Search

Background Epidemiological studies of chemotherapy‐induced peripheral neuropathy (CIPN) have predominantly focused on non‐Hispanic White patients, despite the observation that African Americans are more likely to experience CIPN. To address this health disparities gap, we sought to identify non‐genetic risk factors and comorbidities associated with CIPN in African American cancer survivors using the Detroit Research on Cancer Survivors study. Methods Logistic regression was used to evaluate relationships between presence of self‐reported CIPN and relevant clinical characteristics in 1045 chemotherapy‐treated African American cancer survivors. Linear regression was used to evaluate risk factors for CIPN and quality of life outcomes that reflect physical, social, emotional, and functional domains of health. Results Patients with CIPN were more likely to report hypertension (OR = 1.28, 95% CI: 0.98–1.67, p = 0.07), hypercholesterolemia (OR = 1.32, 95% CI: 1.001–1.73, p = 0.05), history of depression (OR = 1.62, 95% CI: 1.18–2.25, p = 0.003), and diabetes (OR = 1.33, 95% CI: 0.98–1.82, p = 0.06) after adjustment for age at diagnosis, sex, and cancer site. BMI (OR = 1.02 kg/m2, 95% CI: 1.006–1.04 kg/m2, p = 0.008) was also positively associated with CIPN. In addition, CIPN status was significantly associated with quality of life (FACT‐G total: β = −8.60, 95% CI: −10.88, −6.32) p, Although African Americans have an increased susceptibility to developing chemotherapy‐induced peripheral neuropathy, epidemiological studies have predominantly focused on non‐Hispanic Whites. Our study demonstrates that risk factor profiles in African Americans are not entirely consistent with those previously reported for non‐Hispanic Whites, and that neglecting to understand the correlates of common chemotherapy‐induced toxicities for this patient population may further contribute to the health disparities these individuals face in receiving adequate healthcare.

Mounting evidence demonstrates that meditation can lower pain and emotional distress in adults, and more recently, in children. Children may benefit from meditation given its accessibility across a variety of settings (e.g., surgical preparation). Recent neuroimaging studies in adults suggest that meditation techniques are neurobiologically distinct from other forms of emotion regulation, such as distraction, that rely on prefrontal control mechanisms, which are underdeveloped in youth. Rather, meditation techniques may not rely on "top-down" prefrontal control and may therefore be utilized across the lifespan.We examined neural activation in children with cancer, a potentially distressing diagnosis. During neuroimaging, children viewed distress-inducing video clips while using martial arts-based meditation (focused attention, mindful acceptance) or non-meditation (distraction) emotion regulation techniques. In a third condition (control), participants passively viewed the video clip.We found that meditation techniques were associated with lower activation in default mode network (DMN) regions, including the medial frontal cortex, precuneus, and posterior cingulate cortex, compared to the control condition. Additionally, we found evidence that meditation techniques may be more effective for modulating DMN activity than distraction. There were no differences in self-reported distress ratings between conditions.Together, these findings suggest that martial arts-based meditation modulates negative self-referential processing associated with the DMN, and may have implications for the management of pediatric pain and negative emotion.

Epidemiological studies of cancer survivors have predominantly focused on non-Hispanic White, elderly patients, despite the observation that African Americans have higher rates of mortality. Therefore, we characterized cancer survivorship in younger African American survivors using the Detroit Research on Cancer Survivors (ROCS) study to assess health behaviors and quality of life.Five hundred and seventeen patients diagnosed with any cancer between the ages of 20-49 (mean age: 42 years; SD: 6.7 years) completed a survey to identify important clinical, behavioral, and sociodemographic characteristics, measures of health literacy, and experiences of discrimination. Quality of life outcomes were evaluated in patients using FACT-G, FACT-Cog, and PROMIS® Anxiety and Depression scales. Stepwise linear and logistic regression were used to assess the association between quality of life measures and participant characteristics.The mean FACT-G score was 74.1 (SD: 21.3), while the FACT-Cog was 55.1 (SD: 17.1) (FACT-G range 0-108 with higher scores indicating better function; elderly cancer patient mean: 82.2; FACT-Cog 18-item range 0-72 points with higher scores indicating better perceived cognitive functioning; scores54 indicating cognitive impairment). In addition, 27.1% and 21.6% of patients had a score indicative of moderate or severe anxiety and depression, respectively. Perceived discrimination and the number of discriminatory events were significantly associated with reductions in three of the four quality of life measures. Health literacy was positively associated with all four health measures, while total comorbidity count was negatively associated with three of the four measures.Younger adult African American cancer survivors who report experiencing discrimination and suffer from multiple comorbid conditions have poorer mental and overall health. Understanding the unique clinical and socioeconomic stressors that influence this patient population is essential for reducing health disparities and improving long-term survivorship.

Background Although communication quality is associated with patient outcomes, racial disparities in communication exist, disproportionately burdening Black patients. However, most communication research focuses on verbal behaviors in predominantly White patient populations. We used a newly developed and theory-guided network analysis that examines the dynamic interplay and behavioral convergence and divergence between Black patients with cancer and their oncologists during cancer treatment discussions. Methods We applied a nonverbal behavioral coding system to thin slices of video recordings of Black patients and their oncologists discussing treatment. We then estimated 3 networks: 1) a temporal network to determine whether a nonverbal behavior predicts another nonverbal behavior at the next time point in an interaction, and how much each nonverbal behavior influences other nonverbal behaviors and is influenced by other nonverbal behaviors; 2) a contemporaneous network to determine whether a nonverbal behavior co-occurs with other nonverbal behaviors at the same time point in an interaction; and 3) a between-dyads network to examine the covariation between nonverbal behaviors across all dyads. Results Black patients (n = 74) and their non-Black physicians (n = 15) showed a mix of convergence and divergence in their nonverbal behaviors at the same points in time, from one time point to the next, and across dyads. Across analyses, convergence was most likely to occur when physicians matched their behaviors to their patients; especially with smiling, gaze, leaning, and laughter behaviors. Conclusion Our findings reveal patterns of modifiable behaviors that can potentially inform interventions to reduce disparities in clinical communication and, in turn, treatment and mortality disparities.

Hilary A Marusak,1– 3 Allesandra S Iadipaolo,4 Cindy Cohen,5 Elimelech Goldberg,5,6 Jeffrey W Taub,6,7 Felicity WK Harper,3,7 Martin H Bluth,5,8 Christine A Rabinak1,2,4,9 1Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI, USA; 2Merrill Palmer Skillman Institute, Wayne State University, Detroit, MI, USA; 3Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA; 4Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA; 5Kids Kicking Cancer, Southfield, MI, USA; 6Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI, USA; 7Department of Oncology, School of Medicine, Wayne State University, Detroit, MI, USA; 8Department of Pathology, School of Medicine, Wayne State University, Detroit, MI, USA; 9Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USACorrespondence: Hilary A Marusak Tel +1 313-577-1278Fax +1 313-577-6188Email hmarusak@med.wayne.eduObjective: Test whether a martial arts-based therapy, Kids Kicking Cancer (KKC), can reduce pain and emotional distress in children with cancer, other chronic health conditions (e.g., sickle cell), and healthy siblings.Methods: This study surveyed children’s pain and distress levels immediately before and after a 1-hr in-person KKC class. Eligible participants were enrolled in standard KKC classes, were diagnosed with a chronic health condition (e.g., cancer, sickle cell) or were the sibling of a child diagnosed and were between the ages of 5– 17 years (inclusive). Children reported on their pain and distress using Likert-style scales (Coloured Analog Scale and modified FACES scale, respectively). Friedman test was used to test for overall changes in pain and distress, and within subgroups. Age and sex effects were evaluated using Spearman’s rank-order correlation. Additional Yes/No questions were administered regarding KKC satisfaction and use of techniques.Results: Fifty-nine youth (19 cancer patients, 17 non-cancer patients, 23 siblings; 5– 17 yrs, 26 females) completed this study. Overall, there was a significant reduction in pain (p = 0.033) and emotional distress (p < 0.001) after a 1-hr class, with 50% and 89% of youth reporting a reduction in pain and distress, respectively. On average, pain levels remained within the mild/moderate range on average (i.e., pre vs. post levels; pre: M = 1.67, post: M = 1.33) and emotional distress went from mild/moderate to none/mild distress, on average (pre: M = 1.92, post: M = 1.08). Youth with higher pre-class pain and distress reported greater reductions (p = 0.001 and p < 0.001, respectively). The reduction in pain appeared to be most pronounced with cancer and non-cancer patients. In contrast, the reduction in distress appeared to be most pronounced among healthy siblings. However, overall, reductions in pain and distress did not significantly differ among subgroups (i.e., cancer patients, non-cancer patients, siblings), and change in pain and distress was not associated with age or sex. Ninety-six percent of youth would recommend KKC to others and 81% reported using KKC techniques (e.g., the Breath BrakeTM or other martial arts techniques) outside of class, such as at home.Conclusion: Results support the more widespread application of KKC as a psychosocial intervention for reducing pain and distress in various pediatric populations.Keywords: meditation, mindfulness, oncology, psychosocial, sickle cell, leukemia

PURPOSE: Relatively little is known about caregivers of African American cancer survivors. Our goal was to identify the extent of burden among this group of caregivers. METHODS: Responses from 560 informal caregivers of African American participants of the Research on Cancer Survivors (ROCS) study in Detroit, MI were analyzed including demographics, assistance provided including Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), time spent in caregiving, and caregiver burden (CGB). We assessed relationships between CGB and demographic variables, ADLs/IADLs and level of care. Multivariable logistic regression determined which ADLs and IADLs were associated with high CGB. RESULTS: Over 75% of caregivers were female and 97% identified as African American. Mean age was 52.6 years. Fifty-six percent were employed outside the home and 90% were related to the survivor. Caregivers averaged 35.7 hours/week providing care, assisting with on average 2.8 ADLs and 5.0 IADLs. Despite the many hours and activities reported, no caregivers rated CGB as severe; only 4% rated it moderate to severe. ADLs associated with the top quartile of CGB were feeding and toileting; IADLs were finances, telephoning, housework, and medications. CONCLUSIONS: Caregivers for African American cancer survivors provide many hours of care, yet most describe their CGB as low. Although ADL assistance is often available through the healthcare system, assistance with IADLs presents an opportunity to lessen the burden for these caregivers and their care recipients. IMPLICATIONS FOR CANCER SURVIVORS: African American cancer survivors receive much care from informal family caregivers, who assist with multiple ADLs and IADLs. Formal IADL assistance programs, similar to those available for ADLs, would benefit both survivors and caregivers.

Posttraumatic stress symptoms (PTSS) are extremely common among childhood cancer survivors (CCS). However, there are individual differences, which may relate to variability in resilience. Previous studies show differential effects of early adversity on the amygdala and hippocampus—brain regions that mediate the stress response and are implicated in the development and/or maintenance of PTSS. Although many children are diagnosed with cancer and other life-threatening illnesses each year, neurobiological correlates of psychological outcomes following medically related adversity remain unclear. This study tests the impact of childhood cancer, cancer-related PTSS, and resilience on amygdala and hippocampal volumes. Amygdala and hippocampal volumes were measured in 24 CCS (11 females, ages 5–17) and 24 age-, sex-, and IQ-matched controls. Cancer-related PTSS and trait resilience were assessed. We also assessed exposure to non-cancer adversities (e.g., bullying) and the parent’s cancer-related PTSS. Non-cancer adversities, resilience, and volume of the amygdala and hippocampus were similar between groups. Within CCS, higher cancer-related PTSS was associated with larger right amygdala volumes. More resilient CCS showed larger volumes of the left hippocampus relative to less resilient CCS. Higher parental PTSS was associated with higher PTSS in their child, and CCS reporting more non-cancer adversities showed higher PTSS. However, non-cancer adversities and parent PTSS were not related to regional volumes among CCS. We found distinct effects of resilience and PTSS on amygdala and hippocampal volumes in CCS. Altered development of stress response neural circuitry may be an important neurobiological substrate for understanding psychological outcomes in CCS.

PURPOSE: Caregivers of cancer survivors may need to take time off work or make other employment changes to handle caregiving demands. Work impacts of caregiving, financial burden, and psychosocial outcomes of caregivers are not well understood. METHODS: Results include information from surveys completed by 202 employed caregivers of participants in the Detroit Research on Cancer Survivors cohort, a population-based cohort of African American survivors of breast, colorectal, lung, or prostate cancer. Relationships between work outcomes, financial burden, and anxiety and depression were assessed using logistic regression models controlling for demographic and cancer-related factors. RESULTS: Most (73.8%) caregivers made some employment change. Sixty percent changed their schedule, hours, duties, or employment status; 15.3% took at least 1 month off to provide care, and 38% reported difficulty balancing work and caregiving. Employment changes were strongly associated with difficulty balancing work and caregiving (odds ratio [OR], 5.83; 95% CI, 2.38 to 14.0) and financial burden (OR, 2.12; 95% CI, 1.05 to 4.27). Difficulty balancing work and caregiving was associated with symptoms of anxiety (OR, 1.86; 95% CI, 1.01 to 3.43) and depression (OR, 2.40; 95% CI, 1.16 to 4.96). High ( v low) financial burden was associated with symptoms of anxiety (OR, 2.85; 95% CI, 1.01 to 8.06). CONCLUSION: Difficulty balancing work and caregiving is common among caregivers of African American cancer survivors and is associated with symptoms of depression and anxiety. Supports for caregivers facing employment challenges may improve their psychosocial well-being.

Objective This study examines the preferences of patients with metastatic cancer regarding notification of imaging results, as well as distress surrounding the process. Methods On imaging day, preferences for notification, expectations of results, health literacy, and social support were measured. After receiving results, patients reported on actual delivery methods. At both times, patients were screened for overall distress, anxiety, and depression. Results The majority of patients preferred notification within 2 days and during a face-to-face visit with their oncologist. Although levels of distress, anxiety, and depression were low, patients with higher anxiety, depression, and social isolation had higher distress. There was no correlation between absolute distress levels and agreement between notification preferences and actual delivery methods. Receiving results from a preferred provider was associated with a decrease in distress from imaging day to follow-up. Face-to-face delivery of results was more important to people with lower health literacy. Conclusions While distress regarding the receipt of results was low, it was higher for some groups of patients. Attending to the preferences of these subgroups may help to minimize distress. Practice implications Receiving results from preferred personnel and diminishing patients' sense of social isolation might provide psychological benefit during the period surrounding imaging.

Background Coronavirus disease 2019 (COVID‐19) has had profound effects on population health to date. African American cancer survivors are particularly vulnerable to developing severe consequences; therefore, understanding the impact of the virus on this patient population is critical. Methods The Detroit Research on Cancer Survivors cohort is a unique effort to understand the determinants of poor outcomes in African American cancer survivors. To date, more than 4500 cancer survivors and nearly 950 primary caregivers have been enrolled; participation includes a survey and the collection of biospecimens, medical records, and tumor tissue. Beginning in the spring of 2020, a supplemental survey focusing on the impact of COVID‐19 was offered to enrolled participants. The analysis included 890 survivors. Results Nearly all survivors (>99%) reported changes in their daily activities in an effort to reduce the risk of infection. More than 40% of the survivors reported some disruption in their access to medical care. A substantial proportion of the survivors (>40%) reported feeling anxious, depressed, and/or isolated during the COVID‐19 pandemic. Approximately 40% of the patients reported changes in health behaviors shown to negatively affect survivorship outcomes (physical inactivity, smoking, and alcohol use) as a result of the pandemic. Conclusions The influence of the COVID‐19 pandemic on African American cancer survivors is substantial: it has affected both their physical and mental health. Coupled with changes in health behaviors, these factors will likely affect outcomes in this high‐risk patient population, and this makes further study and interventions necessary to mitigate the long‐term impact of the pandemic on cancer outcomes., The COVID‐19 pandemic has had a profound impact on the physical and mental health of African American cancer survivors living in Detroit, Michigan. Strategies focusing on health behaviors such as physical activity would improve patient health and quality of life.

This survey study of adults residing in Michigan during June to December 2020 examines associations between race/ethnicity, medical mistrust within racial/ethnic groups, and willingness to participate in COVID-19 vaccine trials or to receive a COVID-19 vaccine., Key Points Question Is there an association between race/ethnicity and rejection of COVID-19 vaccine trial participation and vaccine uptake in the US, and does racial/ethnic group–based medical mistrust mediate this association? Findings In this survey study of 1835 adults in Michigan, Black participants reported the greatest medical mistrust among the racial/ethnic groups surveyed. Analysis of path models revealed significantly greater COVID-19 vaccine trial and uptake rejection among Black participants, which was partially mediated by medical mistrust. Meaning The findings suggest that racial/ethnic group–based medical mistrust may partially explain the association between Black race/ethnicity and rejection of COVID-19 vaccine trial participation and uptake, potentially informing socially and culturally responsive efforts to promote COVID-19 vaccination in this group., Importance The impact of COVID-19 in the US has been far-reaching and devastating, especially in Black populations. Vaccination is a critical part of controlling community spread, but vaccine acceptance has varied, with some research reporting that Black individuals in the US are less willing to be vaccinated than other racial/ethnic groups. Medical mistrust informed by experiences of racism may be associated with this lower willingness. Objective To examine the association between race/ethnicity and rejection of COVID-19 vaccine trial participation and vaccine uptake and to investigate whether racial/ethnic group–based medical mistrust is a potential mediator of this association. Design, Setting, and Participants This cross-sectional survey study was conducted from June to December 2020 using a convenience sample of 1835 adults aged 18 years or older residing in Michigan. Participants were recruited through community-based organizations and hospital-academic networks. Main Outcomes and Measures Separate items assessed whether respondents, if asked, would agree to participate in a research study to test a COVID-19 vaccine or to receive a COVID-19 vaccine. Participants also completed the suspicion subscale of the Group-Based Medical Mistrust Scale. Results Of the 1835 participants, 1455 (79%) were women, 361 (20%) men, and 19 (1%) other gender. The mean (SD) age was 49.4 (17.9) years, and 394 participants (21%) identified as Black individuals. Overall, 1376 participants (75%) reported low willingness to participate in vaccine trials, and 945 (52%) reported low willingness to be vaccinated. Black participants reported the highest medical mistrust scores (mean [SD], 2.35 [0.96]) compared with other racial/ethnic groups (mean [SD] for the total sample, 1.83 [0.91]). Analysis of path models revealed significantly greater vaccine trial and vaccine uptake rejection among Black participants (vaccine trial: B [SE], 0.51 [0.08]; vaccine uptake: B [SE], 0.51 [0.08]; both P

Background: Financial hardship is common among cancer survivors and is associated with both limiting care due to cost and with poor health-related quality of life (HRQOL). This study estimates the association between limiting care due to cost and HRQOL in a diverse population of cancer survivors and tests whether limiting care mediates the association between financial hardship and HRQOL. Methods: We used data from 988 participants (579 African American, 409 white) in the Detroit Research on Cancer Survivors (ROCS) pilot, a hospital-based cohort of breast, colorectal, lung, and prostate cancer survivors. We assessed associations between financial hardship, limiting care, and HRQOL [measured by the Functional Assessment of Cancer Therapy—General (FACT-G)] using linear regression and mediation analysis controlling for demographic, socioeconomic, and cancer-related variables. Results: FACT-G scores were 4.2 [95% confidence interval (CI), 2.0–6.4] points lower among survivors who reported financial hardship compared with those who did not in adjusted models. Limiting care due to cost was associated with a −7.8 (95% CI, −5.1 to −10.5) point difference in FACT-G scores. Limiting care due to cost explained 40.5% (95% CI, 25.5%–92.7%) of the association between financial hardship and HRQOL overall, and 50.5% (95% CI, 29.1%–188.1%) of the association for African American survivors. Conclusions: Financial hardship and limiting care due to cost are both associated with lower HRQOL among diverse cancer survivors, and this association is partially explained by limiting care due to cost. Impact: Actions to ensure patients with cancer can access appropriate care could lessen the impact of financial hardship on HRQOL.

The experience of childhood cancer is a major life stressor for children and their parents. There is substantial variability among pediatric cancer patients and their parents in their ability to cope with the cancer. Although other models typically focus on the psychological resources families use to broadly cope with a diagnosis of pediatric cancer, we present a model that focuses specifically how parents and children cope with the stress of invasive and often painful treatment episodes. Our resources model is further distinct with its focus on individual differences in personal (e.g., personality traits) and social (e.g., social support) resources and the role these differences may play in psychosocial adjustment of families confronting pediatric cancer. We use findings from the broader pediatric cancer research literature and our own 15-year program of research on individual differences in psychological resources and parents and children's responses to treatment episodes to provide empirical support for our model. Support was found for the six premises of the model: (a) parent resources influence their longer-term psychosocial adjustment, (b) parent resources influence children's responses to treatment episodes, (c) parent resources indirectly influence their longer-term psychosocial adjustment through their responses to treatment episodes, (d) children's personal resources influence how parent responses to treatment episodes, (e) children's resources influence their longer-term psychosocial adjustment, and (f) children's resources indirectly influence their longer-term psychosocial adjustment through their responses to treatment episodes. Understanding how the availability of resources influences parents and children confronting cancer provides a foundation for future research on individual differences in resources and offers other avenues through which clinicians can assess and treat families at risk for poor psychosocial adjustment during treatment and in their life beyond cancer treatments.

Background: African Americans are often diagnosed with advanced stage cancer and experience higher mortality compared with whites in the United States. Contributing factors, like differences in access to medical care and the prevalence of comorbidities, do not entirely explain racial differences in outcomes. Methods: The Detroit Research on Cancer Survivors (ROCS) pilot study was conducted to investigate factors related to short- and long-term outcomes among patients with cancer. Participants completed web-based surveys, and mailed saliva specimens were collected for future genetic studies. Results: We recruited 1,000 participants with an overall response rate of 68%. Thirty-one percent completed the survey without any interviewer support and the remaining participated in an interviewer-administered survey. Seventy-four percent provided a saliva specimen and 64% consented for tumor tissue retrieval. African American survivors required more interviewer support (P < 0.001); however, their response rate (69.6%) was higher than non-Hispanic whites (65.4%). African Americans reported poorer overall cancer-related quality of life compared with non-Hispanic whites, measured by FACT-G score (P < 0.001), however, this relationship was reversed after controlling for socioeconomic factors, marital status, and the presence of comorbidities. Conclusions: In this pilot study, we demonstrated that a web-based survey supplemented with telephone interviews and mailed saliva kits are cost-effective methods to collect patient-reported data and DNA for large studies of cancer survivors with a high proportion of minority patients. The preliminary data collected reinforces differences by race in factors affecting cancer outcomes. Our efforts continue as we expand this unique cohort to include more than 5,000 African American cancer survivors. Impact: Formal investigation of factors influencing adverse outcomes among African American cancer survivors will be critical in closing the racial gap in morbidity and mortality.

PURPOSE: The presence of caregivers or companions during clinical encounters influences the dynamics and outcomes of the encounters. Most prior studies of companions in clinical encounters focus on non-Hispanic White patients. However, there is generally lower-quality patient-physician communication during encounters with Black patients; these communication differences may contribute to racial health disparities. The purpose of the present study was to examine effects of the presence and active participation of companions on encounters between Black patients with cancer and non-Black oncologists. METHODS: This was a secondary analysis of data collected during a larger intervention study. Participants were Black patients with breast, colon, or lung cancer who had a treatment-discussion encounter with a participating non-Black medical oncologist. Video recordings of encounters were coded for patient, companion, and oncologist communication. After the encounter, patients reported perceptions of the recommended treatment; patients and oncologists reported perceptions of each other. RESULTS: Data from 114 patients and 19 oncologists were included in analyses. Only 47% of patients brought a companion to the encounter. Oncologists spent more time with accompanied Black patients, used more patient-centered communication with them, and perceived them as having more social support compared with unaccompanied Black patients. Oncologists reported that accompanied patients asked more questions. When companions participated more actively in the encounter, oncologists used more patient-centered communication. DISCUSSION: Bringing a companion to oncology appointments may be beneficial to Black patients because oncologists spend more time with patients, use more patient-centered communication, and perceive patients more positively, all of which may ultimately improve patient health and well-being outcomes.

BACKGROUND The benefit of regular exercise in improving cancer outcomes is well established. The American Cancer Society (ACS) released a recommendation that cancer survivors should engage in at least 150 minutes of moderate to vigorous physical activity (PA) per week; however, few report meeting this recommendation. This study examined the patterns and correlates of meeting ACS PA recommendations in the Detroit Research on Cancer Survivors (ROCS) cohort of African American cancer survivors. METHODS Detroit ROCS participants completed baseline and yearly follow-up surveys to update their health and health behaviors, including PA. This study examined participation in PA by select characteristics and reported health-related quality of life (HRQOL) as measured with the Functional Assessment of Cancer Therapy and Patient-Reported Outcomes Measurement Information System instruments. RESULTS Among the first 1500 ROCS participants, 60% reported participating in regular PA, with 24% reporting ≥150 min/wk. Although there were no differences by sex, prostate cancer survivors were the most likely to report participating in regular PA, whereas lung cancer survivors were the least likely (P = .022). Survivors who reported participating in regular PA reported higher HRQOL (P

With mortality in the pediatric cardiac intensive care unit (CICU) low at 2–4%, the majority of children survive their admission. While the CICU experience is often part of a broader story of living with and managing cardiac disease, many children are impacted by CICU experience with changes to their physical health, neurocognition, psychological health, and quality of life. Risk factors for poor outcomes after a CICU admission include potentially fixed and immutable factors such as congenital heart disease severity, therapeutic interventions, and hospitalization characteristics. A potential key modifiable factor in child outcomes is the family's ability to facilitate a child's emotional and physical recovery after a CICU admission. For parents, though, having their child admitted to a CICU is often a traumatic experience that can result in posttraumatic stress disorder (PTSD), anxiety, depression, and family burden. Examining the family experience through the Integrative (Trajectory) Model of Pediatric Medical Traumatic Stress could identify modifiable factors to target with interventions for improving child and family outcomes after a CICU admission.

Purpose/objectives To study the relationship between parental verbal and nonverbal caring behaviors and child distress during cancer-related port access placement using correlational and time-window sequential analyses. . Design Longitudinal, observational design. . Setting Children's Hospital of Michigan and St. Jude Children's Research Hospital. . Sample 43 child-parent dyads, each with two or three video recordings of the child undergoing cancer-related port placement. . Methods Two trained raters coded parent interaction behaviors and child distress using the Parent Caring Response Scoring System and Karmanos Child Coping and Distress Scale, respectively. Mixed modeling with generalized estimating equations examined the associations between parent interaction behaviors and parent distress, child distress, and child cooperation reported by multiple raters. Time-window sequential analyses were performed to investigate the temporal relationships in parent-child interactions within a five-second window. . Main research variables Parent caring behaviors, child distress, and child cooperation. . Findings Parent caring interaction behaviors were significantly correlated with parent distress, child distress, and child cooperation during repeated cancer port accessing. Sequential analyses showed that children were significantly less likely to display behavioral and verbal distress following parent caring behaviors than at any other time. If a child is already distressed, parent verbal and nonverbal caring behaviors can significantly reduce child behavioral and verbal distress. . Conclusions Parent caring behaviors, particularly the rarely studied nonverbal behaviors (e.g., eye contact, distance close to touch, supporting/allowing), can reduce the child's distress during cancer port accessing procedures. . Implications for nursing Studying parent-child interactions during painful cancer-related procedures can provide evidence to develop nursing interventions to support parents in caring for their child during painful procedures.

Purpose: Financial hardship due to cancer is more common among African American than White survivors. The COVID-19 pandemic and its economic fallout have also disproportionately affected African Americans. The purpose of this study is to describe the financial and employment impacts of COVID-19 in a population of African American cancer survivors and to compare those impacts with those experienced after a cancer diagnosis. Methods: Results include survey data from 593 participants in the population-based Detroit Research on Cancer Survivors (ROCS) cohort who completed the ROCS enrollment survey and a supplemental questionnaire related to the impact of the COVID-19 pandemic on their financial wellbeing and employment. Most participants (96%) were not diagnosed with COVID-19 by the time they completed the supplement and reflect the societal impact of the pandemic rather than a personal COVID-19 diagnosis. Analyses compare reports of financial hardship (using assets, borrowing money, experiencing debt, decreases in income) and employment impacts (changes to work schedules, duties, hours, employment status) due to cancer and due to the COVID-19 pandemic. Results: A similar proportion of ROCS participants reported financial hardship (41% vs. 42%) and borrowing money (5% vs. 6%) related to the COVID pandemic and their cancer diagnosis, respectively. Fewer survivors reported borrowing money (9% vs. 17%; p

12129 Background: COVID-19 has had profound direct and indirect effects on population health to date and long-term effects are anticipated. Vulnerabilities to the most serious consequences of infection include older age, obesity, African American race and the presence of comorbid conditions. African American cancer survivors represent a particularly high-risk group, therefore understanding the impact of the virus and our strategies to prevent its spread on this patient population is important. Methods: The Detroit Research on Cancer Survivors (ROCS) cohort is a unique effort to understand the determinants of poor outcomes in African American cancer survivors. Eligible participants were diagnosed with breast, prostate, colorectal, or lung cancer on or after 1/1/2013, or with endometrial or any other cancer before age 50 on or after 01/01/2016 and were identified through the Metropolitan Detroit Cancer Surveillance System cancer registry. To date, we have enrolled 4173 survivors. Full participation includes completion of a baseline survey, and collection of biospecimens, medical records and tumor tissue, if available. Participants are also followed annually for outcomes and changes in history. A supplemental survey focused on the impact of COVID-19 was offered to enrolled participants beginning in the spring of 2020. The results presented here include data from 890 survivors who also completed the ROCS COVID survey. Results: Nearly all ( > 99%) survivors reported some change in their daily activities in an effort to reduce the risk of infection. At the time of survey, just over 1/3 of participants reported being tested for the virus and among those, 12% reported positive results. More than 40% of survivors reported some disruption in their access to medical care. A substantial ( > 40%) proportion of survivors reported feeling anxious, depressed and/or isolated during the COVID-19 pandemic. Approximately 40% of patients reported changes in health behaviors as a direct result of the pandemic that are known to negatively affect survivorship outcomes (physical inactivity, smoking, alcohol use). Notably, 30% of survivors reported declines in physical activity and these declines were significantly associated with increased anxiety (p = 0.008), depression (p = 0.005) and poorer health-related quality of life (p < 0.001). Conclusions: The influence of the COVID-19 pandemic on African American cancer survivors has been substantial, affecting both their physical and mental health and access to needed medical care. Coupled with changes in health behaviors as a direct result of the pandemic, these factors will likely affect outcomes in this high-risk patient population making further study and interventions necessary to mitigate the long-term impact of the pandemic on cancer outcomes.

Objective Both physician and patient race-related beliefs and attitudes are contributors to racial healthcare disparities, but only the former have received substantial research attention. Using data from a study conducted in the Midwestern US from 2012 to 2014, we investigated whether 114 Black cancer patients' existing race-related beliefs and attitudes would predict how they and 18 non-Black physicians (medical oncologists) would respond in subsequent clinical interactions. Method At least two days before interacting with an oncologist for initial discussions of treatment options, patients completed measures of perceived past discrimination, general mistrust of physicians, and suspicion of healthcare systems; interactions were video-recorded. Measures from each interaction included patients' verbal behavior (e.g., level of verbal activity), patients' evaluations of physicians (e.g., trustworthiness), patients' perceptions of recommended treatments (e.g., confidence in treatment), physicians' evaluations of patient personal attributes (e.g., intelligence) and physicians' expectations for patient treatment success (e.g., adherence). Results As predicted, patients' race-related beliefs and attitudes differed in their associations with patient and physician responses to the interactions. Higher levels of perceived past discrimination predicted more patient verbal activity. Higher levels of mistrust also predicted less patient positive affect and more negative evaluations of physicians. Higher levels of suspicion predicted more negative evaluations of physicians and recommended treatments. Stronger patient race-related attitudes were directly or indirectly associated with lower physician perceptions of patient attributes and treatment expectations. Conclusion Results provide new evidence for the role of Black patients' race-related beliefs and attitudes in racial healthcare disparities and suggest the need to measure multiple beliefs and attitudes to identify these effects.

Rationale Multiple observational coding systems have been developed and validated to assess parent-child interactions during painful procedures. Most of these coding systems are neither theory-based nor do they well represent parent nonverbal behaviours. Aims Develop the Parent Caring Response Scoring System (P-CaReSS) based on Swanson's Theory of Caring and test its psychometric properties in children in cancer port starts. Methods A hybrid approach of inductive and deductive coding was used to formulate the preliminary observational codes for the P-CaReSS. Twenty-nine children, each with one video-recording of port start available, were selected from the parent study (R01CA138981) to refine the P-CaReSS, train coders and test inter-rater reliability. Videos of another 43 children were used to evaluate the construct validity of P-CaReSS. Per cent agreement and Cohen's kappa were used to present the inter-rater reliability. Spearman rank-order correlations were used to report the construct validity. Results The 18-item P-CaReSS includes three types of parent behaviours: verbal, nonverbal and emotional behaviours. These parent interaction behaviours comprise five caring domains - knowing, being with, doing for, enabling, and maintaining belief - and one noncaring domain. On average the per cent agreement was 0.82 for the P-CaReSS overall, with average per cent agreements above 0.80 for both verbal and nonverbal behaviours. Kappa coefficient was 0.81 for the emotional behaviour. The behavioural codes in the P-CaReSS showed significant correlations with independent ratings of parent distress, child distress and child cooperation. Conclusions The P-CaReSS is a promising tool that can be used to evaluate parent verbal, nonverbal and emotional behaviours during cancer-related port starts. This observational tool can be used to guide the development of nursing interventions to help parents caring for their child during cancer procedures.

Objective Communication during racially-discordant interactions is often of poor quality and may contribute to racial treatment disparities. We evaluated an intervention designed to increase patient active participation and other communication-related outcomes during interactions between Black patients and non-Black oncologists. Methods Participants were 18 non-Black medical oncologists and 114 Black patients at two cancer hospitals in Detroit, Michigan, USA. Before a clinic visit to discuss treatment, patients were randomly assigned to usual care or to one of two question prompt list (QPL) formats: booklet (QPL-Only), or booklet and communication coach (QPL-plus-Coach). Patient-oncologist interactions were video recorded. Patients reported perceptions of the intervention, oncologist communication, role in treatment decisions, and trust in the oncologist. Observers assessed interaction length, patient active participation, and oncologist communication. Results The intervention was viewed positively and did not increase interaction length. The QPL-only format increased patient active participation; the QPL-plus-Coach format decreased patient perceptions of oncologist communication. No other significant effects were found. Conclusion This QPL booklet is acceptable and increases patient active participation in racially-discordant oncology interactions. Future research should investigate whether adding physician-focused interventions might improve other outcomes. Practice implications This QPL booklet is acceptable and can improve patient active participation in racially-discordant oncology interactions.

Objective Although distress during treatment procedures and longer-term treatment-related anxiety are among the most common cancer-related stressors for children and their families, they are not invariant. This study examined whether individual differences in temperament and personality play a role in how children respond to treatment procedures. Attention control, a facet of the effortful control dimension of temperament, and the personality attribute ego-resilience were hypothesized to predict lower levels of distress during procedures. Moreover, ego-resilience and distress during procedures were hypothesized to account for indirect associations between attention control and longer-term treatment-related anxiety. Child gender was examined as a potential moderator of these relationships. Method Participants were 147 children undergoing treatment for pediatric cancer and their parents. At baseline, parents reported on children's effortful control and ego-resilience. Multiple raters assessed children's distress during multiple cancer-related procedures. Treatment-related anxiety was measured 3 and 9 months after the last assessed treatment procedure. Results Attention control was linked to ego-resilience and lower levels of distress, and these variables, in turn, accounted for indirect associations between attention control and treatment-related anxiety. Associations involving ego-resilience were stronger for boys than girls. Conclusion Attention control plays an important role in children's immediate and longer-term responses to cancer-related medical procedures. Medical staff should consider individual differences in child temperament and personality when considering the nature and extent of support to provide to pediatric cancer patients and their families.

This review examines the neurobiological effects of pediatric cancer-related posttraumatic stress symptoms (PTSS). We first consider studies on prevalence and predictors of childhood cancer-related PTSS and compare these studies to those in typically developing (i.e., noncancer) populations. Then, we briefly introduce the brain regions implicated in PTSS and review neuroimaging studies examining the neural correlates of PTSS in noncancer populations. Next, we present a framework and recommendations for future research. In particular, concurrent evaluation of PTSS and neuroimaging, as well as sociodemographic, medical, family factors, and other life events, are needed to uncover mechanisms leading to cancer-related PTSS. We review findings from neuroimaging studies on childhood cancer and one recent study on cancer-related PTSS as a starting point in this line of research.

Background: The benefit of regular exercise in improving cancer outcomes is well established. In 2012, the American Cancer Society (ACS) released a recommendation statement that cancer survivors should engage in regular physical activity (PA) as soon as possible after a cancer diagnosis with the goal of engaging in at least 150 minutes per week of moderate to vigorous PA (1). However, few cancer survivors report meeting this recommendation (2). Using data from the Detroit Research on Cancer Survivors (ROCS) study, we examined the patterns of PA and its association with health-related quality of life (HRQOL) in a cohort of African American cancer survivors. Methods: Detroit ROCS participants complete baseline and yearly follow-up surveys to update their health and provide information on health behaviors including PA, using the International Physical Activity Questionnaire-short form. We assessed the number of survivors who reported participating in regular PA and those who reported ≥150 minutes of moderate to vigorous PA per week by select characteristics and reported HRQOL measured using the Functional Assessment in Cancer Therapy (FACT) and Patient-Reported Outcomes Measurement Information System (PROMIS) instruments. Results: Among the first 1,000 ROCS participants, 58% reported participating in regular PA with just 22% reporting engaging in ≥150 minutes of PA per week. While there were no differences by sex, prostate cancer survivors were the most likely to report participating in regular PA while lung cancer survivors were the least likely (p=0.009). There was a positive relationship between self-reported education and area-level affluence based on US census data with PA (p Conclusions: Fewer than 25% of African American cancer survivors reported meeting the ACS guidelines for PA at baseline recruitment; however, it was encouraging to see significant increases in PA engagement over time. Given the established benefits associated with regular exercise and cancer outcomes, and the positive correlation on HRQOL and inverse relationship with depression observed in this study, identifying, understanding, and eliminating barriers to regular moderate to vigorous PA among African American cancer survivors is critical. Future study of ROCS subjects will attempt to establish the temporality of these relationships. This abstract is also being presented as Poster C048. Citation Format: Julie J. Ruterbusch, Ann G. Schwartz, Terrance Albrecht, Tara Baird, Dave Finlay, Felicity Harper, Stephanie Pandolfi, Julia Mantey, Andrew G. Rundle, Jennifer L. Beebe-Dimmer. Engaging in physical activity after a cancer diagnosis: A Detroit ROCS study [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 PR04.

12057 Background: Given the well-documented benefits of regular exercise to cancer survivors, in 2012, an expert panel assembled by the American Cancer Society recommended that patients engage in at least 150 minutes per week of moderate-to-vigorous physical activity. However, few patients meet this goal. We have also observed racial differences in reported participation in regular exercise among cancer survivors living in Metropolitan Detroit, Michigan. Methods: The CAPABLE study is a 12- week pilot exercise intervention that introduces cancer survivors to the sport of CrossFit. We evaluated the impact of this unique, high-intensity interval training method on functional performance, cardiovascular endurance, body composition and health-related quality of life (HRQOL) as measured by the Functional Assessment of Cancer Therapy (FACT) instrument. All measures were summarized at baseline and program exit. Paired signed rank tests were used to assess change in each of these measures over time. Results: Of the 48 participants enrolled in the pilot, 37 (77%) were considered adherent to the program (attending at least 75% of sessions over the 12-week period). The mean age of participants was 58.5 years, 73% identified as African American and the majority of participants were breast cancer survivors (N = 20). The mean body mass index (BMI) at baseline was 32.8 kg/m2 decreasing to a mean of 31.7 kg/m2 at exit (BMI change -1.1, p < 0.001). Similar changes were observed in % body fat measured by bioelectrical impedance. There were significant improvements in all measures of functional performance over 12-weeks (all p < 0.001). We observed significant and meaningful improvements in reported HRQOL measured by the FACT survey, overall (FACTG total change +9.5 (p < 0.001)) and in each one of the individual domains (physical, social, emotional, and functional well-being). Conclusions: We observed significant improvements in performance, body composition and quality of life among cancer survivors introduced to a high-intensity interval training program. Understanding and eliminating barriers to programs like these are critical to improving outcomes and reducing cancer health disparities. Clinical trial information: NCT03750981 .

UNSTRUCTURED We opted to not include an abstract since we are submitting a short viewpoint paper.

BACKGROUND: Pediatric cancer is a life-changing, stressful experience for children and their families. Although most children adjust well, psychologically, a significant subset report posttraumatic stress symptoms (PTSS), with nearly 75% re-experiencing traumatic parts of cancer and/or its treatment. However, little research has examined the effects of pediatric cancer and related PTSS on emotional processing, and on functional properties of key emotional centers in the brain (e.g., amygdala). PROCEDURE: We examined cancer-related PTSS, behavioral responses during an emotion-processing task, and resting-state functional connectivity of the amygdala in 17 pediatric cancer survivors (ages 6–11) and 17 age- and sex-matched controls. RESULTS: Cancer survivors, relative to controls, were more likely to rate ambiguous (i.e., neutral) faces as negative (i.e., “negativity bias”). Higher re-experiencing PTSS was associated with faster responses to neutral faces. Although there were no group differences in amygdala centrality, within survivors, both higher re-experiencing PTSS and faster reaction times were associated with increased centrality of the amygdala – a functional property associated with hubs of information processing in the brain. In an exploratory mediation analysis, we found that amygdala centrality mediated the link between reaction time and PTSS, suggesting that changes in the brain may be a proximal marker of the expression of emotion-related symptomology. CONCLUSIONS: Negativity bias in cancer survivors may reflect their stressful experiences with cancer and/or its treatment. This negativity bias may represent a susceptibility to changes in emotion-related brain functioning which may, in turn, lead to PTSS.

Objective Black patients and their physicians tend to form relatively negative impressions of each other, and these may contribute to racial disparities in health outcomes. The current research tested the hypothesis that the interaction between positive and negative affective behavior predicts the most positive impressions in clinic visits between Black patients and their oncologists. Method Naive coders rated patients' and oncologists' positive and negative affective behavior in thin slices from 74 video recorded clinic visits. We examined whether (a) physician positive affect, negative affect, or their interaction predicted patients' perceptions of patient-centeredness, trustworthiness, and confidence in recommended treatments and (b) patient positive affect, negative affect, or their interaction predicted physicians' perceptions of patient cognitive ability, likelihood of treatment adherence, and likelihood of treatment tolerance. We also tested whether affective behavior mediated relationships between race-related attitudes and post-visit impressions or influenced post-visit impressions independently of attitudes. Results When oncologists displayed relatively high levels of both positive and negative affect, patients were more confident in recommended treatments but did not rate physicians higher in patient centeredness or trustworthiness. When patients expressed relatively high levels of positive and negative affect, oncologists perceived patients to be higher in cognitive ability and more likely to adhere to treatment recommendations, but no more likely to tolerate treatments. Affective behavior influenced impressions independently of race-related attitudes. Conclusions Positive and negative affective behaviors jointly contribute to impression formation in clinic visits between Black patients and oncologists, and may have implications for patient treatment and outcomes in this underserved patient population.

Objective This study examined the direct and buffering effects of social support on longer-term global psychological distress among parents coping with pediatric cancer. In both sets of analyses, we examined whether these effects depended on the dimension of social support provided (i.e., satisfaction with support versus size of support network). Method Participants were 102 parents of pediatric cancer patients. At study entry, parents reported their trait anxiety, depression, and two dimensions of their social support network (satisfaction with support and size of support network). Parents subsequently reported their psychological distress in 3- and 9-month follow-up assessments. Results Parents' satisfaction with support had a direct effect on longer-term psychological distress; satisfaction was negatively associated with distress at both follow-ups. In contrast, size of support network buffered (moderated) the impact of trait anxiety and depression on later distress. Parents with smaller support networks and higher levels of trait anxiety and depression at baseline had higher levels of psychological distress at both follow-ups; for parents with larger support networks, there was no relationship. Conclusion Social support can attenuate psychological distress in parents coping with pediatric cancer; however, the nature of the effect depends on the dimension of support. Whereas interventions that focus on increasing satisfaction with social support may benefit all parents, at-risk parents will likely benefit from interventions that ensure they have an adequate number of support resources. Copyright © 2015 John Wiley & Sons, Ltd.

Background: The roles parents play in supporting their child during painful cancer procedures have been studied as communication strategies versus a broader caring framework and from a cross-sectional versus longitudinal perspective. Objectives: To examine the longitudinal change in parent communication behaviors over repeated cancer port start procedures experienced by their children. Methods: This study used a longitudinal design. Two trained raters coded 104 recorded videos of port starts from 43 children being treated for cancer. This included 25 children with two video-recorded port starts and 18 children with three (T1, T2, T3). The Parent Caring Response Scoring System derived from Swanson's Caring Theory was used to code parent communication behaviors as caring responses during their children's port starts. Three 3- to 5-minute slices (pre–port start, during, and post–port start) were coded for each video. Mixed modeling with generalized estimating equations and Friedman test were used to analyze longitudinal change in parent behaviors. Results: Significant differences were found between T1 versus T3 in eye contact (β = −1.05, p = .02), distance-close-enough-to-touch (β = −0.81, p = .03), nonverbal comforting (β = −1.34, p = .04), and availability (β = −0.92, p = .036), suggesting that more parents used communication behaviors at T3 compared with T1. Parent burdensome or intrusive questions (e.g., Why do you cry? β = −1.11, p = .03) and nonverbal comforting (β = −1.52, p = .047) increased from T2 to T3. The median values of parent communication behaviors overall had no significant changes from T1 to T3. Conclusion: Parents adjusted to use more nonverbal caring behaviors as their child experienced additional port starts. Experimental studies should be designed to help parents use caring behaviors to better support their children during cancer procedures.

175 Background: Cancer patients commonly rely on loved ones to act as informal caregivers during and after treatment. Caregivers may need to take time off work or make other employment changes to handle caregiving demands. Employment changes due to caregiving and their impacts on psychological outcomes are not well understood, especially among caregivers of African American cancer survivors. Methods: Results include information from caregivers of participants in the Detroit Research on Cancer Survivors (ROCS) cohort, a population-based study of African American survivors of breast, colorectal, lung, or prostate cancer from Metropolitan Detroit. ROCS participants nominated a friend or family member who acted as a caregiver to participate in the caregiver study. Caregivers provided information on employment and PROMIS depression and anxiety measures. The relationship between work outcomes and anxiety/depression was assessed using logistic regression models controlling for age, sex, income, and the caregiver’s relationship to the survivor. Results: For the first 350 caregivers enrolled, more than half (56%) were employed (42% full time, 14% part time) at the time of the survivor’s diagnosis. 53% of employed caregivers took time off work, including 40% who took unpaid time off to provide care. 16% took one month or more off work, including 12% who took at least one month of unpaid time. Taking at least one month off was associated with 2.3 (95% CI: 1.0, 5.4) times the odds of depressive symptoms but was not associated with anxiety. Extended unpaid time off was not associated with depression or anxiety. 38% of employed caregivers reported that it was somewhat, very or extremely difficult to balance work and caregiving. Difficulty balancing work and caregiving was associated with 3.1 times the odds of depressive symptoms (95% CI: 1.5, 6.2), and 2.2 times the odds of any anxiety (95% CI: 1.1, 4.3) compared with those who reported little or no difficulty. Conclusions: Difficulty balancing work and caregiving is common among caregivers of African American cancer survivors, and is associated with symptoms of depression and anxiety. Supports for caregivers facing employment challenges may improve their psychosocial wellbeing.

Objectives Limited research exists on correlates of psychosocial distress in Black breast cancer patients. The goals of the study were to describe the prevalence of distress (anxiety and depression) in Black women with breast cancer and to examine the influence of demographic, clinical, contextual (e.g., self-efficacy, medical mistrust), and process of care factors (e.g., patient satisfaction) on women's level of anxiety and depression. Methods Eighty-two Black women diagnosed with invasive non-metastatic breast cancer were interviewed by phone. Collected data included demographic, clinical, contextual, and process of care factors. Bivariate correlations were used to examine relationships between those variables. Multiple linear regressions were used to examine predictors of anxiety and depression. Results About one-third of the women (32%) met cut-off thresholds for distress. Medical mistrust and positive attitude had significant influences on anxiety levels, whereas age and positive attitude were determinants of levels of depression. Participants with higher medical mistrust reported more anxiety (r = .379; p

Chemotherapy improves breast cancer survival but is underused more often in black than in white women. We examined associations between patient-physician relationships and chemotherapy initiation and timeliness of initiation among black and white patients. Women with primary invasive, non-metastatic breast cancer were recruited via hospitals (in Washington, DC and Detroit) and community outreach between July 2006 and April 2011. Data were collected via telephone interviews and medical records. Logistic regression models evaluated associations between chemotherapy initiation and independent variables. Since there were race interactions, analyses were race-stratified. Factors associated with time from surgery to chemotherapy initiation and delay of ≥90 days were evaluated with linear and logistic regressions, respectively. Among eligible women, 82.8 % were interviewed and 359 (90.9 %) of those had complete data. The odds of initiating chemotherapy were 3.26 times (95 % CI: 1.51, 7.06) higher among black women reporting greater communication with physicians (vs. lesser), after considering covariates. In contrast, the odds of starting chemotherapy were lower for white women reporting greater communication (vs. lesser) (adjusted OR 0.22, 95 % CI: 0.07, 0.73). The opposing direction of associations was also seen among the sub-set of black and white women with definitive clinical indications for chemotherapy. Among those initiating treatment, black women had longer mean time to the start of chemotherapy than whites (71.8 vs. 55.0 days, p = 0.005), but race was not significant after considering trust in oncologists, where initiation time decreased as trust increased, controlling for covariates. Black women were also more likely to delay ≥90 days than whites (27 vs. 8.3 %; p = 0.024), but this was not significant after considering religiosity. The patient-physician dyad and sociocultural factors may represent leverage points to improve chemotherapy patterns in black women.

This study investigated the beliefs and attitudes of older African American colorectal cancer (CRC) survivors that may influence health behavior changes after treatment. Drawing from existing theories of health behavior change and cultural beliefs about health, a semi-structured interview guide was developed to elicit survivors’ perspectives. Qualitative focus groups and interviews were conducted with 17 survivors identified through the Detroit Surveillance Epidemiology and End Results registry. Using verbatim transcripts from the sessions and NVivo software, thematic analysis was conducted to analyze patterns of responses. Transcripts were coded for seven categories (health behaviors, who/what motivates change, self-efficacy, fatalism, religion/spirituality, beliefs about cancer, race/ethnicity). Five themes emerged from the data (personal responsibility, resilience, desire for information, intentions to change, beliefs in divine control). Findings support the relevance of existing theories of health behavior change to older African American CRC survivors. Cultural considerations are suggested to improve interventions seeking to maximize changes in diet and exercise among this group of survivors.

Pediatric cancer caregivers are typically present at their child’s frequent, invasive treatments, and such treatments elicit substantial distress. Yet variability exists in how even the most anxious caregivers cope. Here we examined one potential source of this variability: caregivers’ tendencies to self-distance when reflecting on their feelings surrounding their child’s treatments. We measured caregivers’ self-distancing and trait anxiety at baseline, anticipatory anxiety during their child’s treatment procedures, and psychological distress and avoidance 3 months later. Self-distancing buffered high (but not low) trait anxious caregivers against short- and long-term distress without promoting avoidance. These findings held when controlling for other buffers, highlighting the unique benefits of self-distancing. These results identify a coping process that buffers vulnerable caregivers against a chronic life stressor while also demonstrating the ecological validity of laboratory research on self-distancing. Future research is needed to explicate causality and the cognitive and physiological processes that mediate these results.

Reducing exposure to environmental tobacco smoke significantly reduces lung cancer risk. We used family communication patterns theory and the theory of planned behavior to examine whether perceived norms and lung cancer worry more strongly influenced intentions to avoid environmental tobacco smoke in families higher in conformity and conversation orientations. Results from 52 individuals in 17 high-risk lung cancer families showed injunctive norms were positively related to intentions when families conformed and conversed more. Lung cancer worry was positively related to intentions in high conformity families and negatively related to intentions in low conformity families. Findings can benefit interventions to reduce environmental tobacco smoke exposure.

Background Pain/distress during pediatric cancer treatments has substantial psychosocial consequences for children and families. We examined relationships between parents' caregiving self-efficacy, parents' affect in response to their children's cancer-related treatment procedures, and parents' symptoms of post-traumatic stress at follow-up. Methods Participants were 75 pediatric cancer patients and parents. On the day of each of three procedures (i.e., port-start, lumbar puncture, or bone marrow aspiration), parents rated their self-efficacy for six caregiving goals. Parents also self-reported their negative affect (i.e., state anxiety, negative mood, and distress) in response to each procedure. Three months after the last procedure, parents reported their level of post-traumatic stress symptoms (PTSS). Results Higher parent self-efficacy about keeping children calm before treatment and/or keeping children calm during the procedure was associated with lower state anxiety. Self-efficacy for keeping the child calm during procedures was significantly correlated with distress in parents at the time of procedures, and self-efficacy for keeping the child calm before procedures was significantly correlated with PTSS. All three negative affect measures significantly mediated the effects of parents' caregiving self-efficacy for both goals on parents' PTSS 3 months later. Conclusions Parents' caregiving self-efficacy influences their immediate and longer-term distress reactions to their children's treatment procedures. These findings provide a more nuanced understanding of how parents' cognitions contribute to their ability to cope with their children's treatment and suggest the benefit of an intervention that targets parents' procedure-specific caregiver self-efficacy. Copyright © 2012 John Wiley & Sons, Ltd.

Pain/distress during pediatric cancer treatments has substantial psychosocial consequences for children and families. The authors examined relationships between children's positive dispositional attributes, parents' empathic responses, and children's pain/distress responses to treatment procedures. Participants were 41 pediatric cancer patients and parents. Several weeks before treatment, parents rated children's resilience and positive dimensions of temperament. Parents' pretreatment empathic affective responses to their children were assessed. Children's pain/distress during treatments was rated by multiple independent raters. Children's resilience was significantly and positively associated with parents' empathic affective responses and negatively associated with children's pain/distress. Children's adaptability and attention focusing also showed positive relationships (p < 0.10) with parents' empathic responses. Parents' empathic responses mediated effects of children's resilience on children's pain/distress. Children's positive dispositional attributes influence their pain/distress during cancer treatments; however, these effects may be mediated by parents' empathic responses. These relationships provide critical understanding of the influence of parent-child relationships on coping with treatment.

Background Although people with cancer want and need information from their oncologists, patients and oncologists often disagree about what information was discussed during clinical interactions. Most patients have companions present during oncology visits; we investigated whether companions process information more accurately than patients. Specifically, we examined whether patients and companions differed in agreement with oncologists about what was discussed. We also investigated the effect of topic on agreement and patient/companion self-reported understanding of discussions.

177 Background: Although we continue to make progress in reducing the incidence and mortality for most cancers in the United States, African Americans (AA) continue to experience higher cancer incidence rates and have worse survival than other populations. The causes of these poorer outcomes, from higher mortality to poorer quality of life, in AA cancer survivors are not well understood. The Detroit ROCS study was initiated to improve our understanding of the experience of AAs living with cancer. Methods: 1,000 AA and non-Hispanic white (NHW) patients with primary lung, female breast, prostate or colorectal cancer diagnosed on or after January 1, 2013, and/or treated at the Karmanos Cancer Institute in Detroit, MI were recruited to participate in a cohort study with planned follow-up for 4 years. At baseline, participants completed a web-based survey to gather information about their medical history, family history of cancer, treatment and medication use, behavioral risk factors and self-assessed quality of life. Statistical analyses were performed to examine racial differences in the distribution of patient characteristics including comorbid conditions, stage at diagnosis, first course treatment and reported health-related quality of life (HRQOL). Results: The majority of patients were AA (60%) and female (61%), with a median age at diagnosis of 60 years. AAs were older, more likely to report use of cigarettes and alcohol and report a greater number of comorbidities compared with NHW patients; they were less educated and less likely to be employed full time or married (all p-values < 0.001). AA patients reported poorer overall HRQOL compared with NHW patients (p-value < 0.001). Controlling for marital status and employment attenuated the observed racial differences in mean HRQOL scores across all measured domains. Conclusions: We observed significantly lower self-reported HRQOL among AA cancer survivors compared with NHW, which could be partially explained by differences in specific socioeconomic factors but interestingly, not the presence of multiple comorbidities. Future research efforts will evaluate the relative contribution of social and financial support to HRQOL in AAs.

145 Background: Financial hardship is common among cancer survivors, but its association with health-related quality of life (HRQOL) unknown. Methods: We utilized data from 570 black participants the Detroit Research on Cancer Survivors (ROCS) cohort study diagnosed with breast, colorectal, lung or prostate cancer since 1/1/13 and diagnosed or treated at the Karmanos Cancer Institute, and 402 white survivors meeting the same criteria. HRQOL was measured using the functional assessment of cancer therapy-general (FACT-G) and its subscales of physical, social, emotional and functional wellbeing, and site-specific measures. We fit linear regressions to estimate associations between material (debt, borrowing, selling assets, reduced income) and behavioral (skipping medication, not seeing a doctor, refusing treatment due to cost) financial hardship (MFH and BFH, respectively) and HRQOL. Adjusted models include demographic, socioeconomic, and treatment-related factors. Results: Overall, 50.3% of participants experienced material and 17.6% experienced behavioral financial hardship. In unadjusted models, HRQOL scores were 0.39 (95% CI 0.27, 0.51) standard deviations (SD) lower in those reporting any MFH. MFH was associated with significantly lower physical, emotional, and functional wellbeing scores, and with lower scores on breast-, colorectal-, and prostate-specific HRQOL measures. Total HRQOL was 0.68 SD (95% CI 0.52, 0.84) lower for participants who reported BFH than those who did not, and BFH was inversely associated with each subscale and each cancer-specific measure. In adjusted models, HRQOL scores were 0.15 (95% CI 0.03, 0.27) SD lower among participants reporting MFH and remained inversely associated with physical and functional wellbeing. BFH was associated with 0.42 (95% CI 0.27, 0.57) SD lower HRQOL scores and remained inversely associated with physical, social, emotional, and functional wellbeing; and with breast- and prostate-specific measures. Conclusions: MFH and BFH are associated with lower HRQOL among diverse cancer survivors. Addressing BFH in particular may improve HRQOL among survivors, particularly those with breast and prostate cancer.

Purpose: 17-Allylamino-17-demethoxygeldanamycin (17-AAG) is a benzoquinone ansamycin antibiotic with antiproliferative activity in several mouse xenograft models, including prostate cancer models. A two-stage phase II study was conducted to assess the activity and toxicity profile of 17-AAG administered to patients with metastatic, hormone-refractory prostate cancer. Experimental Design: Patients with at least one prior systemic therapy and a rising prostate-specific antigen (PSA) were eligible. Patients received 17-AAG at a dose of 300 mg/m2 i.v. weekly for 3 of 4 weeks. The primary objective was to assess the PSA response. Secondary objectives were to determine overall survival, to assess toxicity, and to measure interleukin-6, interleukin-8, and maspin levels and quality of life. Results: Fifteen eligible patients were enrolled. The median age was 68 years and the median PSA was 261 ng/mL. Patients received 17-AAG for a median number of two cycles. Severe adverse events included grade 3 fatigue (four patients), grade 3 lymphopenia (two patients), and grade 3 back pain (two patients). The median PSA progression-free survival was 1.8 months (95% confidence interval, 1.3-3.4 months). The 6-month overall survival was 71% (95% confidence interval, 52-100%). Conclusions: 17-AAG did not show any activity with regard to PSA response. Due to insufficient PSA response, enrollment was stopped at the end of first stage per study design. The most significant severe toxicity was grade 3 fatigue. Further evaluation of 17-AAG at a dose of 300 mg/m2 i.v. weekly as a single agent in patients with metastatic, hormone-refractory prostate cancer who received at least one prior systemic therapy is not warranted.

Purpose To investigate how communication among physicians, patients, and family/companions influences patients' decision making about participation in clinical trials. Patients and Methods We video recorded 235 outpatient interactions occurring among oncologists, patients, and family/companions (if present) at two comprehensive cancer centers. We combined interaction analysis of the real-time video-recorded observations (collected at Time 1) with patient self-reports (Time 2) to determine how communication about trial offers influenced accrual decisions. Results Clinical trials were explicitly offered in 20% of the interactions. When offers were made and patients perceived they were offered a trial, 75% of patients assented. Observed messages (at Time 1) directly related to patients' self-reports regarding their decisions (2 weeks later), and how they felt about their decisions and their physicians. Specifically, messages that help build a sense of an alliance (among all parties, including the family/companions), provide support (tangible assistance and reassurance about managing adverse effects), and provide medical content in language that patients and family/companions understand are associated with the patient's decision and decision-making process. Conclusion In two urban, National Cancer Institute–designated comprehensive cancer centers, a large percentage of patients are not offered trials. When offered a trial, most patients enroll. The quality and quantity of communication occurring among the oncologist, patient, and family/companion when trials are discussed matter in the patient's decision-making process. These findings can help increase physician awareness of the ways that messages and communication behaviors can be observed and evaluated to improve clinical practice and research.