Abstract C35: Examining the role of social support and spirituality on the health status of Hispanic cancer survivors
Authors: Ochoa Carol , Haardörfer Regine , Escoffery Cam , Stein Kevin , Alcaraz Kassandra I. 
Published: February 2019

Abstract
Purpose: Although overall survival rates continue to improve for many cancers, disparities persist for ethnic minorities who have a disproportionately high risk of experiencing poor mental health and quality of life. However, limited research has examined the role of social support and spirituality on the health status of Hispanic cancer survivors. This study examined differences between Hispanics and non-Hispanics on health status, emotional support, and spirituality. It also examined the role of social support and spirituality on health status of cancer survivors directly and mediated through emotional distress and mental health.
Methods: We analyzed data (N=9,170) from the American Cancer Society's Study of Cancer Survivors-II (SCS-II), a national cross-sectional study of adult cancer survivors diagnosed at 2, 5, or 10 years prior to sampling. Preliminary analysis compared sociodemographic and medical characteristics between Hispanic and non-Hispanic cancer survivors to identify significant covariates of health status. We used structural equation modeling (SEM) to assess if the latent variables of mental health and emotional distress mediate the impact of social support and spirituality (also modeled as latent variables) on the health status of Hispanic cancer survivors. The final model included sociodemographic characteristics such as age and marital status, health insurance coverage, and cancer-related covariates such as time since diagnosis. Measurement models for social support, spirituality, emotional distress, and mental health were built based on literature and modified through adding meaningful error-covariances. SEM models were estimated in Mplus 7.4. Model fit was assessed using chi-square, RMSEA, TLI, and CFI.
Results: Overall, 7.6% of survivors were Hispanics (n=693) and 92.4% were non-Hispanics (n=8,477). Compared to their non-Hispanic counterparts, Hispanics were significantly younger (M= 63.4 ±12.6 vs 67.7 ±11.8, p=0.002) and had lower levels of educational attainment (X2=347.7, p&lt;0.001). The majority of participants reported currently having some form of health insurance coverage; however, Hispanic cancer survivors reported higher rates of being uninsured (6.0% vs 2.0%, p&lt;0.001). Notable differences in cancer treatment were observed. Hispanics were more likely to undergo chemotherapy and immunotherapy and less likely to undergo surgery compared to non-Hispanics. Hispanic cancer survivors reported poorer health and were more likely to have comorbid conditions such as diabetes, depression, anxiety, and chronic back pain compared to non-Hispanics. Structural equation model (SEM) estimates indicated no direct effect of social support on health or any mediated effect of social support through neither emotional distress nor mental health on overall health among Hispanics. On the contrary, there was a small to medium total effect of spirituality on health. The impact of spirituality on health was fully mediated through mental health (total effect β=.26, p&lt;.001) and neither the direct effect nor the mediated effect through emotional distress was statistically significant. The direct effect of spirituality on mental health was large (β=.60, p&lt;.001). The model accounted for most of the variance in health (r-square = .71). SEM model fit indices other than chi-square were very good (RMSEA=.03, CFI=.98, TLI= .98).
Conclusion: Hispanic cancer survivors were more likely to report poor health (general health, mental health, and emotional distress). Although data were cross-sectional, findings from this study suggest that the association between spirituality and health is mediated by mental health among Hispanic cancer survivors. Future studies are needed to determine if interventions to enhance spiritual well-being as a coping mechanism will have a direct impact on health of Hispanic cancer survivors.
Citation Format: Carol Ochoa, Regine Haardörfer, Cam Escoffery, Kevin Stein, Kassandra I. Alcaraz. Examining the role of social support and spirituality on the health status of Hispanic cancer survivors [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C35.