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Latino cancer caregivers are at risk of physical, mental, and emotional health issues. Sociocultural factors such as informational support, Anglo orientation, and spiritual practice may compound or protect against these risks.The purpose of this research project was to examine self-efficacy as a mediator between sociocultural factors and health outcomes in Latino cancer caregivers.This is a secondary analysis of baseline caregiver data from an experimental study testing two psychoeducational interventions in Latina individuals with breast cancer and their caregivers. Caregivers (N = 233) completed items assessing self-efficacy, informational support, Anglo orientation, spiritual practice, depression, and global health. Caregiver data were analyzed using hierarchical linear regression and mediation analysis.Spiritual well-being was not significantly associated with health outcomes or self-efficacy. In regression analysis, both informational support ( b = 0.32; 95% confidence interval [CI], 0.20 to 0.45; P.001) and Anglo orientation ( b = 0.15; 95% CI, 0.11 to 2.48; P.05) were significant predictors of global health, but informational support ( b = -0.43; 95% CI, -0.55 to -0.30; P.001) was the only significant predictor of depression. There were indirect relationships through self-efficacy for symptom management for both informational support and Anglo orientation and health outcomes.Informational support and Anglo orientation were significantly related to health outcomes directly and indirectly through self-efficacy in Latino cancer caregivers.Informational support through the health system and community, when provided with attention to culture and Spanish language translation, can increase Latino cancer caregivers' self-efficacy to care for themselves and improve health outcomes.

PURPOSE: Describe the feasibility and implementation of an electronic health record (EHR)–integrated symptom and needs screening and referral system in a diverse racial/ethnic patient population in ambulatory oncology. METHODS: Data were collected from an ambulatory oncology clinic at the University of Miami Health System from October 2019 to January 2021. Guided by a Patient Advisory Board and the Exploration, Preparation, Implementation, and Sustainment model, My Wellness Check was developed to assess physical and psychologic symptoms and needs of ambulatory oncology patients before appointments to triage them to supportive services when elevated symptoms (eg, depression), barriers to care (eg, transportation and childcare), and nutritional needs were identified. Patients were assigned assessments at each appointment no more than once in a 30-day period starting at the second visit. Assessments were available in English and Spanish to serve the needs of the predominantly Spanish-speaking Hispanic/Latino population. RESULTS: From 1,232 assigned assessments, more than half (n = 739 assessments; 60.0%) were initiated by 506 unique patients. A total of 65.4% of English and 49.9% of Spanish assessments were initiated. Among all initiated assessments, the majority (85.1%) were completed at home via the patient portal. The most common endorsed items were nutritional needs (32.9%), followed by emotional symptoms (ie, depression and anxiety; 27.8%), practical needs (eg, financial concerns; 21.7%), and physical symptoms (17.6%). Across the physical symptom, social work, and nutrition-related alerts, 77.1%, 99.7%, and 78.8%, were addressed, respectively, by the corresponding oncology health professional, social work team member, or nutritionist. CONCLUSION: The results demonstrate encouraging feasibility and initial acceptability of implementing an EHR-integrated symptom and needs screening and referral system among diverse oncology patients. To our knowledge, this is the first EHR-integrated symptom and needs screening system implemented in routine oncology care for Spanish-speaking Hispanics/Latinos.

The purpose was to determine predictors of scheduled and unscheduled health services use by cancer survivors undergoing treatment and their informal caregivers.English- or Spanish-speaking adult cancer survivors undergoing chemotherapy or targeted therapy for a solid tumor cancer identified a caregiver (N = 380 dyads). Health services use over 2 months was self-reported by survivors and caregivers. Logistic regression models were used to relate the likelihood of service use (hospitalizations, emergency department [ED] or urgent care visits, primary care, specialty care) to social determinants of health (age, sex, ethnicity, level of education, availability of health insurance), and number of comorbid conditions. Co-habitation with the other member of the dyad and other member's health services use were considered as additional explanatory variables.Number of comorbid conditions was predictive of the likelihood of scheduled health services use, both primary care and specialty care among caregivers, and primary care among survivors. Greater probability of specialty care use was associated with a higher level of education among survivors. Younger age and availability of health insurance were associated with greater unscheduled health services use (hospitalizations among survivors and urgent care or ED visits among caregivers). Unscheduled health services use of one member of the dyad was predictive of use by the other.These findings inform efforts to optimize health care use by encouraging greater use of scheduled and less use of unscheduled health services. These educational efforts need to be directed especially at younger survivors and caregivers.

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(1) Background: A healthful diet, regular physical activity, and weight management are cornerstones for cancer prevention and control. Yet, adherence is low in cancer survivors and others, calling for innovative solutions. Daughters, dUdes, mothers, and othErs fighting cancer Together (DUET) is a 6-month, online, diet-and-exercise, weight-loss intervention to improve health behaviors and outcomes among cancer survivor-partner dyads. (2) Methods: DUET was tested in 56 dyads (survivors of obesity-related cancers and chosen partners) (n = 112), both with overweight/obesity, sedentary behavior, and suboptimal diets. After baseline assessment, dyads were randomized to DUET intervention or waitlist control arms; data were collected at 3- and 6-months and analyzed using chi-square, t-tests, and mixed linear models (α < 0.05). (3) Results: Retention was 89% and 100% in waitlisted and intervention arms, respectively. Dyad weight loss (primary outcome) averaged −1.1 (waitlist) vs. −2.8 kg (intervention) (p = 0.044/time-by-arm interaction p = 0.033). Caloric intake decreased significantly in DUET survivors versus controls (p = 0.027). Evidence of benefit was observed for physical activity and function, blood glucose, and c-reactive protein. Dyadic terms were significant across outcomes, suggesting that the partner-based approach contributed to intervention-associated improvements. (4) Conclusions: DUET represents a pioneering effort in scalable, multi-behavior weight management interventions to promote cancer prevention and control, calling for studies that are larger in size, scope, and duration.

The American Society of Clinical Oncology (ASCO) surveyed cancer patients to assess practice patterns related to weight, diet, and exercise as a part of cancer care.An online survey was distributed between March and June 2020 through ASCO channels and patient advocacy organizations. Direct email communication was sent to more than 25,000 contacts, and information about the survey was posted on Cancer.Net. Eligibility criteria included being aged at least 18 years, living in the United States, and having been diagnosed with cancer. Logistic regression was used to determine factors associated with recommendation and referral patterns.In total, 2419 individuals responded to the survey. Most respondents were female (60.1%), 61.1% had an early-stage malignancy, and 48.4% were currently receiving treatment. Breast cancer was the most common cancer (35.7%). The majority of respondents consumed ≤2 servings of fruits and vegetables/d (50.5%) and exercised ≤2 times/wk (50.1%). Exercise was addressed at most or some oncology visits in 56.8% of respondents, diet in 50.1%, and weight in 28.0%. Respondents whose oncology provider provided diet and/or exercise recommendations were more likely to report changes in these behaviors vs. those whose oncology provider did not (exercise: 79.6% vs 69.0%, P.001; diet 81.1% vs 71.3%, P.001; weight 81.0% vs 73.3%, P = .003).In a national survey of oncology patients, slightly more than one-half reported attention to diet and exercise during oncology visits. Provider recommendations for diet, exercise, and weight were associated with positive changes in these behaviors, reinforcing the importance of attention to these topics as a part of oncology care.

PURPOSE: Lifestyle factors such as smoking, alcohol, body weight, physical activity, and diet quality have been associated with the risk of pancreatic cancer. However, studies of their combined association in women are limited. METHODS: Data on smoking habits, alcohol intake, diet composition, recreational physical activity, body weight, and waist circumference, obtained at recruitment for 136,945 postmenopausal women (aged 50–79 years) participating in the Women’s Health Initiative study, were categorized separately, with higher scores for each variable assigned to the categories representing healthier behaviors. The combined healthy lifestyle index (HLI) score, created by summing the scores for each risk factor, was grouped into quartiles. We used multivariable-adjusted Cox regression to estimate hazard ratios (HR) and 95% confidence intervals (CI) for pancreatic cancer risk in association with the HLI. RESULTS: Over an average follow-up period of approximately 16.0 years, 1,119 incident cases of pancreatic cancer were ascertained. Compared to women in the lowest HLI quartile, those in the upper quartiles (qt) had a reduced risk of pancreatic cancer (multivariable-adjusted HRqt(3)(rd) 0.83, 95% CI 0.74–0.99; and HRqt(4)(th) 0.74, 95% CI 0.62–0.88, respectively, p trend = 0.001). Use of waist circumference instead of BMI in the HLI score yielded similar results. Among women who were either non-diabetic or non-smokers, high HLI was also associated with reduced risk HRqt(4)(th) 0.78, 95% CI 0.65–0.85 and HRqt(4)(th) 0.80, 95% CI 0.66–0.97, respectively). Stratification by BMI categories (18.5− < 25.0, 25.0− < 30.0 and > 30.0 kg/m(2)) showed similar results in all groups. CONCLUSIONS: Our findings suggest that in postmenopausal women, a healthy lifestyle is associated with reduced risk of pancreatic cancer.

Purpose: Despite the benefits of diet and physical activity (PA) in improving breast cancer (BC) outcomes, few lifestyle interventions focus on Latina BC survivors who are at increased risk of cardiometabolic disorders, obesity and poor BC outcomes. We developed and tested the effectiveness of the culturally-tailored ¡Mi Vida Saludable! (My Healthy Life) in-person and/or electronic health (eHealth) program on improving diet and PA among Latina BC survivors. The program was developed in collaboration with community partners and used theory-based psychosocial determinants of behavior change. Methods: Latina BC survivors were post-treatment (endocrine therapy allowed) and consumed Citation Format: Heather Greenlee, Margarita Santiago-Torres, Pamela Koch, Wei-Yann Tsai, Heewon L Gray, Adam M Brickman, Ann Ogden Gaffney, Martha Eddy, Cynthia A Thomson, Tracy E Crane, Naxielly Dominguez, Jhack Sepulveda, Amanda M. Marin-Chollom, Rachel Paul, Zaixing Shi, Kathleene T Ulanday, Hanjie Shen, Marisol Castellano, Yanette Fuentes, Katherine Crew, Kevin Kalinsky, Melissa Accordino, Meghna Trivedi, Bret Taback, Melissa Beauchemin, Fernando J Camacho, Daniel T Friedman, Isobel Contento, Dawn L. Hershman. A randomized, controlled, 2x2 factorial trial of a diet and physical activity intervention among Latina breast cancer survivors: ¡Mi Vida Saludable! study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-10-07.

The Breast Cancer Weight Loss (BWEL) trial, is a randomized, controlled trial designed to determine whether weight loss after breast cancer diagnosis can reduce the risk of cancer recurrence in women with overweight or obesity. BWEL will compare the efficacy of a telephone-based, weight loss intervention plus health education materials versus health education materials alone on invasive disease-free survival in 3181 women with stage II-III breast cancer and a body mass index (BMI) >27 kg/m(2). In this report, we provide a detailed description of the goals and methods of the lifestyle intervention and the evidence supporting the intervention used in the BWEL trial. The intervention’s primary goal for participants is to achieve and maintain a weight loss of ≥ 10% of baseline weight through increased physical activity and caloric restriction. The evidence supporting the diet, physical activity and behavioral components of this telephone-based weight loss intervention as well as strategies to promote participant engagement and retention are described. The intervention is provided through 42 sessions, delivered by trained health coaches, over a 2-year period. If the BWEL lifestyle intervention is successful in improving cancer outcomes, then weight loss will be incorporated into the care of thousands of breast cancer patients.

PURPOSE Cancer is the leading cause of death among Hispanics/Latinos in the USA. Latina cancer survivors experience higher symptom burden than other cancer survivors. A healthy lifestyle can decrease recurrent cancer risk, increase well-being, and may decrease symptom burden in cancer survivors. The purpose of this study was to explore the barriers and facilitators for adopting healthy lifestyle behaviors among Latina cancer survivors. METHODS Using the Health Belief Model as the theoretical framework, qualitative descriptive methodology was used for secondary analysis of data from a previously conducted randomized clinical trial. Transcripts from the telephone health coaching calls, analyzed in the original language (English or Spanish), were used for this qualitative analysis. RESULTS Intervention telephone call transcript data from Latina cancer survivors (n = 14) were analyzed. Major themes were as follows: Perceived susceptibility to other chronic illnesses, perceived benefits of a healthy lifestyle, and perceived barriers and facilitators of adopting a healthy lifestyle. Lack of knowledge about healthy lifestyle behaviors could prevent participants from adopting a healthy lifestyle; gaining new knowledge about healthy lifestyle behaviors was a facilitator for changing lifestyle. Family responsibility and wearable technology could both prevent and motivate the participants to adopt a healthy lifestyle. CONCLUSION Developing culturally appropriate interventions for Latina cancer survivors is vital to decrease symptom burden and health risks, as well as improve health outcomes in this population.

Background Many of the 3.8 million breast cancer survivors in the United States experience long‐term side effects of cancer therapy including peripheral neuropathy (PN). We assessed the prevalence and predictors of PN among women with breast cancer followed in the Women's Health Initiative's Life and Longevity After Cancer survivorship cohort. Methods The study population included 2420 women with local (79%) or regional (21%) stage disease. Presence of PN was based on the reports of “nerve problems and/or tingling sensations” after treatment and PN severity was assessed using the Functional Assessment of Cancer Therapy‐Gynecologic Oncology Group/Neurotoxicity instrument. Logistic regression analysis was used to evaluate the socio‐demographic and clinical factors associated with PN prevalence and severity. Results Initial breast cancer treatment included surgery‐only (21%), surgery and radiation (53%), or surgery and chemotherapy (±radiation) (26%). Overall, 17% of women reported PN occurring within days (30%), months (46%), or years (24%) after treatment and 74% reported ongoing symptoms at a median of 6.5 years since diagnosis. PN was reported by a larger proportion of chemotherapy recipients (33%) compared to those who had surgery alone (12%) or surgery+radiation (11%) (p

Objectives To determine the association of physical activity and body image with psychological health outcomes and whether body image mediates the association of physical activity with psychological health among older female cancer survivors. Materials and Methods Data from the Women's Health Initiative (WHI) Life and Longevity after Cancer (LILAC) Study were used. Surveys assessed body image (appearance, attractiveness, scars), moderate-strenuous physical activity (min/week), and psychological health (depression, anxiety, distress). A mediation analysis was conducted to estimate the percentage of the total effect of physical activity on psychological health mediated by body image concerns. Results Among 4567 female cancer survivors aged 66–98 years, the average time since cancer diagnosis was 9.2 years. Approximately 50% reported no moderate-strenuous physical activity; 15% reported depressive symptoms, 6% reported anxiety, and 5% reported psychological distress; 3% had concerns with appearance, 20% had concerns with attractiveness, and 21% had concerns with scars. When unadjusted for body image concerns, every 30 min/week increase in physical activity was associated with lower risk of depressive symptoms (RR = 0.93, 95%CI: 0.90–0.96), anxiety (RR = 0.92, 95%CI: 0.87–0.97), and distress (RR = 0.92, 95%CI: 0.87–0.98). Body image concerns with appearance mediated 7%, 8.8%, and 14.5% of the association between physical activity and depressive symptoms, anxiety, and distress, respectively. Conclusion Older female cancer survivors reported body image concerns, which were associated with both physical activity and psychological health. Our findings suggest that interventions designed to address body image concerns in older female cancer survivors could serve to improve the benefit of physical activity on psychological health.

PURPOSE Symptoms and needs monitoring using patient-reported outcomes (PRO) is associated with improved clinical outcomes in cancer care. However, these improvements have been observed predominantly in non-Hispanic White patients using English assessments with high completion rates. The documented impact of such monitoring on system-level outcomes including emergency room (ER) visits and hospitalizations remains limited. We explored factors affecting the completion of PRO measures and evaluated clinical outcomes in an ambulatory oncology setting with a diverse racial, ethnic, and linguistic population. METHODS A retrospective analysis (October 2019-February 2022) was performed for patients with cancer assigned to My Wellness Check (MWC), a patient-portal-administered and electronic health record–based PRO assessment that generates automated alerts to oncology providers. Patient demographics, clinical characteristics, and clinical outcomes were collected. Logistic regression models examined factors affecting the completion of MWC questionnaires. Cumulative incidence of ER visits and hospitalization were assessed by Cox proportional hazards regression models adjusting for demographics. RESULTS We identified 9,553 patients; 43.1% (n = 4,117) answered one or more questions. Patients age 65 years or older (adjusted odds ratio [aOR], 0.77; P < .0001), male (aOR, 0.81; P < .0001), Hispanic/Latino ethnicity (aOR, 0.70; P < .0001), living without partners (aOR, 0.75; P < .0001), or receiving no treatment (aOR, 0.76; P < .0001) were less likely to answer MWC questionnaires. Patients who completed the entire MWC questionnaires had a reduced risk of an ER visit (adjusted hazard ratio, 0.78; P < .0001) and hospitalization (adjusted hazard ratio, 0.80; P = .0007) relative to patients who did not. CONCLUSION Completing electronic health record–based PRO assessments was associated with significantly better clinical outcomes in a diverse cancer population. Specific patient groups were less likely to participate. Further research is needed to identify barriers to completing PRO measures and the long-term benefits of such programs.

The Lifestyle Intervention for oVarian cancer Enhanced Survival (LIVES) is a national study of a combined diet and physical activity intervention for stage II-IV ovarian cancer survival, an under-represented cancer in lifestyle behavioral intervention research. Here, we present the data on recruitment, retention, and baseline demographic, clinical and lifestyle behavior characteristics of the LIVES study participants.The LIVES study (NRG Oncology/GOG 0225) is a Phase III diet plus physical activity intervention trial testing the hypothesis that ovarian cancer survivors in the lifestyle intervention will demonstrate better progression-free survival than those in the control condition. Study interventions were delivered via centralized telephone-based health coaching. Baseline descriptive statistics were computed for demographic, clinical, and lifestyle behavior characteristics.The LIVES study exceeded its recruitment goals, enrolling 1205 ovarian cancer survivors from 195 NRG/NCORP-affiliated oncology practices across 49 states from 2012 to 2018. The mean age of enrollees was 59.6 years; the majority (69.4%) with stage III disease; 89% White, 5.5% Hispanic; 64% overweight/obese. Baseline self-reported diet showed a mean daily intake of 6.6 servings of fruit and vegetables, 62.7 fat grams, and 21.7 g of fiber. Physical activity averaged 13.0 MET-hours/week of moderate to vigorous physical activity; 50.9 h/week of sedentary time. Retention rates exceeded 88%.The LIVES study demonstrates efficiency in recruiting and retaining ovarian cancer survivors in a 24-month study of diet and physical activity intervention with a primary endpoint of progression free survival that will be reported.ClinicalTrials.govNCT00719303.

Over the last 50 years, there have been shifts in the incidence of gastric and esophageal cancers in the United States, including a decline in noncardia gastric adenocarcinoma (NCGC), and increases in cardia gastric adenocarcinoma (CGC) and esophageal adenocarcinoma (EAC).

Background: Results of observational studies of the association between dietary fat and risk of invasive breast cancer have been inconsistent. In the Women's Health Initiative dietary modification (DM) randomized trial designed to lower fat intake, the intervention was not associated with a statistically significant reduction of overall breast cancer risk. However, the DM association with risk of ductal carcinoma in situ (DCIS) of the breast, a putative breast cancer precursor, has not been reported. Methods: A total of 48,835 postmenopausal women, ages 50–79 years at enrollment, with no breast cancer history and ≥32% of total energy intake from fat, were randomly assigned either to a dietary intervention (n = 19,541) designed to reduce total fat intake to 20% of energy and to increase vegetable, fruit, and grain consumption, or to a comparison group (n = 29,294). Cox proportional hazards models were used to estimate HRs and 95% confidence intervals for the association between the intervention and DCIS risk. Results: During 18.7 years (median) cumulative follow-up, including intervention (∼8.7 years) and post-intervention phases (∼13.0 years), 817 DCIS cases were ascertained. No evidence of an association between the DM intervention and DCIS risk was observed overall, or by trial phase (intervention and post-intervention). Similarly, no associations were found in subgroups defined by potential risk factors for DCIS. Conclusions: DM aiming to reduce fat intake was not associated with altered risk of DCIS. Impact: These results do not provide evidence of an association between dietary fat reduction and the risk of DCIS among postmenopausal women.

PURPOSE: The aim of this study was to describe diet and physical activity (PA) behaviors and health beliefs among cancer survivors and identify potential differences between adolescent and young adult (AYA) and adult/older cancer survivors. METHODS: Cancer survivors (n = 1864) participating in the Health Information National Trends Survey (HINTS) provided responses regarding diet and PA and selected health beliefs related to general health and cancer (self-efficacy, attitudinal belief, normative belief, risk belief, intention, and self-regulation). Health belief associations with diet and PA were assessed using adjusted logistic regression models, and multiple linear regression was used for a computed Modified American Cancer Society Adherence score (0–10, higher score indicates higher adherence to recommendations); age at diagnosis was evaluated as a potential effect modifier. RESULTS: Health behaviors between AYA and adult/older were not significantly different; a greater percent of AYA met fruit and resistance PA recommendations. Higher health self-efficacy was associated with meeting aerobic PA recommendations (odds ratio [OR]: 1.71; confidence interval [95% CI]: 1.13–2.60; p = 0.01). Higher intention was inversely related to meeting vegetable recommendation (OR: 0.58; 95% CI: 0.35–0.97; p = 0.04). Self-regulation was associated with higher odds of meeting each recommendation. Self-efficacy and self-regulation were associated with greater adherence (β = 0.52 ± 0.16, p = 0.001; β = 1.21 ± 0.24, p

Background Sexual minority men are disproportionately affected by HIV. Medical advances in HIV treatment have extended life expectancy, and as this group ages, medical and psychological challenges become more prominent. Older people with HIV experience a higher incidence of cancer and other comorbidities; these burdens along with sexual minority stress can strain coping resources and diminish health-related quality of life. Interventions such as cognitive behavioral stress and self-management (CBSM) can mitigate some of this burden; however, no manualized, eHealth-based interventions have focused on the unique needs of sexual minority men living with HIV and cancer. Objective This study aims to refine and finalize a web-based, CBSM-based intervention to meet the unique needs of this population, including sexual health, comanagement of 2 chronic conditions, and coping with sexual minority stress. Methods This mixed methods study used a previously completed qualitative phase (n=6) to inform the development of a web-based platform and intervention called SmartManage. The pilot phase study (n=50) involved randomization (1:1) into either 10 sessions of adapted CBSM or an attention control health promotion. Both conditions used the SmartManage platform, a web-based eHealth program designed to deliver CBSM and health promotion content and host live groups. Feasibility and acceptability (eg, rates of participant engagement and retention) were the primary outcomes. Results Participant-related activities are expected to be completed by November 2022, and results are expected to be submitted for publication by February 2023. Conclusions We hypothesize that participants would find the intervention acceptable (compared with engagement and retention rates observed in similar CBSM studies). We also hypothesize that participants receiving the SmartManage intervention would have reduced symptom burden and improved health-related quality of life before and after treatment compared with those who do not. International Registered Report Identifier (IRRID) DERR1-10.2196/37822

BACKGROUND Sexual minority men are disproportionately affected by HIV. Medical advances in HIV treatment have extended life expectancy, and as this group ages, medical and psychological challenges become more prominent. Older people with HIV experience a higher incidence of cancer and other comorbidities; these burdens along with sexual minority stress can strain coping resources and diminish health-related quality of life. Interventions such as cognitive behavioral stress and self-management (CBSM) can mitigate some of this burden; however, no manualized, eHealth-based interventions have focused on the unique needs of sexual minority men living with HIV and cancer. OBJECTIVE This study aims to refine and finalize a web-based, CBSM-based intervention to meet the unique needs of this population, including sexual health, comanagement of 2 chronic conditions, and coping with sexual minority stress. METHODS This mixed methods study used a previously completed qualitative phase (n=6) to inform the development of a web-based platform and intervention called SmartManage. The pilot phase study (n=50) involved randomization (1:1) into either 10 sessions of adapted CBSM or an attention control health promotion. Both conditions used the SmartManage platform, a web-based eHealth program designed to deliver CBSM and health promotion content and host live groups. Feasibility and acceptability (eg, rates of participant engagement and retention) were the primary outcomes. RESULTS Participant-related activities are expected to be completed by November 2022, and results are expected to be submitted for publication by February 2023. CONCLUSIONS We hypothesize that participants would find the intervention acceptable (compared with engagement and retention rates observed in similar CBSM studies). We also hypothesize that participants receiving the SmartManage intervention would have reduced symptom burden and improved health-related quality of life before and after treatment compared with those who do not. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/37822

Higher consumption of coffee and tea has been associated with improved health outcomes in the general population and improved breast cancer (BC) prognosis. This study investigated patterns of coffee and tea consumption and association with patient-reported outcomes (PROs) and clinical outcomes among survivors of BC.The authors included survivors of stage I-III BC enrolled in the CANTO cohort (NCT01993498) that provided post-treatment assessment of coffee and tea consumption from years 1 to 4 after diagnosis. Group-based trajectory modeling clustered patients according to daily consumption of coffee and tea. Multivariable mixed models and Cox models examined associations between consumption, PROs and clinical outcomes.Among 3788 patients, the authors identified four stable patterns of consumption: "Low" (25.8%), "Moderate" (37.6%), "High" (25.3%), and "Very high" (11.3%), corresponding to1, 2, 3, and ≥ 4 cups of coffee and/or tea per day. Patients in the "Very high" group (vs. "Low"), were more likely to be younger, smokers, with higher monthly income and education. PROs and survival outcomes were similar across the four groups.Over one in three survivors of BC reported high or very high consumption of coffee and/or tea. The authors found no association between higher consumption of coffee and/or tea, worse PROs and clinical outcomes.

Patients with cancer and caregivers increasingly use the internet to find health and lifestyle information, yet online recipes, diet, and nutrition content are unregulated and may be confusing or even misleading. We describe cancer-related nutrition and meal planning information from Pinterest.In June 2020, we searched Pinterest using "cancer recipe" and "recipe for cancer" at 3 times daily for 2 weeks. Duplicates were removed for a final sample of n = 103 pins. Each pin was coded for 58 variables including descriptives, cancer claims (eg, treatment, prevention, and cure), and nutrition claims (eg, "turmeric cures cancer"). We summarized each variable to describe the content of cancer nutrition claims on Pinterest and examined associations between claim types and contextual factors, including the use of academic citations, disclaimers, and personal anecdotes.Pinners had on average 116,767 followers (range, 0-1.5 million). Almost half of content sites were for profit (48.5%) and 34% were selling a product. Health claims were common, with content that purported to prevent (41.8%), treat (27.2%), or cure (10.7%) cancer. Vague phrases such as "anti-cancer," "cancer-fighting," or "cancer-busting" were also used. The inclusion of validity indicators including academic citations, disclaimers, and personal anecdotes varied significantly by the types of claims made. Together, these analyses informed the development of a conceptual framework of cancer-related nutrition misinformation.There are clear financial incentives for the promotion of cancer nutrition information online. More research is needed to understand how exposure to nutrition information can influence patient/caregiver behavior and downstream clinical and psychosocial outcomes.

AIM: To investigate the association between dietary patterns and total and obesity-related cancers risk. Additionally, to examine if acculturation modifies this relationship. SUBJECT AND METHODS: Dietary intake of postmenopausal Hispanic women (N=5,482) enrolled in the Women’s Health Initiative was estimated from a Food Frequency Questionnaire and used to calculate dietary pattern scores; Healthy Eating Index-2015 (HEI-2015), Mexican Diet (MexD) score, alternate Mediterranean Diet Score (aMED), and the energy adjusted-Dietary Inflammatory Index (E-DII™). Associations were evaluated using Cox proportional hazards regression models. RESULTS: 631 cancers and 396 obesity-related cancers were diagnosed over a mean-follow up of 12 years. Across dietary scores, there were no significant associations with cancer risk or mortality. Trend analysis suggest a potentially lower risk for total cancer related to the highest MexD score (HR 0.68, 95% CI 0.45–1.04, P-trend=0.03), and lower risk for obesity-related cancer mortality related to the highest score category for MexD (HR 0.65, 95% CI 0.37–1.16, P-trend=0.02), and aMED (HR 0.87, 95% CI 0.45–1.67, P-trend=0.04). Further analysis suggests less acculturated women with higher MexD scores had 56% lower risk for any cancer (HR 0.44, 95% CI 0.22–0.88, P-trend=0.03) and 83% lower risk for cancer mortality (HR 0.17, 95% CI 0.04–0.76, P-trend=0.01) compared to more acculturated Hispanic women. CONCLUSIONS: Dietary patterns were not associated with cancer risk and mortality in postmenopausal Hispanic women. Less-acculturated, Spanish-preferred speakers, who reported consuming a more traditional Mexican diet may experience a lower risk for cancer and cancer mortality.

Adolescent and young adult (AYA) cancer survivors, here defined as individuals diagnosed with cancer between 15 and 39 years of age, are at high risk for adverse late-term metabolic effects of treatment through adulthood. Diet is a modifiable lifestyle behavior that may improve metabolic health outcomes in AYA cancer survivors. However, the details of dietary interventions for this unique population remain largely undescribed. In this systematic review, we aim to synthesize the results of dietary interventions for adult AYA cancer survivors. Seven databases and clinical trial registries were searched in March 2019 for interventions targeting dietary behaviors in AYA cancer survivors (PROPSERO systematic review number: CRD42019126376). Descriptive statistics and a narrative synthesis were completed to detail intervention participants and components. After full text review of 233 studies, four studies met all inclusion criteria. All studies were heterogeneous for participant age, cancer type, and duration, and were designed for feasibility and preliminary efficacy. Included studies followed different dietary guidance; however, each resulted in a significant change on a primary outcome of either dietary quality or body composition. Three of the four studies included a theoretical framework, where self-efficacy was a central construct. Counseling, in person, telephone, or electronic, provided behavioral support. Results of this systematic review suggest high potential to change dietary behaviors in AYA, but interventions remain limited. AYA cancer survivors demonstrate unique physiological and psychosocial needs, and future interventions designed to address this care gap should be targeted for this population with consideration of social support, delivery mode, and individual tailoring.

Objective Little is understood about patient expectations and use of complementary therapies (CT) during cancer treatment. A secondary analysis of an 11-week reflexology trial among women with breast cancer was conducted. We examined factors that predicted women's expectations about reflexology for symptom relief, factors that predicted utilisation of reflexology, and whether by the end of the trial they believed that reflexology had helped with symptom management. Methods Women (N = 256) were interviewed at baseline and week 11. Friend or family caregivers in the reflexology group were trained to deliver standardised sessions to patients at least once a week for 4 weeks. Baseline and week-11 reflexology expectations were analysed using general linear models. Reflexology utilisation was analysed with generalised linear mixed effects models. Results Patients who expected benefits from reflexology ("higher expectancy") at baseline were younger, had lower anxiety, higher education, higher spirituality, and greater CT use. Worsening symptoms over time were associated with greater utilisation of reflexology, but only when baseline expectancy was low. At week 11, expectancy was higher for those with greater symptom improvement. Conclusions Assessing patterns of patient factors, expectancy, and change in symptoms can help determine who is likely to use reflexology, and when.

Objective:This study examined associations between diet quality and disease activity in adults with rheumatoid arthritis (RA). Perceived stress was also compared to diet and disease activity. Methods: In a cross-sectional design, 50 adults with RA were recruited. The Arizona Food Frequency Questionnaire was used to measure dietary intake (four weeks) and diet quality scores were calculated with the Healthy Eating Index – 2015. Perceived stress was measured with the Perceived Stress Scale. Disease activity was measured with the Health Assessment Questionnaire-Disability Index and Pain Scale, erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein, and Disease Activity Score Including 28 Joints-ESR. Results: Diet quality (56; SD ± 12) in participants was lower than the national mean (59). Age ( p = 0.015) and gender ( p = 0.003) were associated with higher diet quality. The belief that diet affects RA disease activity was reported by 44% of the participants, and these participants were significantly more likely to report dietary changes ( p

Purpose: Short and long sleep duration and poor sleep quality are risk factors for weight gain and cancer mortality. The purpose of this study is to investigate the relationship between sleep and weight change among postmenopausal breast cancer survivors. Methods: Women participating in the Women’s Health Initiative who were diagnosed with incident breast cancer between year 1 and year 3 were included. Self-reported sleep duration was categorized as ≤5 hours (short), 6 hours, 7-8 hours (optimal), and ≥9 hours (long). Self-reported sleep quality was categorized as poor, average, and above average. Post-diagnosis weight change was the difference of weight closest to, but preceding diagnosis, and year 3 weight. We used linear regression to evaluate sleep duration and sleep quality associations with post-diagnosis weight change adjusted for potential confounders. Results: Among 1,156 participants, 63% were weight stable after diagnosis; average weight gain post cancer diagnosis was 3.2 kg. Six percent of women reported sleeping ≤5 hours, 26% reported 6 hours, 64% reported 7-8 hours, and 4% reported ≥9 hours. There were no differences in adjusted estimates of weight change among participants with short duration (0.37kg; 95%CI -0.88, 1.63), or long duration (-0.56kg; 95% CI -2.03, 0.90) compared to optimal duration, nor was there a difference among poor quality (-0.51kg; 95% CI -1.42, 0.41) compared to above average quality. Conclusion: Among postmenopausal breast cancer survivors, sleep duration and quality were not associated with weight change after breast cancer diagnosis. Future studies should consider capturing change in adiposity and to expand beyond self-reported sleep.

Nutrition and exercise interventions are strongly recommended for most cancer patients; however, much debate exists about the best prescription. Combining fasting with exercise is relatively untouched within the oncology setting. Separately, fasting has demonstrated reductions in chemotherapy-related side effects and improved treatment tolerability and effectiveness. Emerging evidence suggests fasting may have a protective effect on healthy cells allowing chemotherapy to exclusively target cancer cells. Exercise is commonly recommended and attenuates treatment- and cancer-related adverse changes to body composition, quality of life, and physical function. Given their independent benefits, in combination, fasting and exercise may induce synergistic effects and further improve cancer-related outcomes. In this narrative review, we provide a critical appraisal of the current evidence of fasting and exercise as independent interventions in the cancer population and discuss the potential benefits and mechanisms of combined fasting and exercise on cardiometabolic, body composition, patient-reported outcomes, and cancer-related outcomes. Our findings suggest that within the non-cancer population combined fasting and exercise is a viable strategy to improve health-related outcomes, however, its safety and efficacy in the oncology setting remain unknown. Therefore, we also provide a discussion on potential safety issues and considerations for future research in the growing cancer population.

We evaluated the role of seasonality in self-reported diet quality among postmenopausal women participating in the Women’s Health Initiative (WHI). A total of 156,911 women completed a food frequency questionnaire (FFQ) at enrollment (1993–1998). FFQ responses reflected intake over the prior 3-month period, and seasons were defined as spring (March–May), summer (June–August), fall (September–November), and winter (December–February). FFQ data were used to calculate the Alternate Healthy Eating Index (AHEI), a measure of diet quality that has a score range of 2.5–87.5, with higher scores representing better diet quality. In multivariable linear regression models using winter as the reference season, AHEI scores were higher in spring, summer, and fall (all P values < 0.05); although significant, the variance was minimal (mean AHEI score: winter, 41.7 (standard deviation, 11.3); summer, 42.2 (standard deviation, 11.3)). Applying these findings to hypothesis-driven association analysis of diet quality and its relationship with chronic disease risk (cardiovascular disease) showed that controlling for season had no effect on the estimated hazard ratios. Although significant differences in diet quality across seasons can be detected in this population of US postmenopausal women, these differences are not substantial enough to warrant consideration in association studies of diet quality.

Home smoking bans may be an effective way to promote tobacco cessation among treatment seeking smokers. Few studies have examined this relationship in a quitline setting. Data were obtained from 14,296 adults who were enrolled in a state quitline between January 2011 and July 2016. This study investigated whether cessation rates varied by changes in home smoking ban implementation between enrollment and 7-month follow-up. The impact of changes in home smoking bans on cessation at follow-up was significantly modified by having other smokers living in the home at follow-up (P < 0.0001). Among callers who did not live with other smokers in the home, the highest odds ratio of 30-day cessation was for callers who reported bans at follow-up only (OR = 10.50, 95%CI: 8.00, 13.70), followed by callers who reported bans at both enrollment and follow-up (OR = 8.02, 95%CI: 6.27, 10.30) and callers who reported bans at enrollment only (OR = 2.06, 95% CI: 1.47, 2.89) compared with callers with no home smoking bans. When callers reported that they lived with other smokers in the home, the effect of home smoking bans on cessation was much smaller. Quitlines should support the implementation of home smoking bans as a part of callers’ goal setting activities to achieve tobacco cessation.

Background Cancer survivors and their informal caregivers (family members, close friends) often experience significant impairments in health-related quality of life (HRQOL), including disruptions in psychological, physical, social, and spiritual well-being both during and after primary cancer treatment. The purpose of this in-progress pilot trial is to determine acceptability and preliminary efficacy (as reflected by effect sizes) of CBCT® (Cognitively-Based Compassion Training) compared with a cancer health education (CHE) attention control to improve the primary outcome of depressive symptoms and secondary outcomes of other HRQOL domains (e.g., anxiety, fatigue), biomarkers of inflammation and diurnal cortisol rhythm, and healthcare utilization-related outcomes in both cancer survivors and informal caregivers. Methods Forty dyads consisting of solid tumor survivors who have completed primary treatments (chemotherapy, radiation, surgery) and their informal caregivers, with at least one dyad member with ≥ mild depressive symptoms or anxiety, will be recruited from Tucson, Arizona, USA. Survivor-caregiver dyads will be randomized together to complete either CBCT or CHE. CBCT is a manualized, 8-week, group meditation-based intervention that starts with attention and mindfulness and builds to contemplative practices aimed at cultivating compassion to the self and others. The goal of CBCT is to challenge unexamined assumptions about feelings and behaviors, with a focus on generating spontaneous self-compassion and increased empathic responsiveness and compassion for others. CHE is an 8-week, manualized group intervention that provides cancer-specific education on various topics (e.g., cancer advocacy, survivorship wellness). Patient-reported HRQOL outcomes will be assessed before, immediately after (week 9), and 1 month after CBCT or CHE (week 13). At the same time points, stress-related biomarkers of inflammation (e.g., plasma interleukin-6) and saliva cortisol relevant for survivor and informal caregiver wellness and healthcare utilization will be measured. Discussion If CBCT shows acceptability, a larger trial will be warranted and appropriately powered to formally test the efficacy of this dyadic intervention. Interventions such as CBCT directed toward both survivors and caregivers may eventually fill a gap in supportive oncology care programs to improve HRQOL and healthcare utilization in both dyad members. Trial registration Clinicaltrials.gov, NCT03459781. Prospectively registered on 9 March 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3320-9) contains supplementary material, which is available to authorized users.

Objectives: To identify subgroups of Latina breast cancer survivors with unique trajectories of depression and anxiety and examine predictors associated with these subgroups. Sample & Setting: Secondary analysis of Latina breast cancer survivors (N = 293) from three psychosocial intervention studies. Methods & Variables: Depression and anxiety were assessed at intake and at weeks 8 and 16. Group-based growth mixture modeling was used to identify subgroups who followed distinct trajectories of depression and anxiety. Multinomial logistic regression models were used to identify predictors of trajectory-based subgroup membership. Results: Three trajectories emerged for depression: low/moderate-stable (78%), high-improving (7%), and high-stable (15%). Three subgroups based on the trajectories of anxiety were low-stable (73%), high-improving (18%), and high-worsening (9%). Chemotherapy, age, and social support discriminated among the three depression trajectory subgroups. All anxiety trajectory subgroups had significantly different initial scores. No demographic or clinical factors were associated with anxiety trajectories. Implications for Nursing: Latina women treated for breast cancer are at an elevated risk for depression and anxiety and follow distinct trajectories of these symptoms. Psychosocial interventions are needed to manage these symptoms, particularly for subgroups in which depression and anxiety persist or worsen.

e13542 Background: Individuals from the family and social support network of cancer patients can have a pivotal role in reinforcing patients’ efforts to become and remain tobacco-free. This support is critical along the entire continuum of cancer care. While NCI-designated cancer centers across the US are increasingly offering tobacco cessation services, as a result of the NCI Cancer Center Cessation initiative, engaging patients’ family and other support network in tobacco treatment is not yet routine practice and has not been well described. We present findings from NCI designated cancer centers on the practice of assessing and offering tobacco treatment to support persons as part of care. Methods: A 24-item survey was administered (July-August 2021) across 50 cancer centers participating in C3I. Questions focused on the practice of routine assessment, offering information on quitting, referral to tobacco treatment, involving the family and social support person in tobacco treatment, provide tobacco treatment and document treatment for support persons of cancer patients. Responses assessed frequency of these practices, which included “never,” “rarely,” “sometimes,” “always (routine),” and “don’t know”. Additionally, strength of support from leadership for these practices and program access to linguistic and culturally appropriate resources were assessed using responses “not at all,” “some,” “great,” “full extent” and “don’t know”. Descriptive statistics were performed using SPSS (V. 28). Results: Representatives from 45 centers (90%) completed the survey. Less than half of centers (44%) indicated they always identified and 29% always offered resources to patients’ support persons or family members who used tobacco. Fewer clinics (18%), always provided treatment to patients’ support persons or family members and only one reported billing for tobacco use treatment encounters with support persons. For patient’s secondhand smoke exposure, less than half of the clinics report routinely (always) assessing (44%), documenting (49%) and providing intervention (29%). Importantly, 60% of centers reported having access to linguistically and culturally appropriate, population-specific resources to address support persons tobacco use to a great or full extent. Leadership support to address family and support persons’ tobacco use was indicated by 56% of clinics. Conclusions: While some NCI designated cancer centers report routine practices for patients’ support persons, including family members who use tobacco, there is substantial room for improvement. The importance of routine practices to assess and treat support persons who use tobacco can dramatically improve tobacco cessation and ultimately overall outcomes for cancer patients. Similarly, addressing secondhand smoke exposure for cancer patients and their support person(s) who smoke, is critical along the entire continuum of cancer care.

Cancer is the leading cause of death among Hispanics/Latinos in the USA. Latina cancer survivors experience higher symptom burden than other cancer survivors. A healthy lifestyle can decrease recurrent cancer risk, increase well-being, and may decrease symptom burden in cancer survivors. The purpose of this study was to explore the barriers and facilitators for adopting healthy lifestyle behaviors among Latina cancer survivors.Using the Health Belief Model as the theoretical framework, qualitative descriptive methodology was used for secondary analysis of data from a previously conducted randomized clinical trial. Transcripts from the telephone health coaching calls, analyzed in the original language (English or Spanish), were used for this qualitative analysis.Intervention telephone call transcript data from Latina cancer survivors (n = 14) were analyzed. Major themes were as follows: Perceived susceptibility to other chronic illnesses, perceived benefits of a healthy lifestyle, and perceived barriers and facilitators of adopting a healthy lifestyle. Lack of knowledge about healthy lifestyle behaviors could prevent participants from adopting a healthy lifestyle; gaining new knowledge about healthy lifestyle behaviors was a facilitator for changing lifestyle. Family responsibility and wearable technology could both prevent and motivate the participants to adopt a healthy lifestyle.Developing culturally appropriate interventions for Latina cancer survivors is vital to decrease symptom burden and health risks, as well as improve health outcomes in this population.