Kimlin Tam Ashing

Economic hardship of minority and non‐minority cancer survivors 1 year after diagnosis: Another long‐term effect of cancer?

Current literature suggests that racial/ethnic minority survivors may be more likely than whites to experience economic hardship after a cancer diagnosis; however, little is known about such hardship.

A telephonic‐based trial to reduce depressive symptoms among Latina breast cancer survivors

Greater mental health symptomatology of Latina breast cancer (LBC) patients along with the paucity of intervention trials to reduce distress underscores the scientific and practice gaps in comprehensive care. This trial investigated the effect of a paraprofessionally delivered, telephonic‐based psycho‐educational intervention on depressive symptoms among LBC patients.

Recommendations for Cancer Epidemiologic Research in Understudied Populations and Implications for Future Needs

Medically underserved populations in the United States continue to experience higher cancer burdens of incidence, mortality, and other cancer-related outcomes. It is imperative to understand how health inequities experienced by diverse population groups may contribute to our increasing unequal cancer burdens and disparate outcomes. The National Cancer Institute convened a diverse group of scientists to discuss research challenges and opportunities for cancer epidemiology in medically underserved and understudied populations. This report summarizes salient issues and discusses five recommendations from the group, including the next steps required to better examine and address cancer burden in the United States among our rapidly increasing diverse and understudied populations. Cancer Epidemiol Biomarkers Prev; 25(4); 573–80. ©2016 AACR. See all articles in this CEBP Focus section, “Multilevel Approaches to Addressing Cancer Health Disparities.”

Multicenter Study of Human Papillomavirus and the Human Papillomavirus Vaccine: Knowledge and Attitudes among People of African Descent

Objective. To compare knowledge and attitudes of human papillomavirus (HPV) and the vaccine between different cultures of African descent. Methods. A cross-sectional survey of 555 African-Americans and Afro-Caribbeans residing in the US and the Bahamas (BHM) was conducted. Results. General knowledge about HPV and the HPV vaccine differed between the two countries significantly. Bahamian respondents were less likely to have higher numbers of correct knowledge answers when compared to Americans (Adjusted Odds Ratio [Adj. OR] 0.47, 95% Confidence Interval [CI] 0.30–0.75). Older age, regardless of location, was also associated with answering fewer questions correctly (Adj. OR 0.61, 95% CI 0.40–0.92). Attitudes related to HPV vaccination were similar between the US and BHM, but nearly 80% of BHM respondents felt that children should not be able to receive the vaccine without parental consent compared to 57% of American respondents. Conclusions. Grave lack of knowledge, safety and cost concerns, and influence of parental restrictions may negatively impact vaccine uptake among African-American and Afro-Caribbean persons. Interventions to increase the vaccine uptake in the Caribbean must include medical provider and parental involvement. Effective strategies for education and increasing vaccine uptake in BHM are crucial for decreasing cervical cancer burden in the Caribbean.

Contextual factors influencing health-related quality of life in African American and Latina breast cancer survivors

PurposeThis study explored the relationships between systemic- and individual-level contextual factors and health-related quality of life (HRQOL) in a cohort of African American and Latina breast cancer survivors (BCS).MethodsBaseline questionnaire data of 320 BCS who participated in a HRQOL psycho-educational intervention were abstracted from the parent study. Hierarchical regression analysis tested the independent effects of contextual factors on HRQOL.ResultsHRQOL was higher in BCS who: were diagnosed at < stage 2 (b = − 1.38, p < 0.05), expressed satisfaction with their health care (b = 0.20, p < 0.001), had fewer comorbidities (b = − 0.60, p < 0.001) and depressive symptoms (b = − 0.30, p < 0.001), and practiced healthy diet and exercise habits (b = 0.02, p < 0.05). Demographic and cancer-related factors accounted for 14 % of the variance in HRQOL (F[6, 274] = 7.25, p < 0.001). The socio-cultural context (i.e., ethnicity, life stress, perceived social support) explained 20 % of the variance in HRQOL (FΔ[3, 271] = 27.32, p < 0.001). The health care system context contributed an additional 8 % to explaining HRQOL (FΔ[1, 270] = 34.88, p < 0.001). Health status and behavioral factors accounted for 18 % of the variance (FΔ[4, 266] = 29.55, p < 0.001). The full model explained 59 % of the variance in HRQOL (F[14, 266] = 27.76, p < 0.001).ConclusionsHRQOL in ethnic minority BCS is multifaceted and is significantly influenced by cancer-related, socio-cultural, health care system, health status, and behavioral contextual factors. Therefore, survivorship research and practice must address broad multi-level domains to achieve equitable and optimal breast cancer outcomes.Implications for cancer survivorsTo enhance HRQOL, survivors must be provided the know-how and support to maintain healthy lifestyle and self-management practices. Advocates must engage the care team to consider systemic factors, including life stress and community resources, to be more patient-centered.

The ConNECT Framework: a model for advancing behavioral medicine science and practice to foster health equity

Health disparities persist despite ongoing efforts. Given the United States’ rapidly changing demography and socio-cultural diversity, a paradigm shift in behavioral medicine is needed to advance research and interventions focused on health equity. This paper introduces the ConNECT Framework as a model to link the sciences of behavioral medicine and health equity with the goal of achieving equitable health and outcomes in the twenty-first century. We first evaluate the state of health equity efforts in behavioral medicine science and identify key opportunities to advance the field. We then discuss and present actionable recommendations related to ConNECT’s five broad and synergistic principles: (1) Integrating Context; (2) Fostering a Norm of Inclusion; (3) Ensuring Equitable Diffusion of Innovations; (4) Harnessing Communication Technology; and (5) Prioritizing Specialized Training. The framework holds significant promise for furthering health equity and ushering in a new and refreshing era of behavioral medicine science and practice.

Assessing the utility of a telephonically delivered psychoeducational intervention to improve health-related quality of life in African American breast cancer survivors: a pilot trial

Psycho-Oncology Psycho-Oncology 25: 236–238 (2016) Published online 15 April 2015 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/pon.3823 Clinical Correspondence Assessing the utility of a telephonically delivered psychoeducational intervention to improve health-related quality of life in African American breast cancer survivors: a pilot trial Kimlin Tam Ashing* and Aria M. Miller Center of Community Alliance for Research and Education (CCARE), Department of Population Sciences, City of Hope Medical Center, Duarte, CA, USA *Correspondence to: Director, Center of Community Alliance for Research and Education (CCARE), Department of Population Sciences, City of Hope Medical Center, 1500 East Duarte Road, Duarte, CA 91010-3000, USA. E-mail: kashing@coh.org Received: 7 October 2014 Revised: 10 February 2015 Accepted: 18 March 2015 Background There is an urgent need for interventions to enhance the health-related quality of life (HRQOL) of African American breast cancer survivors (AABCS), who bear a disproportionate burden of cancer with some of the worst survival and survivorship outcomes [1,2]. The objective of this pilot trial was to determine the utility of telephonic-based psychoeducational intervention sessions, guided by a culturally informed breast cancer survivorship booklet, to improve HRQOL outcomes among AABCS. Methods Recruitment and participants Participants were recruited from hospital cancer regis- tries and breast cancer survivor support groups, via mailed letters and flyers providing general study details and staff contact information. Study staff then contacted potential participants by phone to assess study eligibility and obtain verbal consent. All partici- pants gave written informed consent. Participants were disease-free women aged ≥18 years who were within 1–6 years after a stage 0–III breast cancer diagnosis and self-identified as African American. A detailed description of study recruitment and enrollment is pre- sented elsewhere [3]. Procedure This pilot trial was grounded in the Contextual Model of HRQOL that emphasizes responsiveness to cultural and socio-ecological considerations [4] and the cognitive– Copyright

Exploring characteristics, predictors, and consequences of fear of cancer recurrence among Asian-American breast cancer survivors.

To address the fear of cancer recurrence (FCR) research gap, we used prospective data to explore FCR predictors and FCR associations with health‐related quality of life among Asian‐American breast cancer survivors (BCS).

Developing a treatment summary and survivorship care plan responsive to African-American breast cancer survivors - eScholarship

Psycho-Oncology Psycho-Oncology (2015) Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/pon.3939 Clinical Correspondence Developing a treatment summary and survivorship care plan responsive to African-American breast cancer survivors Kimlin Tam Ashing 1 *, Lily Lai 2 , Shirley Brown 3 , Kommah McDowell 3 , DeBorrah Carter 3 , June Smith 3 , Eudora Mitchell 3 , Rhonda H. Santifer 3 , Virginia Martin 3 , Betty Betts-Turner 3 , Odicie Fielder 4 and Vanessa Miller 5 CCARE, City of Hope National Medical Center, Duarte, CA, USA Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA African American Cancer Coalition, Altadena, CA, USA Department of Clinical Oncology, City of Hope National Medical Center, Duarte, CA, USA Texas Christian University, Forth Worth, TX, USA *Correspondence to: CCARE, City of Hope National Medical Center, 1500 E Duarte Road, Duarte, CA 91010-3000, USA. E-mail: kashing@coh.org Received: 18 December 2014 Revised: 18 May 2015 Accepted: 15 July 2015 Dear Editor, Background African–American breast cancer survivors (AABCS) are understudied in the emerging survivorship care planning (treatment summary and survivorship care plan, TSSCP) literature. This article presents our TSSCP-African–American breast cancer (AABC) template, initially informed by a consensus review panel of survivor-advocates [1], and now in a format that is available for clinical application cultural, clinical, and socioecological modifications to the American Society of Clinical Oncology (ASCO) [4] Breast Cancer Adjuvant Treatment Plan and Summary and Survivorship Care Plan (v3 10/09) [5]. These advocates challenged the one-size-fits-all approach to TSSCPs and put forth recommendations towards the creation of a more patient-centered TSSCP that considers disease, clinical, and cultural characteristics for African– Americans. Based on this process, the TSSCP-AABC template was developed. TSSCP-AABCS evaluation Methods Methodological framework This project to develop a TSSCP-AABC template employed a two-phase, mixed-methods [2] design with an informative consensus panel to inform the initial TSSCP-AABC template. In this second phase, our stepwise approach towards the TSSCP template creation used a shared care model [3]. This model includes activated patients who joined oncology and primary care providers who provided input and evaluation to make available this current TSSCP-AABC template. Development of treatment summary and survivorship care plan The preliminary informative phase of the development of the TSSCP is described in detail elsewhere [1]; AABCS (N = 25) and community health advocates (N = 3) participated in three facilitated, structured, and informa- tive forums to review and provide input on relevant Copyright

Thoughts and Response to Authority-Perpetrated, Discriminatory, and Race-Based Violence

On a summer drive in 2016, my son and I (K.T.A.) happily chatted about his planned activities for the day while he attended camp. As we listened to the news on the car radio, we were silenced and horrified to hear about the second killing of a young African American man in as many days. We both started crying, and I asked my son, “How do you feel?” He responded somberly, “I am sad Mama... and afraid. I do not feel safe. This [country] does not feel like it is my home.” That exchange is now a prominent, recurrent experience embedded in our minds and hearts. We are dealing with police shootings resulting in publicly witnessed deaths of mostly African American men and women, deaths of Dallas police officers serving and protecting their communities, and “not guilty” verdicts for the 2015 police shooting of a young African American woman in Los Angeles and the 2015 death of Freddie Gray while in Baltimore police custody. We are also witnessing a rise in racial discord and violence after the November 2016 political elections. My son’s words that day now echo within many children of color who feel unsafe, afraid, angry, anxious, and sad. Professionally, I am a psychologist and population health scientist. I am also a mother to 2 African American children—a preadolescent boy and an adolescent girl. I too fear for their well-being.