Abstract B12: Improving quality of life among Latina breast cancer survivors using the “Staying Healthy” program
Authors: Munoz Edgar , Santillan-Gomez Alfredo A. , Sintes-Yallen Amanda , Gallion Kipling , Ramirez Amelie G. 
Published: October 2015

For Latina women, breast cancer is the leading cancer and we expect this trend to continue as the US Hispanic population expands. Latinas generally have lower survival rates for most cancers, even after accounting for differences in age and stage distribution, which may reflect less access to timely, high-quality treatment. Despite these challenges observed among Latina breast cancer survivors (BCS), there is very limited knowledge of survivorship-related issues and priorities among Latinas, specifically the effectiveness of using patient navigators (PN) to link Latina BCS with unmet psychosocial needs to appropriate psychosocial services, screening, risk reduction services and treatment follow-up.

Methods: The Institute for Health Promotion Research at the University of Texas Health Science Center at San Antonio is conducting “Staying Healthy,” a two-year, two-arm randomized controlled trial (75 planned in each arm) of patient navigation among Latina BCS (Susan G. Komen for the Cure Grant #SAB-08-00005). The study compares Enhanced PN (PN+) to Usual PN over time. PN+ subjects receive tailored educational materials and regular personalized assistance including phone calls, meetings, and coordination of targeted care. Usual PN comparison subjects receive navigation upon request for specific needs. All navigation is conducted by trained paraprofessionals from the target community. Participants are Latina BCS age 18 and older who have completed primary treatment at least 3 months prior to study entry, have no metastatic disease, lack cancer or co-morbidity screening and have no ongoing neo-adjuvant therapy.

Study outcomes include general and breast cancer-specific quality of life (QOL: Functional Assessment of Cancer Therapy-General, FACT-G, and breast cancer-specific, FACT-B), and compliance with health care recommendations and screening practices. The study includes overall descriptive statistics and hierarchical linear regression of QOL scores at baseline on self-efficacy (SE), communication (Perceived Efficacy in Patient-Physician Interactions, PEPPI), needs (Supportive Care Needs Survey, SCNS), levels of distress (adapted Cognitive Somatic Anxiety Questionnaire, CSAQ), and worry interference (WI), controlling by acculturation (Short Acculturation Scale for Hispanics, SASH), age, and time (months) since primary treatment.

Results: We have conducted the baseline analyses of 120 enrolled Latina BCS who average 3.6 years post-diagnosis (SD=2.8 years) and 3.2 years post-primary treatment (SD=2.6 years). About 57% of participants reported having Medicare or Medicaid healthcare coverage. Participants were an average age of 57.3 (SD=9.5 years), 38% Spanish monolingual, 58% US born, 47% married or in an equivalent relationship, and 87% parents. More than three-fifths of the sample (61%) reported an annual household income below $25,000.

Consistent with prior work with Latina BCS, our sample reported similar general health-related (M=82, SD=16.8) and breast cancer-specific (M=107, SD=21.4) QOL as measured by the FACT-G and FACT-B scales, respectively. Lower levels of distress (adapted CSAQ) were significantly associated with higher scores of both general QOL (β = -1.3, 95% CI -1.7, -0.9, for FACT-G) and disease-specific QOL (β = -1.9, 95% CI -2.3, -1.4, for FACT-B) after controlling by age, time since primary treatment, and acculturation score.

Conclusion: These results show that among Latina BCS, levels of distress and QOL (general and breast cancer-specific) are inversely associated regardless of age, time since primary treatment, and degree of acculturation. Interventions to address unmet psychological needs may be one effective approach for ameliorating distress and enhancing QOL in this vulnerable population.

Citation Format: Edgar Munoz, Alfredo A. Santillan-Gomez, Amanda Sintes-Yallen, Kipling Gallion, Amelie G. Ramirez. Improving quality of life among Latina breast cancer survivors using the “Staying Healthy” program. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B12.