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    Functioning, Fatigue & Psychological Distress in Breast Cancer Survivors: A 4-Yr Follow-Up Study

    Scientific Abstract:
    Functioning, Fatigue & Psychological Distress in Breast Cancer Survivors: A 4-Yr Follow-Up Study Studies of long-term functioning in large groups of breast cancer survivors are few. While they have made important contributions to the literature, prior studies have often been cross-sectional or limited by small samples, short time frames, few assessment points, heterogeneity of cancer type/stage or homogeneity of race/ethnicity. They sometimes assessed limited domains of functioning, did not examine racial/ethnic disparities, or did not use contemporary multivariate methods. Recent changes in treatment/prognosis raise questions about how earlier findings reflect the experience of survivors today. We propose to examine health-related quality of life (HRQOL), fatigue and psychological distress over a 4-yr follow-up period in a large (n=2975), multiethnic (432 minorities) cohort of survivors of non-recurring early stage breast cancer participating in the Women’s Healthy Eating & Living (WHEL) Study. The WHEL Study is a randomized trial of the effect of a diet intervention on breast cancer survival. By 3/05 data collection will be complete for 5 time points: for the full sample at baseline and Yrs 1&4 (the main short-/long-term points to assess dietary change); Yrs 2 (½ sample) and 3 (the other ½). The WHEL Study was funded to implement the diet intervention and track breast cancer events—not for analysis of functioning. Nonetheless, if funding can be obtained, there is an opportunity for hypothesis-driven analyses of a rich, nuanced database of >2,000,000 pieces of psychosocial data for these women. The aim of this study is to identify the course and relative importance of predictors of physical and mental HRQOL, fatigue and psychological distress in the WHEL Study women. Additional analyses will focus on those women who entered the study with poor functioning or show functional declines over time. We will also examine racial/ethnic disparities and determine if socioeconomic status helps explain them. This project would be one of the largest, most detailed longitudinal studies of functioning in breast cancer survivors. We have sufficient statistical power to determine the relative importance of a wide range of variables in multivariate analyses. Results would include the development of clinically-useful predictive models to identify women likely to experience elevated fatigue or distress. Findings would also provide key preliminary data for a new application to develop tailored psychosocial interventions for breast cancer survivors at risk for distress.

    Lay Abstract:
    Functioning, Fatigue & Psychological Distress in Breast Cancer Survivors: A 4-Yr Follow-Up Study Breast cancer is one of the most-studied cancers in terms of quality of life and distress. These pioneering projects have made key contributions to understanding functioning in survivors of this disease. However, prior studies often did not include enough women to allow examination of multiple aspects of functioning and seldom included many racial/ethnic minorities. In addition, because of recent changes in treatment and prognosis, it is uncertain how findings from earlier studies apply today. Thus, there is a need for new studies that follow large numbers of women survivors over time to understand how they function. We have followed 2975 women breast cancer survivors (including 432 minorities) participating in the Women’s Healthy Eating & Living (WHEL) Study. The WHEL Study was designed to determine the effect of a change in diet on breast cancer survival. The Study also has extensive data on psychological, social, behavioral and physical functioning in participants prior to beginning the Study and 1, 2, 3 & 4 yrs later. Thus, we have a rich, nuanced database of over 2,000,000 pieces of data on functioning in these women. Furthermore, this is one of the largest databases for minority breast cancer survivors. While funding was provided to implement the diet program and track survival, funds were not provided to analyze these data on functioning. While developing this proposal, we scrutinized advocacy websites and met with breast cancer survivors to understand their priorities in terms of psychological and social functioning and quality of life, and problems encountered while living with the disease. We propose to examine the course of quality of life, fatigue and psychological distress over time and to identify predictors of future functioning in these women. We will also examine any racial/ethnic disparities and determine if socioeconomic status helps explain them. This project would be one of the largest and most detailed longitudinal studies of functioning in breast cancer. Results would include tools that can be used in clinics for early identification of women who might experience ongoing fatigue or distress, so that appropriate interventions can be provided. Findings would also provide key preliminary data for a new project to develop a tailored treatment program for breast cancer survivors at risk for distress. Thus, these findings will help ensure that women who could benefit from treatment will, in fact, be offered it.