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Small cell, neuroendocrine tumors, and melanoma of the anus are rare. Limited data exist on the incidence and management for these rare tumors. A large, prospective, population-based database was used to determine incidence and survival patterns of rare anal neoplasms. The Surveillance, Epidemiology and End Results registry was queried to identify patients diagnosed with anal canal neoplasms. Incidence and survival patterns were evaluated with respect to age, sex, race, histology, stage, and therapy. We identified 7078 cases of anal canal neoplasms: melanoma (n = 149), neuroendocrine (n = 61), and small cell neuroendocrine (n = 26). Squamous cell carcinoma (SCC) (n = 6842) served as the comparison group. Anal melanoma (AM) demonstrated the lowest survival rate at 2.5 per cent. Neuroendocrine tumors (NETs) demonstrated similar survival as SCC (10-year survival for regional disease of 25 and 22.3%, respectively). Ten-year survival of small cell NETs resembled AM (5.3 vs2.5%). Age 60 years or older, sex, black race, stage, and surgery were independent predictors of survival. This study presents the largest patient series of rare anal neoplasms. NETs of the anal canal demonstrate similar survival patterns to SCC, whereas small cell NETs more closely resemble AM. Accurate histologic diagnosis is vital to determine treatment and surgical management because survival patterns can differ among rare anal neoplasms.

Limited scientific evidence is available regarding D/deaf women's breast cancer knowledge and early detection practices, as well as about how to increase D/deaf women's breast cancer control practices.

Background:Breast cancer (BC) patients often experience cancer-related fatigue (CRF) before, during, and after their chemotherapy. Circadian rhythms are 24-hour cycles of behavior and physiology that are generated by internal pacemakers and entrained by zeitgebers (e.g., light). A few studies have suggested a relationship between fatigue and circadian rhythms in some clinical populations. Methods:One hundred and forty-eight women diagnosed with stage I–III breast cancer and scheduled to receive at least four cycles of adjuvant or neoadjuvant chemotherapy, and 61 controls (cancer-free healthy women) participated in this study. Data were collected before (Baseline) and after four cycles of chemotherapy (Cycle-4). Fatigue was assessed with the Short Form of Multidimensional Fatigue Symptom Inventory (MFSI–SF); circadian activity rhythm (CAR) was recorded with wrist actigraphy (six parameters included: amplitude, acrophase, mesor, up-mesor, down-mesor and F-statistic). A mixed model analysis was used to examine changes in fatigue and CAR parameters compared to controls, and to examine the longitudinal relationship between fatigue and CAR parameters in BC patients. Results:More severe CRF (total and subscale scores) and disrupted CAR (amplitude, mesor and F-statistic) were observed in BC patients compared to controls at both Baseline and Cycle-4 (all p's < 0.05); BC patients also experienced more fatigue and decreased amplitude and mesor, as well as delayed up-mesor time at Cycle-4 compared to Baseline (all p's < 0.05). The increased total MFSI–SF scores were significantly associated with decreased amplitude, mesor and F-statistic (all p's < 0.006). Conclusion:CRF exists and CAR is disrupted even before the start of chemotherapy. The significant relationship between CRF and CAR indicate possible underlying connections. Re-entraining the disturbed CAR using effective interventions such as bright light therapy might also improve CRF.

Fatigue and sleep disturbances are two of the most common and distressing symptoms of cancer patients. A relationship between the two symptoms was reported in symptom cluster studies; however, only subjective measurements of sleep were examined and most studies were cross-sectional. In this study of women with breast cancer undergoing chemotherapy, we explored the longitudinal relationship between fatigue and sleep measured both subjectively and objectively.

: African American women have disproportionately higher rates of breast cancer mortality than all other ethnic groups, thus highlighting the importance of promoting early detection.

Prior cross-sectional studies have shown that cancer patients have sleep-wake activity cycles that show little distinction between daytime and nighttime, a pattern indicative of circadian disruption. This pattern is seen both before and during cancer treatment. Long-term data are needed, however, to assess to what extent circadian rhythm impairments evolve over the course of chemotherapy. The goal of this study was to assess the longitudinal course of sleep-wake activity rhythms before and during chemotherapy for breast cancer.

Abstract

PurposeThe purpose of this study was to assess the diabetes risk status, incidence, and morbidity within San Diego’s Chamorro community as a foundation to help community leaders and health care providers create culturally customized health promotion interventions.MethodsThe Behavioral Risk Factor Surveillance Survey was used to query a randomly selected, convenience sample of San Diego Chamorros (N = 228) drawn from the Chamorro Directory International. Based on individual survey responses, participants were mailed personalized health-promoting information. Subsequently, they received information that addressed the most commonly observed overall threats to the Chamorro community’s health.ResultsA higher than average prevalence of diabetes and gestational diabetes was reported by study participants along with a high prevalence of the risk factors associated with the premature onset of diabetes and its consequences.ConclusionCollaborative partnerships between health professionals and community leaders can help identify opportunities and strategies for improving the health of the nation’s population subgroups. San Diego’s Chamorro community leaders now have a clearer understanding of the prevalence of diabetes risk factors within their community and can begin working with public health educators to create culturally aligned diabetes prevention and management programs. Given the willingness of Chamorro leaders to get involved in the development of a diabetes awareness campaign and the community’s closely knit social network, it should be possible to promote (1) community participation in the intervention program, (2) an increase in the community’s adherence to recommended behavioral changes, and (3) identification of additional program modifications that will further enhance the program’s cultural relevance.

-Background. Little is known about the health of Chamorros residing in the United States. Methods. The Chamorro Directory International and CDC's Behavioral Risk Factor Surveillance System were used to assess behavioral risk factors and health needs of San Diego's Chamorro women. Results. Of 128 Chamorro women, 42.2% reported having a total frequency of five or more fruits and vegetables daily, 54.5% reported being current on their colorectal cancer screening, and 9.4% smoke. Conclusions. While this sample of Chamorro women reported higher rates of healthpromoting practices than nationwide averages, significant health improvement opportunities remain.

Before psychometric instruments can be used for populations other than those for whom they were originally developed, validation of cultural appropriateness is essential. This article describes the assessment of the cultural appropriateness of the Finding Meaning Through Caregiving Scale (FMTCS) with Korean female family caregivers. The FMTCS measures finding meaning among caregivers from an existential perspective and has three subscales: Loss/Powerlessness, Provisional Meaning, and Ultimate Meaning. The instrument’s cultural appropriateness was examined through semistructured interviews with ten Korean-born female family caregivers, five caregivers living in Korea, and five living in the United States. The interview data are reported according to the three dimensions described by Flaherty and colleagues (1988): content, semantic, and conceptual equivalence. Although the majority of items of the FMTCS appeared applicable to Korean caregivers, items on the Loss/Powerlessness and Provisional Meaning subscales asking caregivers about feelings related to missing their past relationships or communications appeared inappropriate for many Korean daughters-in-law. Of equal importance, a unique source of meaning among Korean caregivers that is not assessed in the FMTCS is an interpersonal context, including the importance caregivers place on teaching children and feeling proud of one’s caregiving accomplishments in the eyes of other relatives. The addition of new items that address the interpersonal context is warranted to improve the instrument’s cultural appropriateness for Korean caregivers.

Background. Prostate cancer, the most common cancer in American men, may increase the risk of emotional distress in patients and their spouses. Problem-solving skills may be related to the emotional distress of the spouses. Method. Thirty-two spouses of prostate cancer patients completed measures of problem-solving skills and emotional distress. Results. Proactive problem-solving skills were related to less emotional distress in spouses. Subtypes of problem-solving skills were differentially related to emotional distress. Conclusions. Enhancement of problem-solving skills may contribute to improved health-related quality of life of spouses of prostate cancer patients.

Background. Problems accompany any experience with cancer. Methods. Patients, spouses, and providers were asked to identify their perceptions of the problems associated with recently diagnosed prostate cancer. Their answers were compared across respondent categories (physician, nurse, patient, and spouse) and cross-informant variance was analyzed. Results. Significant variation in responses was noted by respondent categories in spite of the relatively small sample. Conclusion. The response variance may contribute to communication problems among patients, spouses, and providers, as well as missed opportunities for medically appropriate referrals to psychological treatment and community support resources.

Background. The Deaf community has not been adequately served by mainstream public health interventions. Methods. A breast cancer education program adapted for the needs of the Deaf community was evaluated by 123 deaf and hard-of-hearing women using pre- and post-surveys and focus groups. Results. Among the findings were the difficulty of recruiting Deaf community members to education and research programs; low adherence to breast cancer screening guidelines; insufficient breast-health knowledge; endorsement of the program; and suggestions for strengthening it. Conclusion. Deaf women will benefit from breast cancer education programs that specifically address their language, culture, and preferred learning styles.

Background. Reaching diverse population subgroups with information about cancer prevention/early detection, pain management, and clinical trials has historically been a significant public health challenge. A partnership between clergy and cancer educators might help reduce this challenge. Methods. Participating churches were randomized into two programs for delivering cancer education after their church leaders completed a baseline survey about their knowledge, attitudes, and roles related to the cancer ministry. Results. Clergy reported opportunities to use their acquired cancer knowledge, a high receptivity to their information, comfort discussing cancer care and clinical trials, and a strong recommendation that the educational program/partnership continue to be offered.

Background. The Deaf community reports limited access to health promotion information and care. Literature review, key informant interviews, and focus groups generated a clearer understanding of the community. Health care providers, educators, and policymakers could improve medical care to the Deaf community by: 1) better understanding its culture and language; 2) creating more health education programs specifically for the Deaf community; 3) developing opportunities for more deaf people and American Sign Language (ASL) users to enter the health professions; and 4) creating incentives for hearing health care providers to become ASL proficient.

Culturally and linguistically compatible university students were trained as community health educators to provide breast cancer education and screening information to shoppers at Asian grocery stores. Information about early detection of breast cancer was shared with 8,877 women, who reported speaking 40 different languages. Baseline surveys were completed by 1,202 women; 779 took part in the follow-up survey. The survey questions assessed baseline knowledge, attitudes, and screening behaviors regarding breast cancer, tested the efficacy of the intervention, and sought barriers to accessing screening services. Screening adherence at baseline was low, but reported screening compliance had increased by follow-up. This study confirms the cost-effectiveness of student health educators and Asian grocery store sites as venues to reach the diverse age, ethnic, and socioeconomic segments of the Asian community, while demonstrating the community's receptiveness to the dissemination of health information and introducing bilingual students to health education and research careers.

Background. African Americans suffer a disproportionate burden of illness and premature mortality. Methods. A health education program delivered via cosmetologists was pilot tested as a supplement to other programs seeking to reach this community with information designed to remedy this inequality. Eight cosmetologists were randomized to either an active or a passive educational intervention arm, with the active arm (experimental arm) focused on breast cancer early detection. Results. Both cosmetologists and clients found this an acceptable intervention. Nearly all women in the study demonstrated that they had heard the mainstream messages about the value of breast cancer early detection, but a considerable proportion appeared not to realize breast cancer's high level of morbidity and mortality within their own community. Conclusion. The results suggest this approach is worthy of further evaluation.

The American Cancer Society estimated that in 1993 1,000 new cases of male breast cancer would be diagnosed in the United States and 300 men would die from the disease. The clinical picture of breast cancer among men resembles that seen in women, and the development of the disease among men has been attributed to similar hormonal and genetic causes. The mortality rate from breast cancer is also similar, when corrected for chronological age and stage of the disease at the time of diagnosis and treatment. Guidelines for patient education, health screening, and patient support are presented.

African Americans suffer a disproportionate burden of illness. Afrocentric, community-based health education programs that create permanent health resources within the community offer a viable means to reduce morbidity and mortality. This feasibility study randomized African-American cosmetologists into two groups of peer health educators and trained them to pass along health information to their clients. Cosmetologists in one arm were trained to become actively involved peer health educators, whereas, in the other arm, they were trained to be informed generally about the information they were passing along to their clients. An African-American ancestral storyteller refined the cosmetologists' storytelling skills to facilitate inclusion of key health facts and their repetition to others. Cosmetologists and their clients reported high acceptance of the cosmetologists as peer health educators. Cosmetologists preferred the active involvement in health education over the more passive role and reported no negative consequences to their business. Reported adherence to screening guidelines exceeded the Year 2000 goals for mammograms. Although the reported awareness of and training for breast self examination (BSE) were high, neither the cosmetologists' nor their clients' initial BSE skills suggested that prior teaching had occurred to the point of mastery. Clients reported their willingness to share their health-promotion information with other women. Although difficulties recruiting and retaining women to this research study were reduced by this Afrocentric model, they were not resolved entirely. Overall, this health-promotion model offers considerable promise as a way to reach African-American women with health-promotion information, whereas the feasibility study identified design modifications that will be necessary prior to project expansion. Cancer 1998;83:1836-1839. © 1998 American Cancer Society.