Health Disparities and Cancer Survivorship
In This Section:
Summary
The Office of Cancer Survivorship (OCS) supports research examining the physiological, psychosocial, and economic sequelae of cancer and its treatment, and interventions that may ameliorate or prevent them. The majority of traditional research examining ethnic or minority differences in cancer survivorship outcomes has been limited largely to analyses of differences in cancer risk and survival (as opposed to survivorship), and efforts to extend these findings to address their impact on individuals living with this disease have begun only recently. A recent literature review by Aziz and Rowland (2002) identified 65 articles focused on the impact of cancer on ethnoculturally diverse and medically underserved survivors. The review concluded that socioeconomic and cultural variables that affect "adaptation to and survival from cancer" need to be recognized and addressed in future research studies.
Study Findings
Information describing OCS grants presented below illustrates progress in cancer survivorship research among minority and medically underserved groups:
Pediatric Late Effects:
- Dr. Lipshultz and colleagues are examining physiological sequelae of adriamycin-based cancer treatment - specifically, cardiac risk factors in pediatric cancer survivors and are attempting to assess late treatment-related toxicity among ethno-culturally diverse cancer survivors. Results show that late clinical cardiotoxicity occurs in 5-10% of long-term survivors of pediatric cancer 5-10 years after therapy, is often life threatening, and that African American survivors of childhood cancer may be at increased risk of early cardiotoxicity (occurring during/within a year of completion of treatment). Unclear, and important to explore further, is whether this excess cardiotoxic risk may also affect African-American survivors of adult cancers treated with anthracyclines. (Grenier MA, Lipshultz SE. Epidemiology of anthracycline cardiotoxicity in children and adults. Semin Oncol, 1998; 25: 72-85.)
Older Adult Survivors
- Dr. Deimling and colleagues are conducting research examining the quality of life of older long-term cancer survivors. They recently examined differences between African-American and white, older adult, long-term cancer survivors with respect to reported health problems, illness symptoms, functional difficulties, health concerns, and overall health perceptions. Results (controlled for cancer and treatment factors) show that African-American cancer survivors experience poorer functional health after cancer (perhaps related to more extensive treatment and corresponding higher functional disability), and also consistently higher levels of co-morbidities and decreased physical functioning (thereby increasing general health vulnerability). Thus, they may have diverse health care needs in terms of follow-up care for physical signs/symptoms, co-morbidities, and screening for second cancers. (Deimling GT, Schaefer ML, Kahana B, Bowman K. Racial Differences in the Health of Older Adult Long-Term Cancer Survivors. Psycho-oncology, 11: 2002.)
- Dr. Mishel and colleagues are testing an intervention that teaches specific skills to help older breast cancer survivors manage or cope with the physiological impact of cancer treatment, and its attendant psychosocial outcomes. These authors compared African American and white survivors in terms of: (a) relationship of uncertainty to family coping, psychological adjustment to illness, and spiritual factors; and (b) similarities/differences in relationship patterns between patients and family caregivers. Greater uncertainty was correlated with psychological distress and negative feelings about treatment, and inversely to positive feelings about patient recovery. For both sets of patients but only white caregivers, uncertainty was inversely correlated to quality of domestic environment. Additionally, for white patients and family, higher levels of uncertainty were related to the importance of God and to lower scores on adult role behavior (shopping, running errands). Uncertainty was related with less active problem solving and less perceived social support for white family members only. (Germino BB, Mishel MH, Belyea M, et al. Uncertainty in prostate cancer. Ethnic and family patterns. Cancer Pract, 1998; 6:107 13.)
Social Support and Perceived Distress
- Dr. Antoni and colleagues examined relationships between distress and perceived availability of social support in Hispanic women being treated for early stage breast cancer. They measured distress and different types (emotional, instrumental) and sources (spouse, women family members, other family members, friends) of support around diagnosis and treatment. Emotional support from friends and instrumental support from spouse at presurgery predicted lower distress postsurgery, and distress at several time points predicted erosion of subsequent support, particularly instrumental support from women in the family. (Alferi SM, Carver CS, Antoni MH, Weiss S, Duran RE. An exploratory study of social support, distress, and life disruption among low-income Hispanic women under treatment for early stage breast cancer. Health Psychol, 2001;20:41-6.)
Initiatives: Minority & Underserved Cancer Survivors
The National Cancer Institute (NCI) awarded $1,063,889 to 6 grantees for a one-year P30 administrative supplement to address minority and underserved cancer survivors in the community
Objectives of the Project:
- Promote research in cancer survivorship among minorities and underserved populations who had returned to their communities after the completion of initial treatment, and/or the families of such patients.
- Strengthen linkages between researchers and community representatives
- Disseminate research findings to targeted community and members of the Cancer Center.
Grantees
| Principal Investigator | Institution | Title | Cancer Site | Geographic Areas | Population |
|---|---|---|---|---|---|
| Martin Abeloff (PI) James Zabora (Project Leader) |
Johns Hopkins Oncology Center | Program for Depression Among Minority Cancer Survivors | All Sites | Baltimore | African American |
| Oliver M. Colvin (PI) Francis Keefe (Project Leader) |
Duke University Cancer Center | Partner-Assisted Coping Skills Training for Prostate Cancer Survivors | Prostate | Rural North Carolina | African American |
| John Crissman (PI) Diane Brown (Project Leader) |
Wayne State University, Karmanos Cancer Institute | Breast Cancer Survivors & Community Support | Breast | Detroit | African American |
| Ronald Herberman (PI) Jan Jernigan (Project Leader) |
University of Pittsburgh Cancer | Follow-Up Care in Breast Cancer Survivors | Breast | Western Pennsylvania | African American |
| John Mendelsohn (PI) Leslie Schover (Project Leader) |
University of Texas, MD Anderson Cancer Center | Reproductive Health in African American Breast Cancer Survivors | Breast | Houston | African American |
| Stephen Prescott (PI) Susan Beck (Project Leader) |
University of Utah, Huntsman Cancer Institute | Experiences of Rural & Urban Elderly Cancer Survivors | All Sites | Utah & Adjacent States | Rural/Urban |
Meeting Summary
In September 2002, the Office of Cancer Survivorship and the Cancer Centers Branch showcased the preliminary findings of five P30 administrative supplements to the Board Meeting of the Intercultural Cancer Council, Houston, Texas. A day-long meeting with NCI program staff, the Project Leaders, Community Representatives, and co-investigators, focused on the strength and weaknesses of the supplement mechanism, barriers to conducting community research, and the aims of the project as perceived by the Community Representatives. The major highlights were:
- At least two years are needed to adequately conduct community research because of the time needed to establish a relationship with the community, address design modifications that arise from community participation, and recruit subjects.
- Cancer Centers need a mechanism to provide timely payment to community organizations for their research assistance/collaboration.
- The most successful subject recruitment appears to use multiple recruitment methods: mass media (radio, television, newspaper), cancer advocate groups, cancer organizations (CIS, ACS, Susan B. Komen), and community organizations (churches, YWCA).
- Projects which include the community organization in the actual planning/writing of the research application appear to have less difficulty with recruiting and retaining subjects. Community representatives perceive the aims of the projects in context of the "bigger picture" of serving cancer survivors, which may, or may not, be stated in the research application.
- All Project Leaders intend on using these pilot studies to support larger NCI grant applications which focus on underserved cancer survivors in the community.
Resources
Organizations
The Intercultural Cancer Council (ICC)
The ICC promotes policies, programs, partnerships, and research to eliminate the unequal burden of cancer among racial and ethnic minorities and medically underserved populations in the United States and its associated territories.
Prevalence
Prevalence of Cancer Survivors by Race, Ethnicity, Gender and Cancer Site
Graphical representations demonstrate prevalence of African American, Hispanic and Asian American cancer survivors. Data on Hispanics and Asian American cancer survivors is a new addition and represents the expansion of additional SEER sites.
