A Weight Loss Intervention for African American Breast Cancer Survivors, 2006 Racial and ethnic differences in health status and health behavior among breast cancer survivors—Behavioral Risk Factor Surveillance System, 2009 Ethnicity and breast cancer: factors influencing differences in incidence and outcome. Efficacy of a Weight Loss Intervention for African American Breast Cancer Survivors. Epidemiology of breast cancer subtypes in two prospective cohort studies of breast cancer survivors Healthy lifestyle intervention for African American uterine cancer survivors: Study protocol Heart Healthy and Ethnically Relevant (HHER) Lifestyle trial for improving diet and physical activity in underserved African American women. Triple Negative Breast Tumors in African-American and Hispanic/Latina Women Are High in CD44+, Low in CD24+, and Have Loss of PTEN A Community-Based Exercise and Support Group Program in African-American Breast Cancer Survivors (ABCs). Associations between null mutations in GSTT1 and GSTM1, the GSTP1 Ile105Val polymorphism, and mortality in breast cancer survivors A breast cancer education and on-site screening intervention for unscreened African American women. Impact of race on breast cancer in lower socioeconomic status women. Correlates of quality of life in overweight or obese breast cancer survivors at enrollment into a weight loss trial. Determinants of head and neck cancer survival by race. Matched-Pair Analysis of Race or Ethnicity in Outcomes of Head and Neck Cancer Patients Receiving Similar Multidisciplinary Care The attitudes, communication, treatment, and support intervention to reduce breast cancer treatment disparity. Engaging African American breast cancer survivors in an intervention trial: culture, responsiveness and community Main outcomes of the FRESH START trial: a sequentially tailored, diet and exercise mailed print intervention among breast and prostate cancer survivors. A Lifestyle Intervention via Email in Minority Breast Cancer Survivors: Randomized Parallel-Group Feasibility Study Health behaviors of cancer survivors: data from an Australian population-based survey The Health of Older-Adult, Long-term Cancer Survivors Culturally appropriate breast health educational intervention program for African-American women. Unintended Effects of Emphasizing Disparities in Cancer Communication to African-Americans
Introduction Breast cancer survival rates are lower for African American women than for white women . Obesity , high-fat diets , and lack of regular physical activity increase risk for breast cancer recurrence , comorbid conditions , and premature death . Eighty-two percent of African American women are overweight or obese , partly because of unhealthy eating and exercise patterns . Although successful weight loss and lifestyle interventions for breast cancer survivors are documented , none has considered the needs of African American breast cancer survivors . This study assessed the feasibility and impact of Moving Forward , a culturally tailored weight loss program for African American breast cancer survivors . Methods The study used a pre-post design with a convenience sample of 23 African American breast cancer survivors . The 6-month intervention was theory-based and incorporated qualitative data from focus groups with the targeted community , urban African American breast cancer survivors .  Data on weight , body mass index ( BMI ) , diet , physical activity , social support , and quality of life were collected at baseline and at 6 months . Results After the intervention , we noted significant differences in weight , BMI , dietary fat intake , vegetable consumption , vigorous physical activity , and social support . Conclusion This is the first published report of Moving Forward , a weight loss intervention design ed for African American breast cancer survivors . Although a r and omized trial is needed to establish efficacy , the positive results of this intervention suggest that this weight loss intervention may be feasible for African American breast cancer survivors . Lifestyle interventions may reduce the disparities in breast cancer mortality rates Purpose Differences in health status and behavioral risk factors may explain racial/ethnic breast cancer disparities . We examined racial/ethnic differences in health status and behaviors among female breast cancer survivors compared to females without breast cancer . Methods Using cross-sectional data from the 2009 Behavioral Risk Factor Surveillance System , a national state-based , r and om sample telephone survey , we explored differences in self-rated health , obesity and selected behaviors ( physical activity , smoking , alcohol use , fruit , and vegetable consumption ) among females aged 18 years and older , who reported a previous breast cancer diagnosis ( survivors , n = 10,035 ) and those who reported no breast cancer history ( n = 234,375 ) by race/ethnicity . Adjusted prevalences of health status and behaviors , accounting for sociodemographics , comorbidities and health care access , were estimated by race/ethnicity . Results Compared to all other racial/ethnic groups , more white females reported heavy alcohol consumption and more black females reported obesity regardless of their breast cancer status . Among breast cancer survivors , more whites ( 33.7 % ) were former smokers compared to blacks ( 24.5 % ) , “ others ” ( 20.5 % ) , and Hispanics ( 16.2 % ) ( p = 0.001 ) . Racial/ethnic differences in obesity also varied by reported time since diagnosis ( p value = 0.018 ) . Among long-term survivors ( diagnosed > 5 years before interview ) , more black survivors ( 34.8 % ) reported obesity compared to white survivors ( 23.0 % ) . Also , among “ other ” race survivors , long-term survivors ( 22.0 % ) reported more obesity than survivors diagnosed less than 5 years before interview ( 7.8 % ) . Conclusions These findings suggest opportunities to increase health behaviors and reduce racial disparities among breast cancer survivors . Implication s for Cancer SurvivorsEngaging in healthy behaviors can play a significant role in enhancing health outcomes and quality of life of breast cancer survivors . More research is needed to better underst and racial differences in obesity , smoking and alcohol consumption in order to develop effective , culturally appropriate interventions to promote a healthy lifestyle after a breast cancer diagnosis BACKGROUND The lower breast cancer incidence in minority women and the higher breast cancer mortality in African American women than in white women are largely unexplained . The influence of breast cancer risk factors on these differences has received little attention . METHODS Racial/ethnic differences in breast cancer incidence and outcome were examined in 156,570 postmenopausal women participating in the Women 's Health Initiative . Detailed information on breast cancer risk factors including mammography was collected , and participants were followed prospect ively for breast cancer incidence , pathological breast cancer characteristics , and breast cancer mortality . Comparisons of breast cancer incidence and mortality across racial/ethnic groups were estimated as hazard ratios ( HRs ) and 95 % confidence intervals ( CIs ) from Cox proportional hazard models . Tumor characteristics were compared as odds ratios ( ORs ) and 95 % confidence intervals in logistic regression models . RESULTS After median follow-up of 6.3 years , 3938 breast cancers were diagnosed .  Age-adjusted incidences for all minority groups ( i.e. , African American , Hispanic , American Indian/Alaskan Native , and Asian/Pacific Isl and er ) were lower than for white women , but adjustment for breast cancer risk factors accounted for the differences for all but African Americans ( HR = 0.75 , 95 % CI = 0.61 to 0.92 ) corresponding to 29 cases and 44 cases per 10,000 person years for African American and white women , respectively . Breast cancers in African American women had unfavorable characteristics ; 32 % of those in African Americans but only 10 % in whites were both high grade and estrogen receptor negative ( adjusted OR = 4.70 , 95 % CI = 3.12 to 7.09 ) . Moreover , after adjustment for prognostic factors , African American women had higher mortality after breast cancer than white women ( HR = 1.79 , 95 % CI = 1.05 to 3.05 ) corresponding to nine and six deaths per 10 000 person-years from diagnosis in African American and white women , respectively . CONCLUSION Differences in breast cancer incidence rates between most racial/ethnic groups were largely explained by risk factor distribution except in African Americans . However , breast cancers in African American women more commonly had characteristics of poor prognosis , which may contribute to their increased mortality after diagnosis Purpose African American women with breast cancer have higher cancer-specific and overall mortality rates . Obesity is common among African American women and contributes to breast cancer progression and numerous chronic conditions . Weight loss interventions among breast cancer survivors positively affect weight , behavior , biomarkers , and psychosocial outcomes , yet few target African Americans . This article examines the effects of Moving Forward , a weight loss intervention for African American breast cancer survivors ( AABCS ) on weight , body composition , and behavior . Patients and Methods Early-stage ( I-III ) AABCS were r and omly assigned to a 6-month interventionist-guided ( n = 125 ) or self-guided ( n = 121 ) weight loss program supporting behavioral changes to promote a 5 % weight loss .  Anthropometric , body composition , and behavioral data were collected at baseline , postintervention ( 6 months ) , and follow-up ( 12 months ) . Descriptive statistics and mixed models analyses assessed differences between groups over time . Results Mean ( ± st and ard deviation ) age , and body mass index were 57.5 ( ± 10.1 ) years and 36.1 ( ± 6.2 ) kg/m2 , respectively , and 82 % had stage I or II breast cancer . Both groups lost weight . Mean and percentage of weight loss were greater in the guided versus self-guided group ( at 6 months : 3.5 kg v 1.3 kg ; P < .001 ; 3.6 % v 1.4 % ; P < .001 , respectively ; at 12 months : 2.7 kg v 1.6 kg ; P < .05 ; 2.6 % v 1.6 % ; P < .05 , respectively ) ; 44 % in the guided group and 19 % in the self-guided group met the 5 % goal . Body composition and behavioral changes were also greater in the interventionist-guided group at both time points . Conclusion The study supports the efficacy of a community-based interventionist-guided weight loss program targeting AABCS .  Although mean weight loss did not reach the targeted 5 % , the mean loss of > 3 % at 6 months is associated with improved health outcomes . Affordable , accessible health promotion programs represent a critical re source for AABCS Introduction The aim of this study was to describe breast tumor subtypes by common breast cancer risk factors and to determine correlates of subtypes using baseline data from two pooled prospect i ve breast cancer studies within a large health maintenance organization . Methods Tumor data on 2544 invasive breast cancer cases subtyped by estrogen receptor , progesterone receptor , and human epidermal growth factor receptor 2 ( Her2 ) status were obtained ( 1868 luminal A tumors , 294 luminal B tumors , 288 triple-negative tumors and 94 Her2-overexpressing tumors ) . Demographic , reproductive and lifestyle information was collected either in person or by mailed question naires .  Case-only odds ratios ( ORs ) and 95 % confidence intervals ( CIs ) were estimated using logistic regression , adjusting for age at diagnosis , race/ethnicity , and study origin . Results Compared with luminal A cases , luminal B cases were more likely to be younger at diagnosis ( P = 0.0001 ) and were less likely to consume alcohol ( OR = 0.74 , 95 % CI = 0.56 to 0.98 ) , use hormone replacement therapy ( HRT ) ( OR = 0.66 , 95 % CI = 0.46 to 0.94 ) , and oral contraceptives ( OR = 0.73 , 95 % CI = 0.55 to 0.96 ) . Compared with luminal A cases , triple-negative cases tended to be younger at diagnosis ( P ≤ 0.0001 ) and African American ( OR = 3.14 , 95 % CI = 2.12 to 4.16 ) , were more likely to have not breastfed if they had parity greater than or equal to three ( OR = 1.68 , 95 % CI = 1.00 to 2.81 ) , and were more likely to be overweight ( OR = 1.82 , 95 % CI = 1.03 to 3.24 ) or obese ( OR = 1.97 , 95 % CI = 1.03 to 3.77 ) if premenopausal . Her2-overexpressing cases were more likely to be younger at diagnosis ( P = 0.03 ) and Hispanic ( OR = 2.19 , 95 % CI = 1.16 to 4.13 ) or Asian ( OR = 2.02 , 95 % CI = 1.05 to 3.88 ) , and less likely to use HRT ( OR = 0.45 , 95 % CI = 0.26 to 0.79 ) . Conclusions These observations suggest that investigators should consider tumor heterogeneity in associations with traditional breast cancer risk factors . Important modifiable lifestyle factors that may be related to the development of a specific tumor subtype , but not all subtypes , include obesity , breastfeeding , and alcohol consumption . Future work that will further categorize triple-negative cases into basal and non-basal tumors may help to eluci date these associations further Background Cancer of the uterine corpus is the most common gynecologic malignancy and the fourth most common cancer in U.S. women . There is a racial disparity in the survival from endometrial cancer and this may be addressed by culturally-tailored lifestyle interventions to help African American ( AA ) endometrial cancer survivors lose weight or maintain a healthy weight . Objective The overall purpose of this pilot study is to develop and evaluate a culturally-tailored lifestyle intervention to help AA uterine cancer survivors reduce their risk of cancer recurrence and improve their quality of life through healthy eating , physical activity , and weight management . While many interventions have been evaluated to assist cancer survivors through diet and physical activity , few have focused on AA women with a uterine cancer diagnosis . Methods Community-engaged research principles are being followed . This study was developed with input from the Augusta University ( AU ) College of Nursing Community Advisory Board ( CAB ) and the Division of Gynecologic Oncology at the Georgia Cancer Center at AU . Weekly sessions throughout a 12-week intervention will include physical activity and lectures on improving nutritional status . The pre/post-test design includes baseline and 6-month follow-up , where participants will complete a question naire that assesses knowledge and attitudes about physical activity , nutrition , uterine cancer , social support , and quality of life . Conclusions From this pilot study , we will learn more about the feasibility and integration of healthy lifestyle interventions in this patient population , and the results can provide an opportunity for a larger-scale , multi-center study with a r and omized controlled design BACKGROUND African American women are at increased risk for CVD morbidity and mortality relative to white women . Physical inactivity and poor dietary habits are modifiable health behaviors shown to reduce CVD risk . Community health centers have the potential to reach large numbers of African Americans to modify their risk for CVD , yet few lifestyle counseling interventions have been conducted in this setting . METHODS The HHER Lifestyle trial is a r and omized controlled trial to compare the effects of a st and ard care intervention ( provider counseling , nurse goal setting , and educational material s ) to a comprehensive intervention ( st and ard care intervention plus 12 months of telephone counseling and tailored print material s ) on changes in physical activity and dietary fat consumption in financially disadvantaged African American women at 6 and 12 months . Secondary outcomes are body mass index , central adiposity , and total cholesterol . Potential mediators of outcome are self-efficacy for overcoming barriers , social support , and decisional balance . RESULTS African American women ( N=266 ; 130 st and ard care , 136 comprehensive intervention ) 35 years and older from nine clinics within two community health centers were enrolled . Most participants were overweight or obese with existing chronic health conditions . CONCLUSION The HHER Lifestyle trial is unique in that it targets financially disadvantaged African American women from community health centers , incorporates a st and ard care intervention into a routine clinical appointment , and includes a comprehensive process evaluation . The design will permit further research examining the added effect of regular telephone counseling and tailored print material s to a primary care provider and nurse intervention Background African-American women have higher mortality from breast cancer than other ethnic groups . The association between poor survival and differences with tumor phenotypes is not well understood . The purpose of this study is to assess the clinical significance of ( 1 ) Stem cell-like markers CD44 and CD24 ; ( 2 ) PI3K/Akt pathway associated targets PTEN , activation of Akt , and FOXO1 ; and ( 3 ) the Insulin-like growth factor-1 ( IGF-I ) and IGF binding protein-3 ( IGFBP3 ) in different breast cancer subtypes , and compare the differences between African-American and Hispanic/Latina women who have similar social-economic-status . Methods A total of N=318 African-American and Hispanic/Latina women , with clinical ly-annotated information within the inclusion criteria were included .  Formalin fixed paraffin embedded tissues from these patients were tested for the different markers using immunohistochemistry techniques . Kaplan-Meier survival-curves and Cox-regression analyses were used to assess Relative Risk and Disease-Free-Survival ( DFS ) . Results The triple-negative-breast-cancer ( TNBC ) receptor-subtype was more prevalent among premenopausal women , and the Hormonal Receptor ( HR ) positive subtype was most common overall . TNBC tumors were more likely to have loss of PTEN , express high Ki67 , and have increased CD44+/CD24- expression . TNBC was also associated with higher plasma-IGF-I levels . HR-/HER2 + tumors showed high pAkt , decreased FOXO1 , and high CD24 + expression . The loss of PTEN impacted DFS significantly in African Americans , but not in Hispanics/Latinas after adjusted for treatment and other tumor pathological factors . The CD44+/CD24- and CD24+/CD44- phenotypes decreased DFS , but were not independent predictors for DFS . HER2-positive and TNBC type of cancers continued to exhibit significant decrease in DFS after adjusting for the selected biomarkers and treatment . Conclusions TNBC incidence is high among African-American and Hispanic/Latino women residing in South Los Angeles . Our study also shows for the first time that TNBC was significantly associated with PTEN loss , high Ki67 and the CD44+/CD24- phenotype . The loss of PTEN impacts DFS significantly in African Americans African-American ( AA ) women have higher rates of breast cancer ( BCa ) mortality than Caucasian women , and a recent study using data from the Surveillance , Epidemiology and End Results ( SEER ) registry suggests that this disparity may be due , in part , to the poorer health status of AAs at diagnosis and not treatment related issues . R and omized controlled trials involving supervised aerobic and resistance exercise have shown improved body composition and improvement in cancer-related biomarkers in BCa patients and may lead to improved recurrence and survival rates ; however , most trials have focused on Caucasians and many have been conducted in academic- and clinic-based setting s. We evaluated the feasibility of conducting a 20-week , supervised , resistance training , group exercise intervention coupled with a support group and home walking program utilizing facilities and personnel at a community cancer support center ( The Gathering Place , Beachwood , Ohio ) in AA Stage I-III BCa survivors who were within 12 months of completing treatment ( surgery , chemotherapy , and /or breast irradiation )  ; and , evaluated the potential effects of this intervention on physical measures and cancer-related biomarkers . 27 patients provided informed consent and 19 participated in the program . On average , attendance rates were 70.0 % ± 19.1 % for the exercise sessions and 63.1 % ± 13.8 % for the support group . We observed a significant decrease in circulating C-peptide levels ( B : 893.9 ± 399.1 pg/mL ; EOI : 723.9 ± 319.0 pg/mL ; p=0.01 ) . Although we did not observe a significant decrease in weight in the entire sample , there was a significant decrease in waist circumference and percent total body fat among those who attended 70 % or more of the exercise sessions . In summary , we demonstrated that conducting lifestyle interventions in AA BCa survivors in a community setting is feasible . Future interventions should invoke strategies to enhance adherence and include a structured dietary intervention to enable greater weight loss Purpose Here we assessed associations between null mutations in glutathione-S-transferase (GST)T1 and GSTM1 genes , and the rs1695 polymorphism in GSTP1 ( Ile105Val ) , and risk of breast cancer-specific ( n=45 ) and all-cause ( n=99 ) mortality in a multiethnic , prospect i ve cohort of 533 women diagnosed with stage I-IIIA breast cancer in 1995–1999 , enrolled in the Health , Eating , Activity , and Lifestyle ( HEAL ) Study . Methods We measured the presence of the null mutation in GSTT1 and GSTM1 , and the rs1695 polymorphism in GSTP1 by polymerase chain reaction . We assessed associations between breast-cancer specific and all-cause mortality using Cox proportional hazards models . Results Participants with ER-negative tumors were more likely to be GSTT1 null ( χ2=4.52 ; P=0.03 ) , and African American women were more likely to be GSTM1 null ( χ2=34.36 ; P<0.0001 ) . Neither GSTM1 nor GSTT1 null mutations were associated with breast cancer-specific or all-cause mortality . In a model adjusted for body mass index , race/ethnicity , tumor stage and treatment received at diagnosis , the variant Val allele of rs1695 was associated with increased risk of all-cause ( HR=1.81 , 95 % CI 1.16 - 2.82 , P=0.008 ) , but not breast cancer-specific mortality . The GSTT1 null mutation was associated with significantly higher levels of C-reactive protein . Conclusions GSTM1 and GSTT1 null genotypes had no effect on outcome ; however the variant allele of rs1695 appears to confer increased risk for all-cause mortality in breast-cancer survivors . Given the limited sample size of most studies examining associations between GST polymorphisms with breast cancer survival , and the lack of women undergoing more contemporary treatment protocol s ( treated prior to 1999 ) , it may be helpful to re-examine this issue among larger sample s of women diagnosed after the late 1990s , who all received some form of chemotherapy or radiotherapy BACKGROUND This study tested a breast cancer education intervention for African American women with poor screening histories . Disparities in rates of later-stage disease and death may be related to lower screening rates due to behavioral ( e.g. , knowledge gap ) and structural ( e.g. , access ) barriers . METHODS 94 African American women ( low-income , poor screening histories ) were r and omly assigned for an educational and on-site screening intervention , or non-intervention status . Primary care sites were used for educational purpose s. Three-month post-intervention  mammography  was assessed . RESULTS The intervention group had significantly higher screening rates than the non-intervention group . The latter had a knowledge gap , poor screening history , cancer fears , and insurance differences relative to the screened women . Screening was predicted by behavioral , rather than structural factors . CONCLUSIONS Since low-income African American women face behavioral and structural barriers to breast cancer screening , an educational program that improves knowledge levels and is offered in primary care sites can effectively impact screening Lower socioeconomic status and lack of access to care are often implicated as plausible causes for African American women to present with later stage breast cancer than Caucasian women . Our objective is to determine if racial differences are present in newly diagnosed breast cancer in women of equivalent socioeconomic status . A retrospective review of prospect ively gathered data from women with newly diagnosed breast cancer was performed . All women presented to the indigent ( uninsured and below the poverty line ) breast clinic for evaluation and treatment of their breast pathology . Data pertaining to epidemiologic factors , diagnosis , pathology , and treatment were collected . The data were analyzed by chi-squared and tailed t-tests . Between March 2002 and May 2004 , 52 women ( African American=36 , Caucasian=16 ) were diagnosed with breast cancer at our clinic . The median age for both groups at presentation was 56.6 years . The staging assessment based on the pathologic size of the tumor was also equivalent between African American and Caucasian women at 2.29 cm and 2.21 cm , respectively . Metastatic lymph node involvement occurred in 14 women ( African American=7 , Caucasian=7 ) , with 19.4 % African American and 43.8 % Caucasian being node positive ( p=0.068 ) . In fact , there were no statistically significant differences between the races for menarche , menopause , body mass index ( BMI ) , duration of symptoms before presentation , type of diagnostic biopsy or surgery chosen , histology , receptor status , utilization of chemotherapy and radiation , and length of follow-up . The only statistical differences found were in the age of the first live birth ( African American=19 , Caucasian=22 ; p=0.028 ) , the use of ultrasound in initial evaluation of a breast mass ( less use in African American ; p=0.012 ) , and utilization of sentinel lymph node biopsy  ( Caucasian=75 % , African American=42 % ; p=0.026 ) . Breast cancer in African American women traditionally presents at a more advanced stage and with poor prognostic features . However , when matched for lower socioeconomic status , racial disparities essentially disappear OBJECTIVE The purpose of this analysis was to examine the correlates of the physical and psychosocial domains of quality of life ( QOL ) in a cohort of breast cancer survivors participating in a weight loss intervention trial . METHODS Correlates of QOL and psychosocial functioning were examined in 692 overweight or obese breast cancer survivors at entry into a weight loss trial .  QOL was explored with three measures :  Short-form 36 ( SF-36 ) , Impact of Cancer scale ( IOC ) , and the Breast Cancer Prevention Trial ( BCPT ) symptom scales .  Available data included information on weight and physical activity , as well as demographic and medical characteristics . Multivariate analyses were used to identify associations adjusted for other characteristics . RESULTS In multivariate analysis , younger age was associated with higher negative impact scores ( p < 0.0001 ) . Hispanic , African-American , and Asian women had higher positive IOC impact scores compared with White non-Hispanic women ( p < 0.01 ) . Increased number of comorbidities was associated with lower physical and mental QOL scores ( p < 0.01 ) . Body mass index was not independently associated with QOL measures . Physical activity was directly associated with physical and mental QOL and IOC positive impact , and inversely related to IOC negative impact and Breast Cancer Prevention Trial symptom scales . CONCLUSIONS Quality -of-life measures in breast cancer survivors are differentially associated with demographic and other characteristics . When adjusted for these characteristics , degree of adiposity among overweight or obese women does not appear to be independently associated with QOL . Among overweight or obese breast cancer survivors , higher level of physical activity is associated with higher QOL across various scales and dimensions BACKGROUND Several factors contribute to the documented racial disparity in head and neck cancer , among which are socioeconomic status , access to care , and biologic factors . METHODS Clinical characteristics of 87 African-American patients with head and neck cancer and a r and om sample of 261 white patients matched on age and smoking dose were associated with outcome . RESULTS Black patients with cancers of the oral cavity and larynx were more likely diagnosed with advanced stages than whites , after adjusting for socioeconomic and insurance status and other confounding factors . There was a significant difference in relapse-free survival between blacks and whites with tumors of the larynx ( hazard ratio [ HR ] = 3.36 , 95 % confidence interval [ CI ] : 1.62 - 7.00 ) , but not with tumors of the oral cavity or pharynx . CONCLUSIONS Differences in disease outcome may be attributed to a combination of tumor stage , socioeconomic status , and access to health care . The inclusion of biologic markers such as human papillomavirus ( HPV ) status is needed in future studies to further evaluate racial disparities in head and neck cancer outcomes It is unknown whether population -level racial or ethnic disparities in mortality from squamous cell carcinoma of the head and neck ( SCCHN ) also occur in the setting of st and ardized multidisciplinary-team directed care . Therefore , we conducted a matched-pair study that controlled for several potentially confounding prognostic variables to assess whether a difference in survival exists for African American or Hispanic American compared with non-Hispanic white American SCCHN patients receiving similar care . Matched pairs were 81 African American case and 81 non-Hispanic white control patients and 100 Hispanic American cases and 100 matched non-Hispanic white controls selected from 1,833 patients of a prospect i ve epidemiologic study of incident SCCHN within a single , large multidisciplinary cancer center . Matching variables included age ( ±10 years ) , sex , smoking status ( never versus ever ) , site , tumor stage ( T1 - 2 versus T3 - 4 ) , nodal status ( negative versus positive ) , and treatment . Cases and controls were not significantly different in proportions of comorbidity score , alcohol use , subsite distribution , overall stage , or tumor grade . Matched-pair and log-rank analyses showed no significant differences between cases and controls in recurrence-free , disease-specific , or overall survival . Site-specific analyses suggested that more aggressive oropharyngeal cancers occurred more frequently in minority than in non-Hispanic white patients . We conclude that minority and non-Hispanic white SCCHN patients receiving similar multidisciplinary-team directed care at a tertiary cancer center have similar survival results overall . These results encourage reducing health disparities in SCCHN through public-health efforts to improve access to multidisciplinary oncologic care ( and to preventive measures ) and through individual clinician efforts to make the best multidisciplinary cancer treatment choices available for their minority patients . The subgroup finding suggests a biologically based racial/ethnic disparity among oropharyngeal patients and that prevention and treatment strategies should be tailored to different population s of these patients PURPOSE / OBJECTIVES to test the effect of a supportive , one-time psychoeducational intervention on treatment adherence among African American women receiving first adjuvant therapy for breast cancer . DESIGN a pilot , r and omized , controlled clinical trial , two-group design , with one-time intervention and four data collection points . SETTING two University of Pittsburgh Cancer Institute clinics . SAMPLE 24 African American women . METHODS the Attitudes , Communication , Treatment , and Support ( ACTS ) intervention is a 45-minute one-on-one session with an African American woman recommended to have chemotherapy for breast cancer . The interventionist is an African American breast cancer survivor . The intervention consists of a discussion about chemotherapy and the importance of communicating knowledge needs and distress , an explanation of the specific treatment plan according to pathology , and support through the survivor testimonial and video clips from the African American community . MAIN RESEARCH VARIABLES dose of chemotherapy received and dose of chemotherapy prescribed . FINDINGS Twenty patients completed chemotherapy , and four chose not to begin or discontinued recommended chemotherapy . The groups were equal in key sociodemographic variables . Compared to usual care , the ACTS intervention participants demonstrated trends toward initiation of chemotherapy ( 100 % versus 82 % ) , overall adherence to chemotherapy ( 92 % versus 73 % ) , and percentage of total dose of chemotherapy received or prescribed ( 94 % versus 74 % ) . Compared to usual care , the ACTS intervention participants demonstrated more rapid initiation of chemotherapy and better overall adherence to chemotherapy . CONCLUSIONS the pilot ACTS intervention shows promise as a psychoeducational intervention to assist with chemotherapy decision making among African American women . IMPLICATION S FOR NURSING African American women are at high risk of not receiving the full dose of prescribed chemotherapy for breast cancer for multiple reasons . Nurses must be sensitive to the unique fears and concerns of this population regarding chemotherapy decisions . An intervention addressing these fears and concerns may help to increase adherence Introduction Younger breast cancer survivors often lead extremely busy lives with multiple dem and s and responsibilities , making them difficult to recruit into clinical trials . African American women are even more difficult to recruit because of additional historical and cultural barriers . In a r and omized clinical trial of an intervention , we successfully used culturally informed , population -specific recruitment and retention strategies to engage younger African-American breast cancer survivors . Methods Caucasian and African American breast cancer survivors were recruited from multiple communities and sites . A variety of planned recruitment and retention strategies addressed cultural and population -specific barriers and were guided by three key principals : increasing familiarity with the study in the communities of interest ; increasing the availability and accessibility of study information and study participation ; and using cultural brokers . Results Accrual of younger African-American breast cancer survivors increased by 373 % in 11 months . The steepest rise in the numbers of African-American women recruited came when all strategies were in place and operating simultaneously . Retention rates were 87 % for both Caucasian and African American women . Discusssion/ Conclusions To successfully recruit busy , younger African American cancer survivors , it is important to use a multifaceted approach , addressing cultural and racial/ethnic barriers to research participation ; bridging gaps across cultures and communities ; including the role of faith and beliefs in considering research participation ; recognizing the dem and s of different life stages and economic situations and the place of research in the larger picture of peoples ’ lives . Design s for recruitment and retention need to be broadly conceptualized and specifically applied . Implication s for Cancer SurvivorsFor busy cancer survivors , willingness to participate in and complete research participation is enhanced by strategies that address barriers but also acknowledge the many dem and s on their time by making research familiar , available , accessible and credible PURPOSE Cancer survivors are at increased risk for cardiovascular disease , diabetes , osteoporosis , and second primary tumors . Healthful lifestyle practice s may improve the health and well-being of survivors . The FRESH START trial tested the efficacy of sequentially tailored versus st and ardized mailed material s on improving cancer survivors ' diet and exercise behaviors . METHODS Five hundred forty-three individuals with newly diagnosed locoregional breast or prostate cancer were recruited from 39 states and two provinces within North America . Participants were r and omly assigned either to a 10-month program of tailored mailed print material s promoting fruit and vegetable ( F&V ) consumption , reducing total/saturated fat intake , and /or increasing exercise or to a 10-month program of nontailored mailed material s on diet and exercise available in the public domain . Telephone surveys conducted at baseline and 1 year assessed body mass index ( BMI ) , dietary consumption , physical activity , and other psychosocial/behavioral indices . Clinical assessment s were conducted on a 23 % sub sample ; information was used to vali date self-reports . RESULTS Five hundred nineteen participants completed the 1-year follow-up ( 4.4 % attrition ; sample characteristics : 57 + /- 10.8 years old , 83 % white , 56 % female , 64 % overweight/obese , and 0 % underweight ) . Although both arms significantly improved their lifestyle behaviors ( P < .05 ) , significantly greater gains occurred in the FRESH START intervention versus the control arm ( practice of two or more goal behaviors : + 34 % v + 18 % , P < .0001 ; exercise minutes per week : + 59.3 v + 39.2 minutes , P = .02 ; F&V per day : + 1.1 v + 0.6 servings , P = .01 ; total fat : -4.4 % v -2.1 % , P < .0001 ; saturated fat : -1.3 % v -0.3 % , P < .0001 ; and BMI : -0.3 v + 0.1 kg/m2 , respectively , P = .004 ) . CONCLUSION Mailed material interventions , especially those that are tailored , are effective in promoting healthful lifestyle changes among cancer survivors . Further study is needed to determine sustainability , cost to benefit , and generalizability to other cancer population Background Our data have indicated that minority breast cancer survivors are receptive to participating in lifestyle interventions delivered via email or the Web , yet few Web-based studies exist in this population . Objective The aim of this study was to examine the feasibility and preliminary results of an email-delivered diet and activity intervention program , “ A Lifestyle Intervention Via Email ( ALIVE ) , ” delivered to a sample of racial and ethnic minority breast cancer survivors . Methods Survivors ( mean age : 52 years , 83 % [ 59/71 ] African American ) were recruited and r and omized to receive either the ALIVE program ’s 3-month physical activity track or its 3-month dietary track . The fully automated system provided tools for self-monitoring and goal setting , tailored content , and automated phone calls . Descriptive statistics and mixed-effects models were computed to examine the outcomes of the study . Results Upon completion , 44 of 71 survivors completed the study . Our “ intention-to-treat ” analysis revealed that participants in the physical activity track made greater improvements in moderate to vigorous activity than those in the dietary track ( + 97 vs. + 49 min/week , P<.001 ) . Similarly , reductions in total sedentary time among those in the physical activity track ( −304 vs. −59 min/week , P<.001 ) was nearly 5 times greater than that for participants in the dietary track . Our completers case analysis indicated that participants in the dietary track made improvements in the intake of fiber ( + 4.4 g/day ) , fruits and vegetables ( + 1.0 cup equivalents/day ) , and reductions in saturated fat ( −2.3 g/day ) and trans fat ( −0.3 g/day ) ( all P<.05 ) . However , these improvements in dietary intake were not significantly different from the changes observed by participants in the physical activity track ( all P>.05 ) . Process evaluation data indicated that most survivors would recommend ALIVE to other cancer survivors ( 97 % ) , were satisfied with ALIVE ( 82 % ) , and felt that ALIVE was effective ( 73 % ) . However , survivors expressed concerns about the functionality of the interactive emails . Conclusions ALIVE appears to be feasible for racial and ethnic minority cancer survivors and showed promising results for larger implementation . Although survivors favored the educational content , a mobile phone app and interactive emails that work on multiple email domains may help to boost adherence rates and to improve satisfaction with the Web-based platform . Trial Registration Clinical Trials.gov NCT02722850 ; https:// clinical trials.gov/ct2/show/NCT02722850 ( Archived by WebCite at http://www.webcitation.org/6tHN9VsPh Objective With increases in cancer survival , promotion of healthy lifestyle behaviors among survivors is receiving considerable attention . This study compared health behaviors among a large sample of Australian adult cancer survivors with an age- and sex-matched cohort of people with no cancer history . Methods Using the Australian National Health Survey , 968 cancer survivors were identified , and r and omly matched by age and sex to 5,808 respondents without a history of cancer . Six health behaviors were compared  ( smoking , physical activity , servings of vegetables , servings of fruit , alcohol use , skin checks )  , along with  overweight and obesity , using polytomous logistic regression analyses controlling for selected chronic conditions . Models were applied across both groups and by tumor site . Results Compared to the non-cancer comparison group , cancer survivors were significantly more likely to be current ( OR = 1.35 ) smokers , particularly those under 40 years ( OR = 1.69 ) , and more likely to have regular skin checks ( OR = 1.76 ) . Although not significant , there was consistent evidence that cancer survivors were slightly more likely to be overweight or obese ( p = 0.065 ) and have higher levels of alcohol consumption ( p = 0.088 ) . There was no evidence of differences between survivors and controls for levels of physical inactivity , vegetable consumption or fruit consumption .  Women with a history of gynecological cancers were much more likely to be current smokers ( OR = 2.37 ) , while other differences by sex and cancer site were consistent with overall patterns . Cancer survivors were also significantly more likely to report having a range of co-morbid chronic medical conditions . Conclusion Given their increased risk of second cancers and co-morbid chronic conditions , the lack of difference in behavioral risk factors confirms the need for a focus on improving the health behaviors of cancer survivors . Collaborative chronic disease management models may be particularly appropriate in this regard Research indicates that cancer-related health problems persist for decades among survivors . The combination of late effects of cancer or its treatment and age-related health problems may add to the vulnerability of older survivors . This research reports on the health and functioning of a sample of long-term ( 5+years ) , older-adult ( > 60 years ) survivors of breast , prostate , and colorectal cancer . Data were derived from 321 in-person interviews with a sample r and omly selected from a tumor registry at a comprehensive cancer center . Descriptive data analyzed comorbid health conditions and continued cancer symptoms reported by survivors . Correlational analysis examined the association among demographic cancer-related factors and a range of health quality -of-life outcomes , including functioning and illness impact . Nearly 40 % of respondents have at least 1 symptom attributed to cancer/treatment .  Pain was the most commonly reported symptom , with 21 % attributing it to cancer . More than 40 % of breast cancer survivors and nearly 20 % of prostate cancer survivors reported pain . Being African American or female was significantly associated with more current symptoms and greater functional difficulty .  Survivors who had chemotherapy and survivors with more types of treatment  reported significantly more symptoms both during treatment and currently . Many older-adult survivors are more vulnerable due to both cancer-related symptoms and comorbid health conditions . Women and African Americans are at special risk . This combined vulnerability is an important factor for clinicians treating long-term survivors The purpose of this study was to provide a culturally specific intervention program for African-American women to alter selected behavioral risk factors , psychosocial responses , and breast self-care variables . Two primary directional hypotheses were tested with an alpha set at 0.05 . These hypotheses were : ( 1 ) a Culturally Appropriate Breast Educational Intervention Program ( CABHEIP ) will lower selected behavioral risk factors ( high fat intake , inadequate amount of physical activity , inadequate fiber intake ) and selected psychosocial responses ( perceived stress , negative coping , low self-efficacy , perceived barriers to Breast Self Examination [ BSE ] and Clinical Breast Examination [ CBE ] ) in African-American women , 20 to 40 years of age , who participate in the program as compared to whose who do not participate ; and ( 2 ) a CABHEIP will raise compliance with BSE , proficiency of BSE , and perceived benefits of BSE and CBE in African-American women , 20 to 40 years of age , who participate in the program as compared to those who do not participate . A sample of 120 ( N = 120 ) African-American women was r and omly assigned to the control and treatment groups ( 60 women per group ; ( n = 60 intervention group ; n = 60 attention control group ) . The sample was obtained from a population of African-American women from four southern and three central Mississippi counties . The intervention group , in clusters of 3 to 9 women , received education on breast cancer , breast self-exams , healthy eating , exercise , and stress management ; and heard stories from breast cancer survivors . The attention control group , in clusters of 3 to 8 women , received education on poison control in the home environment . Data was collected and analyzed using descriptive statistics , correlation coefficients , and repeated measures of analysis of covariance ( ANCOVA ) controlling for covariates . Significant differences between groups for BSE proficiency I ( p < 0.0001 ) , BSE proficiency II ( p = 0.013 ) , and benefit BSE ( p = 0.053 ) were found . Compliance for BSE approached significance between groups ( p = 0.053 ) . Significance to nursing is that education can change outcomes in health promotion for breast cancer in African-American women . Further studies with similar interventions and larger sample sizes are needed to determine other avenues to decrease modifiable risk factors for breast cancer in African-American women Little is known about how minority groups react to public information that highlights racial disparities in cancer . This double-blind r and omized study compared emotional and behavioral reactions to four versions of the same colon cancer ( CRC ) information presented in mock news articles to a community sample of African-American adults ( n = 300 ) . Participants read one of four articles that varied in their framing and interpretation of race-specific CRC mortality data , emphasizing impact ( CRC is an important problem for African-Americans ) , two dimensions of disparity ( Blacks are doing worse than Whites and Blacks are improving , but less than Whites ) , or progress ( Blacks are improving over time ) . Participants exposed to disparity articles reported more negative emotional reactions to the information and were less likely to want to be screened for CRC than those in other groups ( both P < 0.001 ) . In contrast , progress articles elicited more positive emotional reactions and participants were more likely to want to be screened . Moreover , negative emotional reaction seemed to mediate the influence of message type on individuals wanting to be screened for CRC . Overall , these results suggest that the way in which disparity research is reported in the medium can influence public attitudes and intentions , with reports about progress yielding a more positive effect on intention . This seems especially important among those with high levels of medical mistrust who are least likely to use the health care system and are thus the primary target of health promotion advertising . ( Cancer Epidemiol Biomarkers Prev 2008;17(11):2946–53
Conclusions : The available literature suggests that African American breast cancer survivors adhere to interventions of various modalities and are capable of making modest to significant changes .
Background : African American breast cancer survivors have a higher incidence of estrogen receptor negative and basal-like ( e.g. , triple negative ) tumors , placing them at greater risk for poorer survival when compared to women of other racial and ethnic groups .
While access to equitable care , late disease stage at diagnosis , tumor biology , and sociodemographic characteristics contribute to health disparities , poor lifestyle characteristics ( i.e. , inactivity , obesity , and poor diet ) contribute equally to these disparities .
Lifestyle interventions hold promise in shielding African American survivors from second cancers , comorbidities , and premature mortality , but they are often underrepresented in studies promoting positive behaviors .
This review examined the available literature to document health behaviors and lifestyle intervention ( i.e. , obesity , physical activity , and sedentary behavior ) studies in African American breast cancer survivors .