Jessica L. Krok

Age Differences in the Presence of Pain and Psychological Distress in Younger and Older Cancer Patients

Psychosocial factors impacting the overall quality of life for cancer patients may differ between younger and older adults. The objective of this study was to examine the differences between younger and older adults in reports of cancer pain, pain severity, and psychological distress. Symptom data from the Memorial Symptom Assessment Scale were collected from younger and older adults (N = 232) receiving outpatient services at a comprehensive cancer center (radiation, chemotherapy). Results showed that younger patients had higher reports of pain and psychological distress compared with the older adults. Multivariate analyses showed that, for younger patients, those who had more functional limitations were more likely to report pain. For older patients, being female, having functional limitations, receiving palliative treatment, irritability, and religious activity predicted a greater likelihood of reporting pain. These findings indicate that older cancer patients have less distress than younger cancer patients, suggesting that older adults may have more effective coping mechanisms to help them better manage their pain. These results endorse the importance of addressing the unique psychological concerns of younger and older cancer patients, while effectively managing their pain.

Satisfaction with pain treatment in older cancer patients: Identifying variants of discrimination, trust, communication, and self-efficacy.

How satisfied a patient is with his/her medical treatment may influence compliance and adherence to medical regimens. Although a number of studies have examined patient satisfaction among younger populations, few have determined the impact that social factors have on satisfaction with pain treatment among older adults. This study aimed to determine the influence that discrimination, trust, communication, and other health characteristics have on satisfaction with pain treatment among older adults receiving outpatient services from a comprehensive cancer center. Participants were surveyed on questions assessing pain symptomatology and identified social (discrimination, trust, and communication), physical (comorbidities, pain interference), behavioral (self-efficacy), and demographic characteristics. Analyses were calculated to determine the total and indirect effects of trust, communication, and self-efficacy as mediators on the perceived relationship between discrimination and patient satisfaction with pain treatment. Data showed a significant relationship of communication and discrimination with patient satisfaction. However, none of the mediating effects were significant. It must be recognized that patient satisfaction is contingent upon a myriad of social factors that are not exclusive but rather coexisting determinants of health. Particularly among the elderly population, perceived discrimination and incidences of poor communication may be significant influences on health and the lived day-to-day experiences of this adult population.

Sexual activity and body image: examining gender variability and the influence of psychological distress in cancer patients.

Psycho-social factors impacting on the overall quality of life for cancer patients may differ between men and women. This study examined the influence that psychological distress and clinical and social variables have on sexual activity and body image in adult oncology patients. Symptom data were collected from the Memorial Symptom Assessment Scale (MSAS). Analysis indicated women and patients with reported functional limitations were more likely to be less satisfied with how they looked. The final model showed that younger adults, Caucasians, those who were married, and patients with some functional limitations were more likely to have problems with sexual interest/activity. Gender was not a significant predictor of having problems with sexual interest/activity. These results can be used by clinicians to identify patients who may be at an increased risk for negative body image and problems in sexual functioning. Further research regarding gender differences in cancer-related psychological symptoms is needed to assist health care professionals in providing comprehensive care while alleviating unresolved and interrelated health and psycho-social symptoms.Psychosocial factors impacting on the overall quality of life for cancer patients may differ between men and women. This study examined the influence that psychological distress, clinical, and social variables have on sexual activity and body image in adult oncology patients. Symptom data was collected from the Memorial Symptom Assessment Scale (MSAS). Analysis indicated women and patients with reported functional limitations were more likely to be less satisfied with how they looked. The final model showed that younger adults, Caucasians, those who were married and patients with some functional limitations were more likely to have problems with sexual interest/activity. Gender was not a significant predictor of having problems with sexual interest/activity. These results can be used by clinicians to identify patients who may be at an increased risk for negative body image and problems in sexual functioning. Further research regarding gender differences in cancer-related psychological symptoms is needed to assist healthcare professionals in providing comprehensive care while alleviating unresolved and interrelated health and psychosocial symptoms.

Effects of tomato and soy on serum adipokine concentrations in postmenopausal women at increased breast cancer risk: a cross-over dietary intervention trial.

CONTEXT Breast cancer risk among postmenopausal women increases as body mass index increases. Practical preventive methods to reduce risk of breast cancer are lacking. Few studies have investigated the effects of carotenoids and isoflavones on circulating adipokines in postmenopausal women. OBJECTIVE The aim was to examine the effects of lycopene- and isoflavone-rich diets on serum adipokines. DESIGN This was a 26-week, two-arm, longitudinal crossover trial. SETTING Participants were recruited from clinics at The Ohio State University Comprehensive Cancer Center. PARTICIPANTS Seventy postmenopausal women at increased breast cancer risk participated in the study. The mean age and body mass index of participants was 57.2 years and 30.0 kg/m(2), respectively; the study was comprised of 81.4% whites. INTERVENTIONS The interventions included 10 weeks of consumption of a tomato-based diet (≥25 mg lycopene daily) and 10 weeks of consumption of a soy-based diet (≥40 g of soy protein daily), with a 2-week washout in between. MAIN OUTCOME MEASURES Changes in serum adiponectin, leptin, and the adiponectin to leptin ratio were examined for each intervention through linear mixed models, with ratio estimates corresponding to postintervention adipokine concentrations relative to preintervention concentrations. RESULTS After the tomato intervention, among all women, adiponectin concentration increased (ratio 1.09, 95% confidence interval (CI) 1.00-1.18), with a stronger effect observed among nonobese women (ratio 1.13, 95% CI 1.02-1.25). After the soy intervention, adiponectin decreased overall (ratio 0.91, 95% CI 0.84-0.97), with a larger reduction observed among nonobese women (ratio 0.89, 95% CI 0.81-0.98). Overall, no significant changes in leptin or the adiponectin to leptin ratio were observed after either intervention. CONCLUSIONS Increasing dietary consumption of tomato-based foods may beneficially increase serum adiponectin concentrations among postmenopausal women at increased breast cancer risk, especially those who are not obese. Additional studies are essential to confirm these effects and to elucidate the specific mechanisms that may make phytonutrients found in tomatoes practical as breast cancer chemopreventive agents.

Improving Symptom Communication Through Personal Digital Assistants: The CHAT (Communicating Health Assisted by Technology) Project

BACKGROUND Communication problems impede effective symptom management during chemotherapy. The primary aim of this pilot randomized controlled trial was to test the effects of a personal digital assistant-delivered communication intervention on pain, depression, and fatigue symptoms among breast cancer patients undergoing chemotherapy. Secondary aims included assessment of 1) study feasibility, 2) patient and clinician responses to study participation, and 3) intervention effects on health-related quality of life (HRQoL) and communication self-efficacy. METHODS Intervention group participants (n = 27) completed symptom inventories at baseline, once per week during treatment, and at posttreatment. Depending on symptom severity, they viewed race-concordant videos on how to communicate about pain, depression and/or fatigue, using the personal digital assistant. Symptom records were tracked and shared with clinicians. Control group participants (n = 23) received usual care. Longitudinal random effects modeling assessed the changes in average symptom scores over time. Descriptive statistics assessed study feasibility and intervention effects on HRQoL and communication self-efficacy. Postintervention focus groups, interviews, and surveys assessed responses to study participation. RESULTS Mean age of the participants was 51.0 years; 42 participants (84%) were white. In comparison with control, intervention group participants reported lower average pain severity over time (P = .015). Mean pain interference scores over time were marginally different between groups (P = .07); mean depression and fatigue scores over time were statistically nonsignificant. Feasibility outcomes and perspectives about study participation were positive. Mean pre-post decreases in HRQoL were generally higher among intervention group participants; pre-post changes in communication self-efficacy were equivalent. CONCLUSION Mixed findings of the study indicate the need for future research.

The influence of personality on reported pain and self-efficacy for pain management in older cancer patients

This study examines the relationship of personality traits and affect on cancer-related pain in 150 older adults receiving outpatient treatment at a comprehensive cancer center. Regression analyses revealed extraversion as a significant predictor of current pain, with openness to experience as a significant indicator of average pain. Similarly, positive affect and negative affect were significant predictors of self-efficacy for pain management. Moderation models showed that conscientiousness and extraversion were significant moderators in the relationship between self-efficacy for pain management and worst pain. These findings suggest that different personality types may influence perceptions of pain severity.

Transdisciplinary Cardiovascular and Cancer Health Disparities Training: Experiences of the Centers for Population Health and Health Disparities

The Centers for Population Health and Health Disparities program promotes multilevel and multifactorial health equity research and the building of research teams that are transdisciplinary. We summarized 5 areas of scientific training for empowering the next generation of health disparities investigators with research methods and skills that are needed to solve disparities and inequalities in cancer and cardiovascular disease. These areas include social epidemiology, multilevel modeling, health care systems or health care delivery, community-based participatory research, and implementation science. We reviewed the acquisition of the skill sets described in the training components; these skill sets will position trainees to become leaders capable of effecting significant change because they provide tools that can be used to address the complexities of issues that promote health disparities.

Community Engagement as a Process and an Outcome of Developing Culturally Grounded Health Communication Interventions: An Example from the DECIDE Project

Community engagement is a process often used in developing effective health communication interventions, especially in traditionally underserved cultural contexts. While the potentially positive outcomes of community engagement are well established, the communication processes that result in engagement with cultural groups are less apparent. The focus on the outcomes of engagement at the expense of describing how engagement occurs makes it difficult for methods to be improved upon and replicated by future studies. The purpose of the current manuscript is to illustrate the process of achieving community engagement through the development of a culturally grounded health communication intervention. We offer practical suggestions for implementing community engagement principles, as well as the benefits and challenges inherent in this approach to research. Key points are illustrated using examples from the DECIDE Project, a culturally grounded intervention for improving communication about clinical trials in the medically underserved Appalachian region.

Abstract C45: Effects of low-fat and low-carbohydrate dietary patterns combined with physical activity on serum adipokine concentrations among premenopausal women: A randomized trial

Background: There is an ongoing debate regarding what dietary pattern is the most effective for breast cancer prevention. Several studies have examined hypocaloric diets with an emphasis on various macronutrient compositions, yielding inconclusive data regarding their effects on weight loss and breast cancer risk reduction. This study examined the effects of a 1-year intervention of 2 calorie-restricted diets (low-fat or low-carbohydrate [LFD and LCD, respectively]), in combination with increased physical activity (PA), on circulating adipokine concentrations among premenopausal women at increased risk of developing breast cancer. Methods: Seventy nine overweight/obese premenopausal women were randomized to a LFD or LCD with PA for 52 weeks. Serum adiponectin, leptin and the adiponectin to leptin ratio (A/L) were measured at baseline, and weeks 25 and 52. Linear mixed models, which included fixed effects of treatment arm, time, and a treatment-by-time interaction, were used to assess intervention effects on serum adipokine concentrations. Results: Compared to baseline, at week 25, adiponectin decreased 4.1% and 2.3%, leptin decreased 30.0% and 35.3%, and the A/L ratio increased 10.5% and 19.4%, among LFD and LCD participants, respectively. Compared to baseline, at week 52, adiponectin decreased 8.5% and 5.0%, leptin decreased 23.0% and 19.7%, and the A/L ratio increased 23.7% and 44.4%, among LFD and LCD participants, respectively. No differences in adipokine changes by diet were observed. Notably, we observed favorable improvement of adipokine concentrations (adiponectin increased 4.4% and 9.5%, leptin decreased 13.0% and 30.1%, and the A/L ratio increased 21.0% and 52.6%, at weeks 25 and 52, respectively) among women who were adherent to the LCD. Conclusion: These findings suggest that long-term caloric-restriction with increased PA can effectively modify the obesity-related adipokines and thus, may prove useful as cancer preventive strategies for premenopausal women. Future studies of larger samples are required to confirm the beneficial effects of these interventions among high-risk women. Citation Format: Adana A.M. Llanos, Jessica L. Krok, Juan Peng, Michael L. Pennell, Susan E. Olivo-Marston, Mara Z. Vitolins, Cecilia R. Degraffinreid, Electra D. Paskett. Effects of low-fat and low-carbohydrate dietary patterns combined with physical activity on serum adipokine concentrations among premenopausal women: A randomized trial. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr C45.

Abstract C46: Effects of lycopene- and isoflavone-rich dietary interventions on serum adipokine concentrations among postmenopausal women at increased breast cancer risk

Background: Breast cancer risk among postmenopausal women increases as body mass index increases, likely due to the biological effects of the obesity-related adipokines, adiponectin and leptin. Few studies have investigated the effects of carotenoids and isoflavones on circulating adipokines among postmenopausal women. Our aim was to examine the effects of lycopene- and isoflavone-rich diets on adipokine concentrations in overweight and obese postmenopausal women at increased breast cancer risk. Methods: Seventy women were enrolled in a 26-week, 2-arm (tomato and soy based diets, 10 weeks each, with 2-week wash-out periods in between) longitudinal, cross-over trial. Changes in serum adiponectin, leptin and the adiponectin to leptin ratio (A/L) were examined through linear mixed models, with ratio estimates corresponding to post-intervention adipokine concentrations relative to pre-intervention concentrations. Results: Among all women, the lycopene-rich intervention yielded a 9% increase in serum adiponectin concentration (Ratio=1.09, 95% CI: 1.00-1.18), with a stronger effect observed among non-obese women (Ratio=1.13, 95% CI: 1.02-1.25). Following the isoflavone-rich intervention, adiponectin decreased 9% overall (Ratio=0.91, 95% CI: 0.84-0.97), with a larger reduction observed among non-obese women (Ratio=0.89, 95% CI: 0.81-0.98). Overall, no significant changes in leptin or the A/L ratio were observed following either intervention. Conclusions: Increasing dietary consumption of lycopene- and isoflavone-rich foods may have beneficial effects on adipokine concentrations, specifically increasing adiponectin and decreasing leptin, among postmenopausal women at increased breast cancer risk. Additional studies are essential to confirm these effects and to elucidate the specific mechanisms that may make these phytonutrients practical as breast cancer chemopreventive agents. Citation Format: Adana A.M. Llanos, Juan Peng, Michael L. Pennell, Jessica L. Krok, Mara Z. Vitolins, Cecilia R. Degraffinreid, Electra D. Paskett. Effects of lycopene- and isoflavone-rich dietary interventions on serum adipokine concentrations among postmenopausal women at increased breast cancer risk. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr C46.