conclusions: Although several themes were consistent among survivors from diverse backgrounds and life experiences, important differences in the financial consequences of cancer were observed by both race and geography. These findings can inform both future research and efforts to improve financial hardship after cancer for diverse survivor populations. Citation Format: Theresa A. Hastert, Lorna M. Mabunda, Lisa Berry-Bobovski, Tanina Foster, Susan Eggly. Understanding the financial consequences of cancer: A qualitative study of racially and geographically diverse survivors [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C55.

Psychopathology and Coping in Survivors of Intimate Partner Violence: Associations with Race and Abuse Severity

ABSTRACTThe present study examined how race and abuse severity independently and interactively predicted psychopathology and coping in a sample of 206 African-American and White survivors of intimate partner violence (IPV). Women reported on their exposure to physical violence, their psychological symptoms, and their coping behaviors. White women reported more symptoms of anxiety and depression than African-American women. More severe abuse was generally related to more psychological symptoms and to greater denial. Interactions between race and abuse severity indicated that African-Americans reported fewer psychological symptoms than Whites at lower levels of abuse but not when abuse was very severe. African-Americans reported more coping-related substance use than Whites at the highest level of abuse severity. The implications of the findings for future research and for treatment of IPV survivors are considered.