Background Prior studies have observed greater levels of psychosocial stress (PSS) among non-Hispanic (nH) African American and Hispanic women when compared to nH White patients after a breast cancer diagnosis. We aimed to determine the independent and interdependent roles of socioeconomic position (SEP) and unmet support in the racial disparity in PSS among breast cancer patients. Methods Participants were recruited from the Breast Cancer Care in Chicago study (n = 989). For all recently diagnosed breast cancer patients, aged 25–79, income, education, and tract-level disadvantage and affluence were summed to create a standardized socioeconomic position (SEP) score. Three measures of PSS related to loneliness, perceived stress, and psychological consequences of a breast cancer diagnosis were defined based on previously validated scales. Five domains of unmet social support needs (emotional, spiritual, informational, financial, and practical) were defined from interviews. We conducted path models in MPlus to estimate the extent to which PSS disparities were mediated by SEP and unmet social support needs. Results Black and Hispanic patients reported greater PSS compared to white patients and greater unmet social support needs (p = 0.001 for all domains). Virtually all of the disparity in PSS could be explained by SEP. A substantial portion of the mediating influence of SEP was further transmitted by unmet financial and practical needs among Black patients and by unmet emotional needs for Hispanic patients. Conclusions SEP appeared to be a root cause of the racial/ethnic disparities in PSS within our sample. Our findings further suggest that different interventions may be necessary to alleviate the burden of SEP for nH AA (i.e., more financial support) and Hispanic patients (i.e., more emotional support).
potential to reduce inflammation, modulate epigenetic changes and affect biological processes involved in the pathogenesis of symptoms. The objective of this study was to determine if pretreatment dietary patterns are associated with the presence of symptoms 1-year after diagnosis. Methods: This was a longitudinal study of 295 newly diagnosed HNC patients. All patients completed a food frequency questionnaire and epidemiologic health survey. Self-reported symptoms were assessed pre-treatment and 1-year after diagnosis using a Likert scale ranging from "1: not at all bothered" by symptom to "5: extremely bothered". Symptom scores were dichotomized as "not at all" vs. "slight-extremely". Principal component analysis was used to derive pre-treatment dietary patterns. Multivariable logistic regression models examined the association of derived dietary patterns (fit by quartiles) and seven symptoms (trismus, xerostomia, dysphagia of liquids, dysphagia of solids, difficulty chewing, taste and mucositis). An overall symptom summary score was calculated (range 8-39) and dichotomized as <17 vs. !17. This cutoff was chosen by examining the distribution of scores and categorizing into two distinct subgroups naturally present in the data. Results: Two dietary patterns emerged: Prudent (high intakes of vegetables, fruit, fish, poultry, and whole grains) and Western (high intakes of red and processed meats, refined grains, potatoes, and French fries). After adjusting for age, baseline symptoms, tumor site, cancer stage, smoking, calories and HPV status, significant inverse associations were observed between pre-treatment Prudent pattern score and dysphagia of liquids (P ¼ 0.01), dysphagia of solids (P ¼ 0.02) and difficulty chewing (P ¼ 0.02) at 1 year post-diagnosis. A statistically significant inverse association was observed between the overall symptom summary score and the Prudent pattern (P < 0.001). No significant associations were observed between the Western pattern and symptoms. Conclusion: Consumption of a pre-treatment Prudent diet may help reduce the risk of symptoms such as dysphagia and difficulty chewing 1-year after diagnosis in HNC survivors.
Background: Greater levels of stress, anxiety, or isolation (psychosocial stress) have been hypothesized to negatively alter the sympathetic-parasympathetic autonomic nervous system, suppress immune function, and have other physiologic effects that, in turn, might impact survival in breast cancer patients. Prior research in a variety of contexts has documented greater levels of psychosocial stress among non-Latina (nL) Black and Latina women when comparted to nL White women in the United States. We examined associations between patient-reported psychosocial stress and survival (breast cancer-specific and overall) in the Breast Cancer Care in Chicago (BCCC) study, a cross-sectional study of 989 recently diagnosed breast cancer patients, including 397 non-Hispanic White (white), 411 non-Hispanic Black (black), and 181 Latina patients. Methods: Eligible patients were between 30 and 79 years of age at diagnosis, resided in Chicago, and were diagnosed with a first primary breast cancer (in situ or invasive) between 2005 and 2008. Psychosocial stress was defined based on three existing scales. The four items from the Cohen perceived stress subscale were summed to create a measure with an inter-item reliability (Cronbach's alpha of 0.74). The three items from the UCLA felt loneliness scale (alpha=0.79) and the 12 items from the Cockburn psychological consequences scale (alpha=0.93) were also summed. The probability of death due to breast cancer was modeled in multivariable logistic regression followed by conditional standardization, separately for each psychosocial stress measure while controlling for age, race/ethnicity, insurance, mode of detection, socioeconomic status, and treatment variables. Results: Compared to white patients, black and Latina patients reported greater levels of stress, loneliness, and psychological consequences (p=0.001 for each). When comparing patients one SD above vs. one SD below the mean for each psychosocial stress measure, perceived stress and psychological consequences were associated or marginally associated with increased risk of death from breast cancer (RR =1.90, 95% CI: 1.21, 3.12 and RR=1.42, 95%CI: 0.84, 2.36, respectively), whereas loneliness was not (RR=1.08, 95%CI: 0.61, 1.68). With respect to death from all causes, RRs for perceived stress, psychological consequences, and loneliness were 1.77 (95% CI: 1.24, 2.46), 1.37 (95%CI: 0.94, 2.04) and 1.17 (95%CI: 0.78, 1.63), respectively. The black-white disparity in breast cancer-specific death (HR=3.63, 95%CI: 2.08, 6.34) was slightly attenuated with control for all three psychosocial stress variables (HR=3.46, 95%CI: 1.98, 6.06). The black-white disparity in death from any cause (HR=2.41, 95%CI: 1.60, 3.62) was again slightly attenuated with control for all three psychosocial stress variables (HR=2.30, 95%CI: 1.53, 3.47). Additional mediation analyses confirmed that these three psychosocial stress variables did not appear to mediate black-white survival disparities. Conclusions: Psychosocial stress was associated with increased mortality from breast cancer among recently diagnosed patients. Although it seems to not be very meaningful in the context of black-white survival disparities, elevated stress could lead to detrimental effects on immune function, or could adversely affect patient adherence and completion of recommended treatment, in addition to other mental health illnesses, such as depression. For this reason, further analysis and interventions at the extent of multilevel contributing factors may be needed in order to address survival disparities in breast cancer. Citation Format: Carola T. Sánchez-Díaz, Garth H. Rasucher. Disparities in psychosocial stress and breast cancer survival by race/ethnicity [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 A52.
Behavioral surveillance systems in groups such as MSM in on the island will aid to monitor prospectively the effectiveness of HIV testing outreach and engagement, as well as capacity capacity-building strategies targeted towards health care providers, aimed to increase HIV testing and awareness among this group.
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