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    Awarded Grants
    The Re-entry of Hispanic Breast Cancer Survivors to the Healthcare Delivery System and Workforce

    Scientific Abstract:
    Title: The Re-entry of Hispanic Breast Cancer Survivors to the Healthcare Delivery System and Workforce Background: Epidemiologic research has repeatedly demonstrated disparities in mortality and survival amongst Hispanics with breast cancer, perhaps due to late stage at diagnosis as well as differences in treatment-related factors such as insurance status and interaction with the health service delivery system. Most research on Latinas and breast health is related to screening behaviors and barriers to mammography, not to their unique needs during or following breast cancer treatment. The few available studies suggest they experience higher levels of distress and use different coping mechanisms than Anglo patients. We propose to identify and examine gaps and barriers in breast healthcare service delivery for minority breast cancer survivors in Colorado by utilizing an established cohort of Latina and non-Hispanic white breast cancer cases diagnosed between 1999-2002 from the SHINE Women’s Health Study (Southwest Hormone, Insulin, Nutrition, and Exercise – R01 CA78552; Tim Byers, PI), a population-based case-control study. Specific Objectives/Hypotheses: We will assess ethnic differences with regard to two emerging issues facing longer-term breast cancer survivors: return to work; and health care system interaction, specifically in regard to adherence to treatment and follow-up recommendations and the use of ancillary services (such as physical therapy, support groups, and counseling) through re-entry. Recent studies have indicated that adherence to treatment and follow-up recommendations is an area of concern for many breast cancer survivors, particularly in regard to the rapid drop-off of compliance with adjuvant chemotherapy (tamoxifen) - which may contribute to risk of recurrence. We will assess ethnic differences in long-term compliance and identify predictors of compliance in this study population, since some of the side effects of tamoxifen and other hormonal therapies that may lead to non-compliance (such as sexual functioning, body image issues surrounding weight gain, and relationship with doctor and healthcare system) are likely influenced by sociocultural values. Similarly, new evidence suggests that lymphedema and range of motion issues often do not become apparent until 1 year or more following breast cancer treatment, and we postulate this may be particularly problematic for low-income and minority survivors who typically perform physical labor as part of their job requirements. Lastly, we will assess and describe attitudes and beliefs regarding disease and recovery unique to Latina breast cancer survivors. Study Design: Fifty (50) Latina and fifty white breast cancer survivors who participated in the SHINE Women’s Health Study and reside in the Front Range area in Colorado at the time of data collection will be randomly selected for an in-person interview and medical records review. These women have agreed to be contacted for future studies and consented to a medical records review. The in-person interview will be a quantitative survey covering adherence to follow-up as well as other aspects of interest. Return to work will be assessed with a novel questionnaire under development by the Colorado Health Outcomes Center here at the University of Colorado Health Sciences Center (John Steiner, PI - R21 CA97361). In addition, qualitative methods will be used to ascertain beliefs regarding disease attribution and recovery. The interviewer will be culturally competent as well as highly trained to provide case management services (resources/referrals) to those breast cancer survivors with unmet needs identified through the research study. Potential Outcomes and Benefits of the Research: This pilot study will gather important preliminary data on ethnic differences and identify predictors of compliance with follow up regime, use of supportive services; and differences by ethnicity of return to work experiences and beliefs about disease. Successful completion of this research will bridge funding for support of an existing outreach effort to Latinas (Project SOL – Survivorship Outreach to Latinas with Breast Cancer) to transition to research that will benefit the community. Ultimately the results of this project will elucidate programmatic efforts to improve the survivorship experience among minority breast cancer patients and fill in the gaps of existing services.

    Lay Abstract:
    Title: The Re-entry of Hispanic Breast Cancer Survivors to the Healthcare Delivery System and Workforce Most recently research has shown existing disparities in mortality and survival amongst Hispanics with breast cancer, perhaps due to late stage at diagnosis as well as differences in treatment-related factors such as insurance status and interaction with the health service delivery system. The majority of what we know about Latinas and breast health is related to screening behaviors and barriers to mammography, not about their unique needs during or following breast cancer treatment. The few available studies suggest they experience higher levels of distress and use different coping mechanisms than Anglo patients. We propose to identify and examine gaps and barriers in breast health care service delivery for minority breast cancer survivors in Colorado by utilizing an established group of Latina and non-Hispanic white breast cancer cases diagnosed between 1999-2002 from the SHINE Women’s Health Study (Southwest Hormone, Insulin, Nutrition, and Exercise). We will assess ethnic differences between Hispanic and white breast cancer survivors who are over two years after diagnosis. We will look at their experiences regarding returning to work after diagnosis and treatment; and their use of follow up care since treatment such as tamoxifen; and use of supportive services including physical therapy, support groups, and counseling since treatment. Breast cancer survivors are often asked to continue with adjuvant chemotherapy for up to five years following treatment, yet recent studies have shown a rapid drop-off of compliance with adjuvant chemotherapy (tamoxifen) - which may contribute to risk of recurrence. We will assess ethnic differences in long-term compliance with tamoxifen and other medical recommendations for follow up care and identify predictors of compliance, since some of the side effects of tamoxifen and other hormonal therapies that may lead to non-compliance (such as sexual functioning, body image issues surrounding weight gain, and relationship with doctor and healthcare system) are likely influenced by sociocultural values. Similarly, new evidence suggests that breast cancer survivors experience physical difficulties such as lymphedema, arm discomfort and pain years after treatment, and we will investigate whether this may be particularly problematic for low-income and minority survivors who may perform more physical labor as part of their job requirements. Lastly, we will assess and describe attitudes and beliefs regarding disease and recovery unique to Latina breast cancer survivors. We will interview fifty (50) Latina and fifty white breast cancer survivors who participated in the SHINE Women’s Health Study and reside in the Front Range area in Colorado. These breast cancer survivors will be randomly selected for an in-person interview and medical records review. They have already agreed to be contacted for future studies and to a medical records review. The in-person interview will be a survey about adherence to follow-up recommendations as well as other aspects of interest. Their return to work issues will be assessed with a new questionnaire under development by a current study looking at return to work issues among cancer survivors. In addition, open-ended questions will be used to ask women about their beliefs regarding cause of breast cancer and recovery. The interviewer will be culturally competent as well as highly trained to provide case management services (resources/referrals) to those breast cancer survivors with unmet needs identified through the research study. This pilot study will be a first step in understanding ethnic differences and identifying predictors of compliance with follow up care, use of supportive services; and differences by ethnicity of return to work experiences and beliefs about disease. This project will transition an existing outreach effort to Latinas survivors (Project SOL – Survivorship Outreach to Latinas with Breast Cancer) to research that will benefit the community. Ultimately the results of this project will help develop programs to improve the survivorship experience among minority breast cancer patients and fill in the gaps of existing services.