Betina Yanez

Facets of Spirituality as Predictors of Adjustment to Cancer: Relative Contributions of Having Faith and Finding Meaning

Spirituality is a multidimensional construct, and little is known about how its distinct dimensions jointly affect well-being. In longitudinal studies (Study 1, n = 418 breast cancer patients; Study 2, n = 165 cancer survivors), the authors examined 2 components of spiritual well-being (i.e., meaning/peace and faith) and their interaction, as well as change scores on those variables, as predictors of psychological adjustment. In Study 1, higher baseline meaning/peace, as well as an increase in meaning/peace over 6 months, predicted a decline in depressive symptoms and an increase in vitality across 12 months in breast cancer patients. Baseline faith predicted an increase in perceived cancer-related growth. Study 2 revealed that an increase in meaning/peace was related to improved mental health and lower cancer-related distress. An increase in faith was related to increased cancer-related growth. Both studies revealed significant interactions between meaning/peace and faith in predicting adjustment. Findings suggest that the ability to find meaning and peace in life is the more influential contributor to favorable adjustment during cancer survivorship, although faith appears to be uniquely related to perceived cancer-related growth.

Quality of life among Latina breast cancer patients: a systematic review of the literature

IntroductionThe Latino population is the most rapidly growing ethnic minority in the United States and Latinas have higher rates of advanced breast cancer and more rigorous treatments than White women. However, the literature lacks reviews on quality of life among this population of breast cancer patients.MethodsA systematic review of the breast cancer quality of life (QOL) literature was conducted among studies that provided a comparison of mental, physical, social, or sexual QOL between Latinas and other racial/ethnic groups. Of the 375 studies reviewed, 20 quantitative studies and two qualitative studies met criteria for inclusion.ResultsLatinas were more likely to report poor mental, physical, and social QOL, relative to non-Latinas. Only four studies assessed sexual QOL, making it difficult to draw any conclusions. Of these four QOL domains, the largest disparity was found in the area of mental health in which Latinas reported poorer QOL compared to non-Latina Whites and Blacks.Discussion/conclusionsMost quantitative studies revealed either that Latinas consistently evidenced significantly lower QOL than non-Latinas on all measures (6 studies) or reported mixed findings in which Latinas generally demonstrated significantly worse QOL on most, but not all, measures (12 studies) included in the study. Explanatory mechanisms including socio-demographic, treatment-related, and culturally-relevant factors are discussed. Implications for research design, measurement, and clinical work are also included.Implications for cancer survivorsAlthough not entirely consistent, data suggest that Latina breast cancer survivors on average experience worse QOL than non-Latina Whites.Understanding ethnic differences in QOL among breast cancer survivors can inform interventions targeted at improving health status for Latinas.

Physical, emotional, and social health differences between posttreatment young adults with cancer and matched healthy controls

Young adults (YAs; ages 18‐39 years) with cancer face interrupted developmental milestones and increased stressors that can adversely influence psychosocial adjustment. Transitioning from active treatment to posttreatment survivorship can be particularly challenging. The purpose of this study is to describe the health‐related quality of life (HRQL) and psychological adaptation of YAs after treatment, relative to young adults without cancer.

Breast cancer treatment decision making among Latinas and non-Latina Whites: a communication model predicting decisional outcomes and quality of life.

OBJECTIVE Deciding among medical treatment options is a pivotal event following cancer diagnosis, a task that can be particularly daunting for individuals uncomfortable with communication in a medical context. Few studies have explored the surgical decision-making process and associated outcomes among Latinas. We propose a model to elucidate pathways through which acculturation (indicated by language use) and reports of communication effectiveness specific to medical decision making contribute to decisional outcomes (i.e., congruency between preferred and actual involvement in decision making, treatment satisfaction) and quality of life among Latinas and non-Latina White women with breast cancer. METHODS Latinas (N = 326) and non-Latina Whites (N = 168) completed measures six months after breast cancer diagnosis, and quality of life was assessed 18 months after diagnosis. Structural equation modeling was used to examine relationships between language use, communication effectiveness, and outcomes. RESULTS Among Latinas, 63% reported congruency in decision making, whereas 76% of non-Latina Whites reported congruency. In Latinas, greater use of English was related to better reported communication effectiveness. Effectiveness in communication was not related to congruency in decision making, but several indicators of effectiveness in communication were related to greater treatment satisfaction, as was greater congruency in decision making. Greater treatment satisfaction predicted more favorable quality of life. The final model fit the data well only for Latinas. Differences in quality of life and effectiveness in communication were observed between racial/ethnic groups. CONCLUSIONS Findings underscore the importance of developing targeted interventions for physicians and Latinas with breast cancer to enhance communication in decision making.

Feasibility, acceptability, and preliminary efficacy of a technology-assisted psychosocial intervention for racially diverse men with advanced prostate cancer.

The utility of psychosocial interventions in reducing symptom burden and improving health‐related quality of life (HRQOL) for men with localized prostate cancer has been demonstrated. However, studies have yet to demonstrate the efficacy of interventions in advanced prostate cancer (APC). This study examined the feasibility, acceptability, and preliminary efficacy of a technology‐assisted, 10‐week, group‐based psychosocial intervention for diverse men with APC.

Linking Fatigue Measures on a Common Reporting Metric

CONTEXT Fatigue is one of the most common and debilitating symptoms experienced by patients living with chronic conditions and is also commonly experienced in the general U.S. population. Linking fatigue scores from some of the most widely used measure of fatigue to the same metric will facilitate interpretation of fatigue outcomes. OBJECTIVES The goal of this study is to report the methods used to develop linking (crosswalk) tables to enable the direct comparison of Patient-Reported Outcomes Measurement Information System-Fatigue with fatigue scores on the Functional Assessment of Chronic Illness Therapy-Fatigue Scale, the Medical Outcomes Study Short Form-36 four-item Vitality Scale, and the Quality of Life in Neurological Disorders Fatigue Scale. METHODS Participants were recruited from two data sets (n=1120 and n=803). Two item response theory-based linking methods, the Stocking-Lord calibration and fixed-parameter calibration, were used to establish linking between measures. The item response theory calibrations were derived using the graded response model. RESULTS Both the Stocking-Lord calibration and fixed-parameter calibration linking methods produced comparable results. Final crosswalk tables are reported for the fixed-parameter calibration. CONCLUSION Findings can facilitate comparison of scores across some of the most widely used fatigue measures and assist in comparing patient-reported fatigue outcomes in clinical trials, comparative effectiveness research, and clinical practice.

Ambulatory Cancer and US General Population Reference Values and Cutoff Scores for the Functional Assessment of Cancer Therapy

Health‐related quality of life (HRQOL) measures are commonly used in oncology research. Interest in their use for monitoring or screening is increasing. The Functional Assessment of Cancer Therapy (FACT) is one of the most widely used HRQOL instruments. Consequently, oncology researchers and practitioners have an increasing need for reference values for the Functional Assessment of Cancer Therapy–General (FACT‐G) and its 7‐item rapid version, the Functional Assessment of Cancer Therapy–General 7 (FACT‐G7), to compare FACT scores across specific subgroups of patients in research trials and practice. The objectives of this study are to provide 1) reference values from a sample of the general US adult population and a sample of adults diagnosed with cancer and 2) cutoff scores for quality of life.

Fatalism, medical mistrust, and pretreatment health-related quality of life in ethnically diverse prostate cancer patients.

Few studies have examined the impact of cultural processes prevalent in minority ethnic groups such as cancer fatalism and medical mistrust on health‐related quality of life (HRQoL) following a cancer diagnosis. The present study examined relationships among ethnicity, HRQoL, and two possible cultural vulnerability factors—fatalistic attitudes and medical mistrust—among an ethnically diverse sample of men with prostate cancer (PC) prior to undergoing active treatment.

Predictors of psychological outcomes in a longitudinal study of Latina breast cancer survivors

Objective: This study sought to investigate the unique contributions of socio-ecological, cultural and cancer treatment-related factors in predicting depressive symptoms and cancer-specific distress among Latinas. Design: Participants were 140 English or Spanish-speaking Latinas (Mage = 50.6) with non-metastatic breast cancer who were assessed within two years of diagnosis (Time 1) and three months later (Time 2). Main Measures: Hierarchical regression analyses identified predictors of depressive symptoms and cancer-specific distress at Time 1 and 2. Results: Most women scored above the clinical cut-offs for depressive symptoms and cancer-specific distress. After adjusting for socio-ecological factors, greater Latino enculturation, measured by Latino ethnic identity, was significantly associated with greater cancer-specific distress at Time 1 (β = .20, p < .05). A significant interaction (p < .01) revealed that among women high on Latino identity, lower English language use was associated with more cancer-specific distress than higher English language use. After adjusting for socio-ecological factors, greater satisfaction with surgical treatment predicted improved depressive symptoms and cancer-specific distress across time (βs range from −.31 to −.18, ps < .01). Conclusions: Findings elucidate the complex relationship between culture and psychological outcomes in the breast cancer context and suggest that treatment satisfaction might be an important intervention target for Latinas.

Self-Reported Cancer Prevalence among Hispanics in the US: Results from the Hispanic Community Health Study/Study of Latinos

Cancer has surpassed heart disease as the leading cause of death among Hispanics in the U.S., yet data on cancer prevalence and risk factors in Hispanics in regard to ancestry remain scarce. This study sought to describe (a) the prevalence of cancer among Hispanics from four major U.S. metropolitan areas, (b) cancer prevalence across Hispanic ancestry, and (c) identify correlates of self-reported cancer prevalence. Participants were 16,415 individuals from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), who self-identified as Cuban, Dominican, Mexican, Puerto Rican, Central or South American. All data were collected at a single time point during the HCHS/SOL baseline clinic visit. The overall self-reported prevalence rate of cancer for the population was 4%. The rates varied by Hispanic ancestry group, with individuals of Cuban and Puerto Rican ancestry reporting the highest cancer prevalence. For the entire population, older age (OR = 1.47, p < .001, 95% CI, 1.26–1.71) and having health insurance (OR = 1.93, p < .001, 95% CI, 1.42–2.62) were all significantly associated with greater prevalence, whereas male sex was associated with lower prevalence (OR = 0.56, p < .01, 95% CI, .40-.79). Associations between study covariates and cancer prevalence also varied by Hispanic ancestry. Findings underscore the importance of sociodemographic factors and health insurance in relation to cancer prevalence for Hispanics and highlight variations in cancer prevalence across Hispanic ancestry groups. Characterizing differences in cancer prevalence rates and their correlates is critical to the development and implementation of effective prevention strategies across distinct Hispanic ancestry groups.