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Self-rated health (SRH) is a salient outcome for cancer survivors. Although depression is a well-studied correlate with SRH, few studies have focused on the role of cancer survivors' age on the association between depression and SRH. This study evaluates demographic and psychosocial factors associated with cancer survivors' SRH. We also assess the moderating role of age to the association between depression and SRH.This paper analyzed 2,470 U.S. cancer survivors from the 2019 National Health Interview Survey. Two ordered logistic regression models with complex survey weights were used for analyses. Missing data was addressed using multiple imputations by chained equations.Being female, higher education and higher income were positively associated with better SRH. While the relationship between higher education and higher income was consistent with previous findings, the positive association between being female and SRH was different from previous studies. Age significantly moderated the association between depression and SRH, evidenced by results of the joint tests of all interaction term coefficients being statistically significant,The findings of the study highlighted the significance of screening for social determinants of health and health disparity when supporting cancer survivors. Additionally, findings of this study emphasized the significance of adopting an age-specific approach when evaluating and addressing depression across different age groups of cancer survivors.

BackgroundYoung adults and other working-age adults with cancer are at risk for cancer-related financial toxicity (FT), including material hardships, depletion of coping resources, and psychological burden. This study compares FT domains in young adults (18-39years old) (YAs), other working-age adults (40-64years old), and older adults (≥65years old) receiving cancer care.MethodsA total of 311 adults were surveyed using the multi-domain Economic Strain and Resilience in Cancer instrument measuring FT (0-10 score indicating least to greatest FT; score ≥5 severe FT). Participants were receiving ambulatory care from March-September 2019. Associations of age with overall FT and material hardship, coping resource depletion, and psychological burden FT domains were tested using Kruskal-Wallis and χ2 tests and multivariable generalized linear models with gamma distribution.ResultsYAs (median age, 31.5years) comprised 9.6% of the sample; other working-age adults comprised 56.9%. Overall, material, coping, and psychological FT scores were worse in younger age adults versus older adults (P&nbsp

Purpose: Technology-assisted interventions are essential in supporting cancer survivors' psychosocial outcomes, especially for childhood, adolescent, and young adult (AYA) cancer survivors, a tech-savvy generation. This study aims to systematically evaluate review and meta-analyze technology-assisted interventions for childhood and AYA cancer survivors. Methods: Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, the study team used a pre-set of key words and searched studies across 11 electronic databases and 4 professional websites, and conducted a manual search of reference lists from published reviews. Meta-analysis of small sample size corrected Hedges' g was conducted using meta-regression with robust variance estimation. Results: Final analysis included a total of 28 clinical trials, including 237 effect sizes reported an overall statistically significant treatment effect of technology-assisted psychosocial interventions for childhood and AYA cancer survivors, g = 0.382, 95% confidence interval (CI) 0.243 to 0.521, p

PURPOSE: Patients with cancer frequently encounter financial hardship, yet systematic strategies to identify at-risk patients are not established in care delivery. We assessed sensitivity of distress-based screening to identify patients with cancer-related financial hardship and associated care delivery outcomes. METHODS: A survey of 225 patients at a large cancer center assessed cancer-related financial hardship (0-10 Likert scale; highest quintile scores ≥ 5 defined severe hardship). Responses were linked to electronic medical records identifying patients’ distress screening scores 6 months presurvey (0-10 scale) and outcomes of missed cancer care visits and bad debt charges (unrecovered patient charges) within 6 months postsurvey. A positive screen for distress was defined as score ≥ 4. We analyzed screening test characteristics for identifying severe financial hardship within 6 months and associations between financial hardship and outcomes using logistic models. RESULTS: Although patients with positive distress screens were more likely to report financial hardship (odds ratio [OR], 1.21; 1.08-1.37; P < .001), a positive distress screen was only 48% sensitive and 70% specific for identifying severe financial hardship. Patients with worse financial hardship scores were more likely to miss oncology care visits within 6 months (for every additional point in financial hardship score from 0 to 10, OR, 1.28; 1.12-1.47; P < .001). Of patients with severe hardship, 72% missed oncology visits versus 35% without severe hardship ( P = .006). Patients with worse hardship were more likely to incur any bad debt charges within 6 months (OR, 1.32; 1.13-1.54; P < .001). CONCLUSION: Systematic financial hardship screening is needed to help mitigate adverse care delivery outcomes. Existing distress-based screening lacks sensitivity.

Background: Financial toxicity (FT) is a multi-faceted construct, encompassing material hardship, psychological responses, and coping behaviors. FT adversely impacts patient-reported outcomes by decreasing mental health, affecting health-related quality of life (HRQOL), and deteriorating healthcare adherence. Few studies have assessed the relationship between financial toxicity, distress, coping, self-efficacy, and HRQOL within the context of cancer care disruptions resulting from the pandemic. Methods: In the COVID-19 Breast Cancer Care Survey, 46 women with primary breast cancer were cross-sectionally evaluated for financial hardship (FACIT-COST), distress (Perceived Stress Scale), coping behaviors (Brief COPE), self-efficacy (Cancer Behavior Inventory–Brief) and HRQOL using the Functional Assessment of Cancer Therapy General (FACT-G) measure. Cancer care disruptions were measured with a series of questions investigating the impact of COVID-19 guidelines on access to healthcare services, treatment, and transition to telemedicine. Given the role of informal caregivers for patients’ outcomes, social isolation was additionally included (PROMIS Social Isolation Scale). Descriptive statistics were computed, and bivariate correlations examined. Then, a subsequent regression model investigated predictors of FT in the present sample. Statistical analyses were performed using SAS 9.4 and significance level was set at p< 0.05. Results: Overall, participants were adult (Mage= 46.3±10.9) women diagnosed with early-stage breast cancer (75.61% Stage I/II). Approximately half of the participants were in active treatment (51.2%) and received multiple types of treatment (85.4% surgery; 61% chemotherapy, and 36.5% radiation). Although all participants were insured at time of the study, the mean score of FT was 22.75 (SD=4.10, range: 0-44). Correlation analyses indicated that cancer care disruptions (r= -0.57, p Citation Format: Chiara Acquati, Tzuan Chen, Isabel Martinez Leal, Shahnjayla Connors, Anastasia Rogova, Mathew Banegas, Grace Smith, Lorraine R. Reitzel, Lorna McNeill. Investigating Financial Toxicity among Breast Cancer Patients Diagnosed during the Pandemic: The Role of Cancer Care Disruptions and Social Isolation [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-05-03.

The present work investigated the relationship between patient activation, treatment decision-making, and adherence to the prescribed treatment regimen. Given the role of informal caregivers in patient-reported outcomes, it was additionally assessed whether caregiver involvement acted as a moderator of this relationship. Survey data collected from 504 cancer survivors were utilized. Structural equation modeling (SEM) controlling for covariates was used to examine the relationship between patient activation measure (PAM), caregiver involvement, and the identified outcomes. Moderator analysis was conducted using multiple group SEM. Patient activation was significantly associated with treatment planning being reflective of survivors’ goals and values (p

BACKGROUND Sexual dysfunction represents a critical aspect of quality of life for adolescent and young adult cancer survivors. Studies have consistently documented that adolescents and young adults report greater psychological and physical morbidity than older survivors and healthy peers, including elevated rates of sexual dysfunction, often accompanied by lower satisfaction with sex life and delays in meeting sexual milestones. Moreover, sexual dysfunction, body image concerns, and fertility status affect their confidence in being both physically and emotionally intimate. Despite this evidence, limited research has investigated the influence of psychosocial and interpersonal factors on sexual health outcomes reported by this group. This constitutes a significant gap in the provision of comprehensive sexual health care for adolescent- and young adult–onset cancer survivors, especially since greater emphasis has been recently placed on the biopsychosocial model of sexuality and dyadic approaches to intervention and treatment. In comparison to other cancer types, the incidence of colorectal cancer (CRC) has been increasing at an alarming rate for the adolescent and young adult group. Patients with early-onset CRC experience elevated rates of sexual dysfunction, psychological distress, and social and physical burden, often resulting from issues with bowel control, incontinence, and body image. OBJECTIVE This study uses an explanatory sequential mixed methods approach to (1) characterize sexual function, sexual distress, dyadic coping, infertility-related distress, relationship and mental health outcomes of adolescent and young adult CRC survivors within the first 5 years post diagnosis and their partners; (2) examine the reciprocal influence of sexual function and dyadic coping behaviors on sexual distress; and (3) identify interpersonal or couple characteristics associated with coping with sexual dysfunction and its associated distress. METHODS Participating couples (n=60) will complete a quantitative web-based survey investigating sexual function, sexual distress, dyadic coping, infertility-related distress, emotional functioning, relationship satisfaction, and body image (cancer survivors only). A subset of 20 couples will participate in an in-depth dyadic interview with 2 members of the research team to further explore couple-based strategies implemented to cope with cancer-related sexual dysfunction and distress. RESULTS The study received institutional review board approval. Recruitment and enrollment of couples began in July 2022. CONCLUSIONS Results will provide a deeper understanding of the challenges couples experience as they navigate sexual intimacy after CRC treatment by highlighting the role of interpersonal processes. These findings will inform a dyadic intervention for young couples at risk of greater sexual distress in the aftermath of CRC. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/41831

Approximately one-half of individuals with cancer face personal economic burdens associated with the disease and its treatment, a problem known as financial toxicity (FT). FT more frequently affects socioeconomically vulnerable individuals and leads to subsequent adverse economic and health outcomes. Whereas multilevel systemic factors at the policy, payer, and provider levels drive FT, there are also accompanying intervenable patient-level factors that exacerbate FT in the setting of clinical care delivery. The primary strategy to intervene on FT at the patient level is financial navigation. Financial navigation uses comprehensive assessment of patients' risk factors for FT, guidance toward support resources, and referrals to assist patient financial needs during cancer care. Social workers or nurse navigators most frequently lead financial navigation. Oncologists and clinical provider teams are multidisciplinary partners who can support optimal FT management in the context of their clinical roles. Oncologists and clinical provider teams can proactively assess patient concerns about the financial hardship and employment effects of disease and treatment. They can respond by streamlining clinical treatment and care delivery planning and incorporating FT concerns into comprehensive goals of care discussions and coordinated symptom and psychosocial care. By understanding how age and life stage, socioeconomic, and cultural factors modify FT trajectory, oncologists and multidisciplinary health care teams can be engaged and informative in patient-centered, tailored FT management. The case presentations in this report provide a practical context to summarize authors' recommendations for patient-level FT management, supported by a review of key supporting evidence and a discussion of challenges to mitigating FT in oncology care. CA Cancer J Clin. 2022;72:437-453.

Cancer is a serious, life-threatening illness that impacts the entire family system, with implications for patients themselves, their siblings, parents, and extended family. Given increasing identi...

Background Prostate cancer is the most commonly diagnosed cancer in both African American and Hispanic men. Active surveillance is a treatment option for low- or very low-risk prostate cancer survivors, and lifestyle interventions have been found to reduce the disease progression and improve the quality of life for both survivors and their partners. To date, no lifestyle interventions that specifically target African American or Hispanic men and their partners exist. This protocol describes a study that tests the feasibility of a randomized controlled trial, a lifestyle intervention developed to enhance healthy lifestyle and quality of life among African American and Hispanic men on active surveillance and their partners. Methods A mixed-method study, including a two-arm randomized controlled trial (n = 30 dyads in the intervention arm and n = 10 dyads in the control arm) and in-depth interviews, will be conducted. Intervention arm participants will receive bi-weekly health coaching calls (a total of 12 calls based on Motivational Interviewing), as well as physical activity-specific (e.g., power point slides, print materials about physical activity, and activity trackers for self-monitoring) and nutrition-specific education (e.g., two nutrition counseling sessions from a registered dietitian, print materials about nutrition, and food intake recording for self-monitoring) over 6 months. All participants will be assessed at baseline, month 3, and month 6. Blood will be collected at baseline and month 6 from the prostate cancer survivors. Finally, in-depth interviews will be conducted with subsamples (up to n = 15 dyads in the intervention arm and up to n = 5 dyads in the control arm) at baseline and months 3 and 6 to conduct a process evaluation and further refine the intervention. Discussion If effective, the intervention may have a higher health impact compared with a typical lifestyle intervention targeting only survivors (or partners), as it improves both survivors’ (tertiary prevention) and partners’ health (primary prevention). Results from this study will provide important information regarding recruiting racial/ethnic minority cancer survivors and their partners. Lessons learned from this study will be used to apply for a large-scale grant to test the impact of the dyadic intervention in a fully powered sample. Trial registration ClinicalTrials.gov (NCT No. 03575832) registered on 3 July 2018.

Becoming parents represents a potentially stressful transition, which may negatively affect the individual and relational well-being of both partners. Limited literature has investigated the role of dyadic coping during the transition to parenthood. This work explored partners’ differences in dyadic coping, anxiety, depression, and couple adjustment during pregnancy and 3 months postpartum. Furthermore, through Actor–Partner Interdependence Model analyses, the relationship between common dyadic coping and well-being was investigated. Women reported higher levels of depression at both times and men presented higher levels of anxiety in the postpartum. For women, higher scores on couple adjustment were predicted by their own and their partner’s common dyadic coping. For men, higher scores on anxiety were associated with elevated common dyadic coping. Results highlight gender-related predictors on postpartum well-being and support the need to assess individual and relational outcomes across the transition to parenthood to better understand the role of dyadic coping behaviors.

Despite significant declines in breast cancer (BC) incidence in the West, this disease is widespread in Jordan, where cancer detection occurs at much advanced stages. This is particularly concerning for Syrian refugee women resettled in Jordan, who are less likely to undergo cancer preventative procedures because of poor health literacy and lack of health services access. The present work assesses and compares breast cancer awareness and breast cancer screening behaviors among Syrian refugee women and Jordanian women residing close to the Syrian–Jordanian border city of Ar-Ramtha. A cross-sectional survey was conducted using a validated Arabic version of the Breast Cancer Screening Beliefs Questionnaire (BCSBQ). A total of 138 Syrian refugee women and 160 Jordanian women participated in the study. Results indicate that 93.6% of Syrian refugee women and Jordanian women ≥ 40 years of age reported never having undergone a mammogram. Syrian refugee women and Jordanian women reported low attitudes toward general health checkup (mean score for Syrian refugees 45.6 vs. 42.04 among Jordan women; p = 0.150). Barriers for BC screening were higher among Syrian refugees (mean score = 56.43) than Jordanian women (mean score = 61.99, p = 0.006). Women with higher education were more likely to report fewer barriers to screening (p = 0.027). The study documents a significant lack of BC screening awareness among Syrian refugee women and Jordanian women, indicating that future work is needed to alter current attitudes towards mammograms and early detection measures especially for Syrian refugee women and Jordanian women residing in rural areas of Jordan.

For women diagnosed with breast cancer, partners are consistently identified as the primary support person. Despite growing consensus about the psychosocial experience and unmet needs of cancer caregivers, limited evidence exists about strategies to offer partner-centered care across the cancer continuum. This study describes challenges endured by partners of breast cancer survivors (BCS), strategies implemented to manage these experiences, and recommendations for healthcare providers to inform targeted psychosocial care. Using convenience sampling, 22 partners of female BCS were recruited and completed semi-structured interviews. Conventional content analysis was used to code and synthesize findings. Participants described undergoing five experiences in their role as romantic partners: (a) assuming the role of caregiver, (b) becoming healthcare advocates for BCS, (c) connecting emotionally with the partner, (d) managing their own painful emotions, and (e) connecting with others for support. Experience-specific coping strategies and recommendations were identified. Romantic partners face multiple transitions across the cancer care continuum, which warrant investigation to sustain their well-being and active participation in illness management. Psychosocial interventions for this group will benefit from flexible implementation and attention to care delivery, mental health, and supportive/social needs.

Rectal cancer (RC) patients experience unique sources of distress, including sexual dysfunction and body image concerns, which can also cause distress among partners. This preliminary study investigated patterns of psychological distress, sexual functioning, sexual distress, and relationship satisfaction among RC patient-partner couples at pivotal points during cancer treatment.Twenty couples participated (N = 40). Patients and partners completed a series of validated measures of psychological distress (ET), sexual functioning (FSFI; IIEF), sexual distress (GMSEX; Sexual Distress Scale) and relationship satisfaction (GMREL) at time of diagnosis, 3 weeks after radiation, 4 weeks post-surgery, and after chemotherapy and surgery for ostomy closure. Descriptive statistics, t-tests, and repeated-measures ANOVA were used to analyze scores over time, first for patients and partners, and then by sex.Relationship satisfaction remained elevated over time. In this sample, 55% of patients and 78.9% of partners reported clinically significant rates of psychological distress at diagnosis, which decreased to 23% and 46% respectively at the last assessment. Sexual satisfaction and distress worsened for patients and partners between baseline and surgery for ostomy closure. Both male and female participants reported statistically significant declines in sexual function from baseline to end of treatment (p 0.05).Relative to relationship satisfaction, psychological and sexual health outcomes seem more vulnerable to the effects of RC treatment during the first year after diagnosis, both for patients and partners and for men and women. Results support the need for psychosocial care and sexual education/counseling for couples coping with RC.

The ability to actively cope with cancer has been extensively associated with better patient-reported outcomes (PROs). This systematic review aims to synthesise the available literature assessing the experience of cancer patients from racial-ethnic minoritised groups. Given the role of sociocontextual factors, greater emphasis was placed on the relationship between family communication and cancer patients' coping within the three largest racial-ethnic minority groups in the United States. Five databases (CINAHL, MEDLINE, PsycINFO, PubMed, Web of Science) were used to search for peer-reviewed empirical studies published between 2008 and 2021, investigating family communication patterns, coping, and well-being among Black/African American, Asian, and Hispanic/Latinx cancer survivors. Short reports, chapters, abstracts/summaries, systematic reviews, and conference proceedings were excluded. This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). The Criteria for Critically Appraising Systematic Reviews and Meta-Analyses were used to assess the quality and risk of bias in the included studies. The synthesis process focused on study aims, methods, measures of interests, sample characteristics, data analysis, and study findings. A total of 117 articles were identified, of which 9 met the inclusion criteria. The selected articles were cross-sectional, implementing both quantitative and qualitative designs. Studies included breast, prostate, and mixed cancer types. Sample sizes of quantitative studies ranged from 64 to 338 respondents, while qualitative studies' samples ranged between 9 and 43 participants. Family communication and coping styles varied across minoritised groups, with open family communication contributing to effective individual and family coping. However, empirical evidence about the nature and contribution of family communication to the coping process is sparse. Future research is needed to increase knowledge and psychosocial assessment techniques and interventions targeting family communication and coping among minority communities.

The COVID-19 pandemic has had critical consequences for cancer care delivery, including altered treatment protocols and delayed services that may affect patients’ quality of life and long-term survival. Breast cancer patients from minoritized racial and ethnic groups already experience worse outcomes, which may have been exacerbated by treatment delays and social determinants of health (SDoH). This protocol details a mixed-methods study aimed at comparing cancer care disruption among a diverse sample of women (non-Hispanic White, non-Hispanic Black/African American, and Hispanic/Latina) and assessing how proximal, intermediate, and distal SDoH differentially contribute to care continuity and health-related quality of life. An embedded mixed-methods design will be implemented. Eligible participants will complete an online survey, followed by a semi-structured interview (with a subset of participants) to further understand factors that influence continuity of care, treatment decision-making, and self-reported engagement. The study will identify potentially modifiable factors to inform future models of care delivery and improve care transitions. These data will provide the necessary evidence to inform whether a subsequent, multilevel intervention is warranted to improve quality of care delivery in the COVID-19 aftermath. Additionally, results can be used to identify ways to leverage existing social resources to help manage and support patients’ outcomes.

A growing recognition of the impact of distress on the quality of life and adherence to treatment of cancer patients has been documented. As a result, national guidelines and standards of care mandate providers to implement distress screening protocols to connect patients with psychosocial services. However, limited literature has examined whether distressed patients are referred to care and their needs addressed. This article assessed differences in rates of referral and psychosocial services by demographic factors, clinical characteristics, and distress severity. Potential predictors of these two outcomes were investigated.A retrospective analysis of patient data abstracted from electronic medical records of a NCI-designated Academic Comprehensive Cancer Center was conducted. Of the 399 cases meeting the inclusion criteria, 302 (75.7%) were screened for distress with the Distress Thermometer. Differences were examined with chi-square, t-tests, and ANOVAs. Predictors were identified with multivariate logistic regressions.Overall, patients who were identified as distressed were referred to a psychosocial provider (71.4%) and psychosocial services were delivered in approximately 64% of the cases. Referrals and service delivery rates varied by age group, clinic, health insurance coverage, distress severity, and presence of psychosocial issues. Only the distress score predicted the likelihood of being referred, and of a provider intervention to occur. Conclusions and implications for psychosocial providers: Although the protocol appeared to facilitate referral and service delivery to patients scoring above the cutoff for distress, our results suggest that patients were more likely to not have their distress and psychosocial needs addressed if they were older, without insurance coverage, and were seen in clinics where a social worker was not consistently available. Future studies able to monitor patient outcomes in terms of quality of life, satisfaction with care, and service utilization are recommended.

Objectives: Breast reconstruction (BR) potentially can improve quality of life in postmastectomy breast cancer survivors (BCS); however, African-American women are less likely to undergo BR than Caucasian women. This qualitative study was undertaken to explore individual, sociocultural, and contextual factors influencing African-American women's BR decision-making processes and preferences. Methods: Postmastectomy African-American BCS with and without BR participated in semi-structured interviews. We adopted a grounded theory approach using the constant comparison method to understand the contexts and processes informing participants' BR decision-making. Results: Twenty-three women participated, of whom 17 elected BR and 6 did not. Whereas women's primary reasons for deciding for or against BR differed, our core category, "empowered choices ," describes both groups' decision-making as a process focused on empowering themselves physically and/or psychologically, through self-advocacy, informed and shared decision-making, and giving back/receiving communal and spiritual support from church and African-American survivor groups. Socioeconomic factors influenced women's access to BR. Women preferred autologous BR and expressed the need for greater culturally-matched resources and support to inform treatment and shared BR decision-making. Conclusions: Understanding and supporting African-American women's BR preferences and empowerment is essential to ensuring equal access, and culturally-relevant, high-quality, and informed patient-centered care.

The present work investigated the relationship between patient activation, treatment decision-making, and adherence to the prescribed treatment regimen. Given the role of informal caregivers in patient-reported outcomes, it was additionally assessed whether caregiver involvement acted as a moderator of this relationship.Survey data collected from 504 cancer survivors were utilized. Structural equation modeling (SEM) controlling for covariates was used to examine the relationship between patient activation measure (PAM), caregiver involvement, and the identified outcomes. Moderator analysis was conducted using multiple group SEM.Patient activation was significantly associated with treatment planning being reflective of survivors' goals and values (p 0.001); adherence to treatment (p = 0.011); and satisfaction (p 0.001). Caregiver's involvement significantly moderated the association between activation and adherence to treatment.Patient activation was positively associated with all three selected outcomes. However, for cancer survivors reporting low rates of caregiver's involvement, patient activation was not associated with treatment adherence. Research is needed to test and deliver self-management interventions inclusive of informal caregivers.Findings supported the need not only to monitor and sustain patient activation across the cancer continuum, but also to assume a dyadic perspective when designing self-management interventions in cancer survivorship.

Although a number of lifestyle interventions have been developed for cancer survivors, the extent to which they are effective for African American men with cancer is unclear. Given that African American men have the highest prostate cancer burden and the lack of proven interventions, this study developed a culturally-tailored lifestyle intervention for African American men with prostate cancer and their partners that aimed to improve healthy lifestyle behaviors (physical activity and healthy eating) and quality of life. The aim of the present study is to provide a detailed overview of the model-based process of intervention adaptation. Based on the IM Adapt approach (Highfield et al., 2015) and Typology of Adaptation (Davidson et al., 2013), the present study adapted existing, evidence-based interventions to address African American prostate cancer survivors’ and their partners’ potential unmet needs including anxiety/uncertainty about cancer progression, communication between partners, cultural sensitivity, and concordance/discordance of motivation and behaviors between partners. The intervention adaptation was a comprehensive and fluid process. To the best knowledge of the author, this is the first couple-based lifestyle intervention specifically developed for African American men with prostate cancer. The present study will be highly informative to future investigators by providing flexible and detailed information regarding lifestyle intervention adaptation for racial/ethnic minority men with prostate cancer and their partners.

Cancer diagnosis and treatments negatively affect quality of life and developmental processes of adolescents and young adults (AYAs), with self-esteem, self-efficacy, and body image discomfort reported. Despite increasing awareness of the psychosocial issues experienced by this group, a paucity of psychosocial interventions has been developed. This study aims to investigate the Framed Portrait Experience (FPE) as an intervention to promote well-being among AYA cancer survivors. A pilot study was conducted using a quasi-experimental design. The sample included 18 AYA leukemia survivors. Individuals in the intervention group (

Relative to White women, African American/Black women are at an increased risk of breast cancer mortality. Early detection of breast cancer through mammography screening can mitigate mortality risks, however, screening rates are not ideal. Consequently, there is a need to better understand factors associated with adherence to breast cancer screening guidelines to inform interventions to increase mammography use, particularly for groups at elevated mortality risk. This study used the Andersen Behavioral Model of Health Services Use to examine factors associated with adherence to National Comprehensive Cancer Network breast cancer screening guidelines amongst 919 African American, church-going women from Houston, Texas. Logistic regression analyses measured associations between breast cancer screening adherence over the preceding 12 months (adherent or non-adherent) and predisposing (i.e., age, education, and partner status), enabling (i.e., health insurance status, annual household income, employment status, patient-provider communication, and social support), and need (i.e., personal diagnosis of cancer, family history of cancer, and risk perception) factors, separately and conjointly. Older age (predisposing: OR = 1.015 (1.007–1.023)), having health insurance and ideal patient–provider communication (enabling: OR = 2.388 (1.597–3.570) and OR = 1.485 (1.080–2.041)), and having a personal diagnosis of cancer (need: OR = 2.244 (1.058–4.758)) were each associated with greater odds of screening adherence. Only having health insurance and ideal patient-provider communication remained significantly associated with screening adherence in a conjoint model, cancer survivorship did not moderate associations between predisposing/enabling factors and screening adherence. Overall, results suggest that interventions which are designed to improve mammography screening rates amongst African American women might focus on broadening health insurance coverage and working to improve patient–provider communication. Implications for multi-level intervention approaches, including the role of churches in their dissemination, are proposed.

BACKGROUND Cancer-related sexual dysfunction has been reported among adolescents and young adults (AYAs); however, its prevalence over time has not been examined. This longitudinal study investigated sexual dysfunction in AYAs over the course of 2 years after the initial diagnosis. METHODS Young adult patients (18-39 years old) completed the Medical Outcomes Study Sexual Functioning Scale within the first 4 months of their diagnosis (n = 123) and again 6 (n = 107) and 24 months later (n = 95). An ordered multinomial response model analyzed changes in the probability of reporting sexual dysfunction over time and the independent effects of demographic, clinical, and psychosocial variables. RESULTS More than half of the participants reported sexual functioning to be problematic at each assessment. The probability of reporting sexual dysfunction increased over time (P < .01) and was greater for cancer patients who were female (P < .001), older (P < .01), married or in a committed relationship (P < .001), treated with chemotherapy (P < .05), and reporting comorbid psychological distress (P < .001) and lower social support (P < .05). For women, being in a relationship increased the likelihood of reporting sexual problems over time; for men, the likelihood of reporting sexual problems increased regardless of their relationship status. CONCLUSIONS A substantial proportion of young adults report ongoing problems with sexual functioning in the first 2 years after their cancer diagnosis. These findings justify the need to evaluate and monitor sexual functioning throughout a continuum of care. Cancer 2018;124:398-405. © 2017 American Cancer Society.

Background Despite the adverse effects that treatment for colorectal cancer can have on patients' quality of life and, in particular, their intimate relationships, very little research has been conducted on the psychosocial adjustment for both patients and their partners/spouses. Objectives The aim of this systematic review was to examine dyadic studies of adjustment in couples in which one partner has been diagnosed with colorectal cancer. Methods Pub Med, PsychINFO, MEDLINE, Social Sciences Abstracts (EBSCO), and the Cochrane Library were systematically searched for studies reporting quality of life outcomes for colorectal cancer patients and their partners/spouses. Only studies that included dyads in the sample were eligible for inclusion. The Quality Assessment Tool for Quantitative Studies was used to evaluate each study. Results A total of 277 studies were identified, of which 9 studies met the inclusion criteria (N = 388 couples). The methodological quality of the studies was high in that they used standardized instruments validated with their samples, conducted dyadic data analyses (when appropriate), and used longitudinal designs. A synthesis of the studies revealed that (1) relationship factors (eg, support, communication, dyadic coping, and relationship satisfaction) affect adjustment to cancer; (2) cancer-related distress impacts each partner's adjustment or the relationship; and (3) gender, role (patient/caregiver), and clinical characteristics (treatment, mental health) can mediate adjustment to cancer. Conclusion The quality of the relationship can influence patients' and their partners' adjustment to colorectal cancer. Psychosocial interventions that address relationship issues may be beneficial to couples facing the challenges of colorectal cancer.

The consequences of breast cancer on physical and psychological well-being have been extensively studied. One of the long-term effects of the disease is Post-Traumatic Stress Symptoms (PTSS). However, only a small number of studies examined PTSS among Chinese-speaking breast cancer survivors. This study investigated interpersonal and physical health predictors of PTSS and explored sociodemographic and clinical factors linked to PTSS in this group. We hypothesized that higher levels of social constraints and lower levels of social support, relationship closeness, and physical health would be associated with higher levels of PTSS. A sample of 96 Chinese-speaking breast cancer survivors completed measures of PTSS, social constraints, social support, closeness, health-related quality of life, and acculturation. Bivariate correlation examined association between variables of interest. Then, a hierarchical multiple regression analysis was conducted to examine predictors of PTSS. Participants reported an average score of 14.7 (SD = 10.46, range 0–44) on the severity of PTSS, with 54.2% (N = 52) meeting the criteria for likelihood of PTSD. PTSS were positively associated with social constraints and negatively associated with social support, closeness, and physical health. More medication usage was linked to worse PTSS. Only social constraints in the ability to communicate cancer-related concerns to the caregiver predicted worse PTSS severity. The study unveils the role of interpersonal factors in mental health outcomes of Chinese-speaking breast cancer survivors. Future research should be conducted on larger samples and culturally relevant psychosocial interventions should be developed.

Objective The study examined how a couple's capacity for mutuality as conceptualized by the Relational-Cultural Theory plays a role in their managing the stresses accompanying breast cancer. Methods Eighty-six women treated for a primary, non-metastatic breast cancer and their partners completed measures of quality of life, relational mutuality, and dyadic coping. Demographic and clinical factors were self-reported. The relationship between mutuality and dyadic coping was evaluated using the Actor-Partner Interdependence Model (APIM). Results Relational mutuality was positively associated with both the patients' and the caregivers' scores on common and positive dyadic coping. Similarly, relational mutuality was associated with both patients' and caregivers' reduced scores on avoidance of dyadic coping. Conclusions Relational mutuality emerges as a significant factor in our understanding about dyadic coping in the context of cancer and this study highlights the role it plays in dyadic coping behaviors. Implications The promotion of relational mutuality in couples coping with cancer-related stress should be a major focus in couple-based interventions.

12083 Background: With increasing demands for a more active role on the part of individuals with cancer and their families in cancer care, patient activation (PA) is emerging as a key factor to promote self-management, adherence to treatment, and satisfaction with treatment planning. The present work investigated the relationship between patient activation and treatment decision making. Given the role informal caregivers play on patient-reported outcomes, it was additionally assessed whether caregiver involvement acted as a moderator of this relationship. Methods: Survey data collected from 504 cancer survivors recruited through online consumer panels were utilized. The survey contained questions concerning treatment options, quality of life, adherence to treatment, next to presence and involvement of informal caregivers. Additionally, the Patient Activation Measure (PAM), sociodemographic and clinical questions were included. A path analysis Structural Equation Modeling (SEM) controlling for covariates was used to examine the relationship between Patient Activation Measure (PAM), caregiver involvement, and the identified outcomes. Moderator analysis was conducted using multiple group SEM. Results: Respondents were mostly women (57.1%), non-Hispanic white (72.9%), middle aged or older adults (68% ≥ 55 y.o.) The four largest cancer type groups were prostate (16.3%), early stage breast (9.7%), gynecological (8.9%), and colorectal cancer (8.3%). Most of the respondents were diagnosed more than 4 years earlier (52.0%). Participants were evenly split between those who received care at an academic cancer center (29.4%) and those treated at community hospital (31.7%). Patient activation was significantly associated with treatment planning being reflective of survivors ’goals and values ( p < 0.001); adherence to treatment ( p = 0.011); and satisfaction ( p < 0.001). Caregiver’s involvement significantly moderated the association between activation and adherence to treatment. Conclusions: Patient activation was positively associated with all three selected outcomes. However, for cancer survivors reporting low rates of caregiver involvement, patient activation was not associated with treatment adherence. Research is needed to deliver and test patient activation interventions inclusive of informal caregivers to improve self-management.

Purpose The American College of Surgeons Commission on Cancer has mandated implementation of a systematic protocol for psychosocial distress screening and referral as a condition for cancer center accreditation beginning in 2015. Compliance with standards requires evidence that distress screening protocols are carried out as intended and result in appropriate referral and follow-up when indicated. The purpose of this study was to examine the fidelity of distress screening protocols at two tertiary cancer treatment centers. Methods A retrospective review and analysis of electronic medical records over a 12-week period examined clinic adherence to a prescribed distress screening protocol and responsiveness to patients whose scores on the National Comprehensive Cancer Network Distress Thermometer (DT) indicated clinically significant levels of distress requiring subsequent psychosocial contact. A weekly online survey assessed clinician perspectives on the acceptability of the protocol. Results Across clinics, rates of adherence to the distress screening protocol ranged from 47% to 73% of eligible patients. For patients indicating clinically significant distress (DT score ≥ 4), documentation of psychosocial contact or referral occurred, on average, 50% to 63% of the time, and was more likely to occur at one of two participating institutions when DT scores were high (DT score of 8 to 10). Clinician assessments of the protocol's utility in addressing patient concerns and responding to patient needs were generally positive. Conclusion Systematic tracking of distress screening protocols is needed to demonstrate compliance with new standards of care and to demonstrate how well institutions are responding to their clinical obligation to address cancer patients' emotional and psychosocial needs.

BACKGROUND: Cancer-related sexual dysfunction has been reported among adolescents and young adults (AYAs); however, its prevalence over time has not been examined. This longitudinal study investigated sexual dysfunction in AYAs over the course of 2 years after the initial diagnosis. METHODS: Young adult patients (18–39 years old) completed the Medical Outcomes Study Sexual Functioning Scale within the first 4 months of their diagnosis (n = 123) and again 6 (n = 107) and 24 months later (n = 95). An ordered multinomial response model analyzed changes in the probability of reporting sexual dysfunction over time and the independent effects of demographic, clinical, and psychosocial variables. RESULTS: More than half of the participants reported sexual functioning to be problematic at each assessment. The probability of reporting sexual dysfunction increased over time (P < .01) and was greater for cancer patients who were female (P < .001), older (P < .01), married or in a committed relationship (P < .001), treated with chemotherapy (P < .05), and reporting comorbid psychological distress (P < .001) and lower social support (P < .05). For women, being in a relationship increased the likelihood of reporting sexual problems over time; for men, the likelihood of reporting sexual problems increased regardless of their relationship status. CONCLUSIONS: A substantial proportion of young adults report ongoing problems with sexual functioning in the first 2 years after their cancer diagnosis. These findings justify the need to evaluate and monitor sexual functioning throughout a continuum of care.

Although the transition to parenthood is currently defined as a normative event, it can be potentially stressful for the couple relationship as it may contribute to psychological distress and reduced marital satisfaction. Using the systemic-transactional conceptualisation of stress and coping as a theoretical framework, we claimed that the ability of the parents-to-be to adjust to their new roles and identity is influenced by dyadic coping strategies. This study examined the effects of dyadic coping on marital adjustment in a sample of 78 primiparous couples. Women and partners completed the Dyadic Adjustment Scale and the Dyadic Coping Questionnaire during late pregnancy. Data were analysed using the Actor-Partner Interdependence Model. Results revealed that both women and partners' scores on positive dyadic coping behaviours contributed to higher marital adjustment, suggesting that risks for marital dissatisfaction may exist for couples not able to implement adaptive dyadic coping strategies, or for those unsatisfied with the implemented coping behaviours.