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Objectives. We evaluated a community-based, translational stress management program to improve health-related quality of life in Spanish-speaking Latinas with breast cancer. Methods. We adapted a cognitive–behavioral stress management program integrating evidence-based and community best practices to address the needs of Latinas with breast cancer. Spanish-speaking Latinas with breast cancer were randomly assigned to an intervention or usual-care control group. Trained peers delivered the 8-week intervention between February 2011 and February 2014. Primary outcomes were breast cancer–specific quality of life and distress, and general symptoms of distress. Results. Of 151 participants, 95% were retained at 6 months (between May 2011 and May 2014). Improvements in quality of life from baseline to 6 months were greater for the intervention than the control group on physical well-being, emotional well-being, breast cancer concerns, and overall quality of life. Decreases from baseline to 6 months were greater for the intervention group on depression and somatization. Conclusions. Results suggest that translation of evidence-based programs can reduce psychosocial health disparities in Latinas with breast cancer. Integration of this program into community-based organizations enhances its dissemination potential.

Author(s): Napoles, Anna Maria; Ortiz, Carmen; Santoyo-Olsson, Jasmine; Stewart, Anita L; Lee, Howard E; Duron, Ysabel; Dixit, Niharika; Luce, Judith; Flores, Diana J | Abstract: BackgroundA comprehensive assessment of Spanish-speaking breast cancer survivors' (SSBCS) survivorship needs is lacking.ObjectiveAssess SSBCS' post-treatment symptom management, psychosocial, and informational needs.Methods118 telephone surveys and 25 in-person semi-structured interviews with SSBCS, and semi-structured interviews with 5 support providers and 4 physicians who serve SSBCS from 5 Northern California counties.ResultsSurveys identified the most bothersome (bothered by it in the past month "somewhat/quite a bit/a lot") physical symptoms as: joint pain, fatigue, hot flashes, numbness in hands/feet, and vaginal dryness. The most bothersome emotional symptoms were thoughts of recurrence/new cancers, depression/sadness, anxieties, and stress. Seven themes emerged from interviews: 1) unmet physical symptom management needs; 2) social support from family/friends often ends when treatment is completed; 3) challenges resuming roles; 5) sense of abandonment by health care system when treatment ends; 6) need for formal transition from active treatment to follow-up care; 6) fear of recurrence especially when obtaining follow-up care; and 7) desire for information on late effects of initial treatments and side effects of hormonal treatments. Based on survey and interview results, we present a conceptual framework for survivorship care interventions for SSBCS.LimitationsSample may not represent SSBCS' concerns seen outside of Northern California hospitals.ConclusionsPhysical and psychosocial symptoms were common. SSBCS need culturally appropriate survivorship care programs that address symptom management, psychosocial concerns, follow-up care, and healthy lifestyles.

e16072 Background: While targeted therapies have significantly changed clinical practice for metastatic renal cell carcinoma (RCC), the economic burden of these drugs is increasing without concomitant advances in strategies for choosing among such agents. We present a model of cost savings using a hypothetical biomarker panel of early response to guide selection of targeted and immune therapies in metastatic RCC patients. Methods: Using the Stanford RCC Outcomes database, we identified patients diagnosed with metastatic RCC who received any of the following: sunitinib, pazopanib, axitinib, sorafenib, cabozantinib, nivolumab, lenvatinib & everolimus, temsirolimus from 2003 through 2016 at Stanford Cancer Center. Primary outcomes included short-term and long-term costs of treatment according to standard-of-care imaging criteria. Drug costs were inferred from the 2017 Veterans Affairs Federal Supply Schedule pricing in USD. A hypothetical biomarker cost was set at $4,620—the current market price of an actively employed diagnostic test in breast cancer, OncotypeDX. These parameters were combined in a Markov model to simulate patient treatment courses and to assess the impact of an early response biomarker on drug expenditures. Results: 370 patients received a range of one to six lines of successive therapy. 170 (45.9%) were long-term patients with cumulative drugs costs totaling $31 million, or on average $185,362 per patient, and $104,521 per individual line of therapy received. 200 (54%) were short-term patients who received less than 3 months of targeted therapy. The costs of such potentially ineffective treatment totaled $4.1 million, or $15,455 per patient per individual line of therapy received. Application of an early biomarker panel at the outset would result in a potential cost savings of up to $6,215 per patient. Conclusions: Bothmetastatic RCC patients and payers suffer high costs from ineffective therapy. Our findings suggest an economic benefit for developing biomarker panels to predict early therapeutic response. Such biomarkers can result in immediate cost savings, and possibly improved quality-of-life for those liberated from unnecessary drug toxicity.

Background Latinas with breast cancer suffer symptom and psychosocial health disparities. Effective interventions have not been developed for or tested in this population. Purpose We describe community-based participatory research methods used to develop and implement the Nuevo Amanecer program, a culturally tailored, peer-delivered cognitive-behavioral stress management intervention for low-income Spanish-speaking Latinas with breast cancer, and unique considerations in implementing a randomized controlled trial to test the program in community settings. Methods We applied an implementation science framework to delineate the methodological phases used to develop and implement the Nuevo Amanecer program and trial, emphasizing community engagement processes. Results In phase 1, we established project infrastructure: academic and community co-principal investigators, community partners, community advisory board, steering committee, and funding. In phase 2, we identified three program inputs: formative research, a community best-practices model, and an evidence-based intervention tested in non-Latinas. In phase 3, we created the new program by integrating and adapting intervention components from the three sources, making adaptations to accommodate low literacy, Spanish language, cultural factors, community context, and population needs. In phase 4, we built community capacity for the program and trial by training field staff (recruiters and interventionists embedded in community sites), compensating field staff, and creating a system for identifying potential participants. In phase 5, we implemented and monitored the program and trial. Engaging community partners in all phases has resulted in a new, culturally tailored program that is suitable for newly diagnosed Latinas with breast cancer and a trial that is acceptable and supported by community and clinical partners. Lessons learned Engagement of community-based organizations and cancer survivors as research partners and hiring recruiters and interventionists from the community were critical to successful implementation in community settings. Having culturally and linguistically competent research staff with excellent interpersonal skills facilitated implementation. Facilitating and maintaining excellent communication among community partners was imperative to troubleshoot implementation issues. Randomization was challenging due to community concerns about assigning women to a control group. Patient privacy regulations and the need for extensive outreach to establish relationships between community partners and clinical sites hampered initial recruitment. Limitations These were resource-intensive processes to develop and implement the program that need to be compared to less-intensive alternatives. Conclusion Engaging community members in design and implementation of community-based programs and trials enhances cultural appropriateness and congruence with the community context. If the randomized trial demonstrates that the intervention is effective, it will fill a gap in evidence-based programs to address ethnic disparities in quality of life among Spanish-speaking Latinas with breast cancer.