Velda Gonzalez

Mexican-American and Puerto Rican Breast Cancer Survivors’ Perspectives on Exercise: Similarities and Differences

Qualitative data was collected from Mexican-American (MA) and Puerto Rican (PR) breast cancer survivors to gain their perspectives on the relevant issues surrounding breast cancer survivorship and exercise. Six focus groups, a total of 31 participants were convened (three in Puerto Rico and three in Texas). Responses were analyzed and compared between the MA and PR groups. Follow-up sessions were conducted at the sites to review the initial results and to validate a culturally adapted exercise intervention trial. A total of 900 responses were catalogued into 27 codes. Both groups had similar descriptions of exercise and barriers to exercise. Both groups expressed lack of information regarding their exercise capabilities. The groups differed in their responses to perceived safety in their community and how to deliver a culturally adapted exercise intervention in their community. We found important cultural differences and similarities in relevant factors of exercise and breast cancer survivorship.

Expression of Sestrin Genes in Radiotherapy for Prostate Cancer and Its Association With Fatigue: A Proof-of-Concept Study:

Genetic factors that influence inflammation and energy production/expenditure in cells may affect patient outcomes following treatment with external beam radiation therapy (EBRT). Sestrins, stress-inducible genes with antioxidant properties, have recently been implicated in several behaviors including fatigue. This proof-of-concept study explored whether the sestrin family of genes (SESN1, SESN2, and SESN3) were differentially expressed from baseline to the midpoint of EBRT in a sample of 26 Puerto Rican men with nonmetastatic prostate cancer. We also examined whether changes in expression of these genes were associated with changes in fatigue scores during EBRT. Method: Participants completed the 13-item Functional Assessment of Cancer Therapy—Fatigue subscale, Spanish version. Whole blood samples were collected at baseline and at the midpoint of EBRT. Gene expression data were analyzed using the limma package in the R (version R 2.14.0.) statistical software. Linear models and empirical Bayes moderation, adjusted for radiation fraction (total number of days of prescribed radiation treatment), were used to examine potential associations between changes in gene expression and change in fatigue scores. Results: Expression of SESN3 (adjusted p < .01, log fold change −0.649) was significantly downregulated during EBRT, whereas the expressions of SESN1 and SESN2 remained unchanged. After adjustment for radiation fraction, change in SESN3 expression was associated with change in fatigue during EBRT (false discovery rate <.01). Conclusions: Downregulation of SESN3, a novel pharmacoactive stress response gene, was associated with fatigue intensification during EBRT. SESN3 may serve as an interventional target and a biomarker for the cellular and molecular events associated with EBRT-related fatigue.

Symptom Burden: Experiences of Puerto Rican Men With Prostate Cancer Prior to External Beam Radiation Therapy

BACKGROUND: Prostate cancer is the most frequently diagnosed cancer in men in Puerto Rico, and external beam radiation therapy (EBRT) is a popular treatment. Although symptom management is a clinical priority of comprehensive oncology care, symptom assessment at the time of primary or adjuvant EBRT has received limited attention. OBJECTIVES: This article examines the prevalence and severity of symptoms experienced by 54 Puerto Rican men prior to EBRT. METHODS: Participants completed a demographic form and the MD Anderson Symptom Inventory. Descriptive statistics were generated. FINDINGS: Most participants had received hormonal treatment, and about a third had received no treatment prior to EBRT. About a third of those who received hormonal treatment reported experiencing side effects before EBRT, and disturbed sleep, numbness and tingling, fatigue, and dry mouth were the most severe. Puerto Rican men with prostate cancer who receive hormonal treatment are at increased risk for experiencing symptom burden prior to EBRT. Greater need for symptom surveillance, treatment, and control may be needed among this population.

Relationship between physical activity, disability, and physical fitness profile in sedentary Latina breast cancer survivors

ABSTRACT Objective: To report baseline data from a physical activity (PA) intervention for Latina breast cancer survivors, and assess the relationship between PA, fitness, and disability. Methods: Eighty-nine Latina breast cancer survivors from San Juan, PR and Houston, TX (age: 55.4 ± 9.9 years; BMI: 29.87 ± 5.62 kg/m2; ≥ 3 months post-treatment) participated in this study. At baseline participants completed fitness testing (six-minute walk test [6MWT], 30-second sit-stand; grip strength, lower and upper extremity and low back strength, shoulder range of motion, balance testing), and assessment of physical activity (PA) and disability. PA was assessed using the International Physical Activity Questionnaire (IPAQ). A subsample (n = 27) received an accelerometer to compare objective versus self-reported PA. Results: Participants exhibited low PA (M = 76.5 MET·minutes/week; SD = 183.4), poor fitness (6MWT M = 436.4 meters, SD = 99.1; 30s sit-stand, M = 11.6 stands, SD = 3.1), and no detectable disability. In an adjusted model lower extremity fitness was associated with PA, with a one repetition increase in sit-to-stand associated with 49 additional minutes of self-reported PA plus walking per week. The correlation between IPAQ moderate-vigorous PA and accelerometer was 0.38 (p = 0.047). Conclusion: Latina breast cancer survivors have low physical activity and fitness levels that increase their risk of disability, cardiometabolic comorbidities, and potential cancer recurrence.

Communication about sex and HPV among Puerto Rican mothers and daughters

ABSTRACT Objective: Although opportunities to vaccinate against human papillomavirus (HPV) are available, vaccination rates in Puerto Rico remain low. Communication between parents and adolescents about sexual topics may influence decisions about HPV vaccination uptake, particularly among young women; yet, few studies have addressed this issue. This qualitative study explored Puerto Rican mothers’ and daughters’ communication on sex-related topics, and HPV, including the HPV vaccine. Design: Thirty participants, including 9 mothers and 21 daughters, participated in seven focus groups. Participants were divided into groups of mothers and daughters, and further stratified by vaccination status. Transcripts were analyzed using a modified grounded theory approach to identify emergent themes. Results: Focus group data revealed four main themes: (1) limited parent–daughter communication about sex-related topics; (2) daughters’ discomfort discussing sex-related topics with their parents; (3) parental focus on abstinence; and, (4) limited parent–daughter communication about HPV and the HPV vaccine. Conclusion: Although daughters in this study struggled with feelings of embarrassment, invasion of privacy, encouragement of abstinence, and the fear of parents’ reaction to them being sexually active prior to marriage, they also recognized the need to increase the parent–daughter communication about sex-related topics including HPV and the HPV vaccine. Educational efforts should target both daughters and parents to increase communication skills and self-efficacy and to enable them to discuss sexual health in open and nonjudgmental conversations.

Abstract B29: Differences in physical fitness, disability, and health-related quality of life between physical active and sedentary Hispanic breast cancer survivors

Background: Breast cancer remains the leading cause of cancer mortality among Latina women in the US. Physical activity (PA) and exercise have been shown to reduce morbidity and mortality from cardiometabolic diseases and cancer while improving individual fitness; disability and health related quality of life (HRQoL). However, Latinas, particularly those who speak only Spanish, have not been included in studies in sufficient numbers to identify factors to promote their participation in cancer prevention interventions. Purpose: To compare physical fitness, disability, and HRQoL between physically active and sedentary Hispanic breast cancer survivors. Methods: A total of 94 women (Age: 55.4 ± 9.9; BMI: 29.87 ± 5.62; ) from the Puerto Rico Comprehensive Cancer Center and MD Anderson Cancer Center in Houston, TX participating in Project VIVA! were recruited for this study. The VIVA! Program is a 16-week exercise intervention emphasizing in the minimum guidelines from The American College of Sports Medicine targeting aerobic endurance, muscular strength, balance, and muscle endurance. Participants visited the clinic for fitness testing and assessment of physical activity (PA), disability, and HRQoL through a battery of self-administered questionnaires previous to starting the intervention. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ) in the preferred language of the participant; English or Spanish. The physical fitness assessment included: anthropometrics (BMI & waist to hip ratio) measures, adiposity (% body fat) by skinfolds measurement, six-minute walk test (6MWT), lumbar and isquiotibial flexibility by sit-and-reach, grip strength by hand dynamometry, lower extremity endurance testing by sit-to-stand in 30 seconds, upper extremity, low back, and leg strength by Jackson strength testing protocol, shoulder range of motion (ROM) with inclinometer, and balance testing by a functional reach test. Upper and lower extremity function, joint motion and disability were assessed by The Disabilities of the Arm, Shoulder and Hand Score (QuickDASH) and The Western Ontario McMaster University Osteoarthritis Index (WOMAC), respectively. HRQoL was measured by the short version of the QOL (SF-36) questionnaire. For physical activity analyses, sample was divided into two groups based on results from the IPAQ; those with less than 150 min/wk (n = 58) and those exceeding 150 min/wk (n = 36). For analyses of sedentary time, sample was also divided into two groups based on the IPAQ; those spending less than 180 min/day in sitting (n = 46) and those spending greater than 180 mins/day sitting (n = 45). Groups were compared for all variables using analysis of variance (ANOVA). Results: ANOVA for physical activity revealed that those participants engaging in more than 150 min/wk of PA have better 6MWT (p = 0.04) and 30-second sit-to-stand ( p = 0.027) results demonstrating greater cardiorespiratory fitness and muscular endurance, respectively. Those participants spending less than 180 mins/day sitting exhibited better mental component scores in the SF-36 than those spending more time sitting (p = 0.012). Conclusion: It appears that meeting or exceeding the minimum recommended amount of PA and decreasing time spent in sedentary activities have positive physical fitness and HRQoL outcomes in Hispanic women breast cancer survivors. Even though the relationship between PA and sedentary behaviors with measures of physical fitness, disability, and HRQoL are difficult to establish, it is sound for clinicians to start considering PA as a preventive and rehabilitative strategy to improve breast cancer survivors HRQoL. Funding Sources: This project was partially supported by the Center for Energy Balance in Cancer Prevention and Survivorship, Duncan Family Institute, and by the following NIH awards: U54 CA 96297; P30 CA016672; R25T CA057730; and K01 CA 134550. Citation Format: Alexis Ortiz, Maribel Tirado-Gomez, Daniel C. Hughes, Velda Gonzalez, Karen Basen-Engquist. Differences in physical fitness, disability, and health-related quality of life between physical active and sedentary Hispanic breast cancer survivors. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B29.

Abstract B57: Comparing determinants of physical activity in Puerto Rican, Mexican-American, and non-Hispanic white breast cancer survivors

Purpose: Among the plethora of benefits of moderate to vigorous levels of physical activity for breast cancer survivors is a link to reduced risk for cancer recurrence. However, after the experience of cancer, many breast cancer survivors who were not previously active will stay inactive; and, those who were active do not return to their previous level of activity. Latinas are among the least physically active segments of the U.S. population. Utilizing a Social Cognitive Theory (SCT) based model as a guide, we conducted a cross sectional survey to investigate similarities and differences in SCT variables associated with current level of physical activity in Puerto Rican, Mexican-American and non-Hispanic white breast cancer survivors. The results reported here are being used to culturally adapt an exercise intervention specific for Mexican-American and Puerto Rican breast cancer survivors. Methods: A total of 150 breast cancer survivors completed an interviewer-guided survey. Fifty Puerto-Rican (PR) participants completed the survey in San Juan Puerto Rico in the Oncologic Hospital. Fifty Mexican-American (MA) and fifty non-Hispanic (NHW) white breast cancer survivors completed the survey in the Breast Clinic at the University of Texas M. D. Anderson Cancer Center. The survey included information on: current physical activity (Godin Leisure Time Exercise Scale, [GLTES]); current health status; and, anthropometric measures of BMI (kg/m 2 ) with hip and waist circumferences (W:H). SCT measures included: exercise self-efficacy (ESE), barriers self-efficacy (BSE), modeling (MOD), social support from friends (SSFR), and social support from family (SSFA). Descriptive statistics, one-way analysis of variance and correlation analyses were conducted for the three groups. Results: Participants were similar in age (M=56.75, SD=11.0), BMI (M=29.0, SD=5.7) and level of co-morbidity (M=1.63, SD=1.42). There were differences in GLTES score (p Conclusions: Consistent with current literature, Hispanic breast cancer survivors indicate that they are less physically active than non-Hispanic whites. Variables associated with current physical activity differ between Hispanic breast cancer survivor groups and non-Hispanic whites. Further research to understand culturally specific variables of exercise behaviors for ethnic breast cancer survivors are warranted in order to develop culturally competent interventions that can result in increased physical activity. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B57.

Abstract B5: Mexican-American and Puerto Rican breast cancer survivors’ perspectives on exercise

Purpose: To provide formative data for culturally tailoring an exercise intervention based on social cognitive theory, six focus groups of Mexican-American and Puerto Rican breast cancer survivors were formed to gain insight from breast cancer survivors’ perspectives on the issues surrounding cancer survivorship and exercise. Methods: Six focus groups with 4-7 breast cancer survivors were conducted; 3 in San Juan Puerto Rico metropolitan area and 3 in different cities in Texas (Houston, San Antonio, and Harlingen in the Lower Rio Grande Valley). A total of 29 breast cancer survivors participated in the sessions. This is the first out of four focus group sessions projected to be held over a year9s time. Using a social cognitive theory-based behavioral model as a guide, six questions were consistently presented to each focus group. The focus groups explored the meaning of exercise, previous experience with exercise, relationship between exercise and cancer, safety issues, barriers to exercise, and ideas on a possible exercise intervention. Based on discussion, follow-up questions were added as relevant to the overall six questions. The focus groups met for approximately an hour and a half. Each session was recorded, transcribed verbatim and then the responses were coded with Atlas.ti software using the same social cognitive theory behavioral model as a guide. Frequency and details of coded responses were compared between the six focus groups and compared between the Mexican-American and Puerto Rican groups. Results: A total of 29 codes were identified and used to catalogue 983 responses. Some responses were catalogued in more than one code. Both groups had similar descriptions of what they considered exercise and similar responses for barriers to exercise. Some of these barriers included time and fatigue. Walking, dancing, and using a gym facility were described throughout as exercise. However, the Mexican-American and the Puerto Rican groups greatly differed in their responses to perceived safety in their community and accessibility to exercise equipment/facilities. For example Puerto Ricans mostly felt secure exercising around their neighborhoods while Mexican-Americans did not; Mexican-Americans had more accessibility to parks or trails while Puerto Ricans did not. Both ethnic groups also expressed the absence of information from health care providers regarding their exercise capabilities and exercise limitations during and after their cancer treatments. In regards to delivering an intervention, the Mexican-American group was open to having a group intervention, while the Puerto Rican group preferred more of an individual intervention. Conclusions: Using a social cognitive theory-based behavioral model as a guide for coding, we found differences and similarities in factors of exercise behaviors and cancer survivorship exercise adherence between Mexican-American and Puerto Rican breast cancer survivor focus groups. This information can be used to help design culturally competent interventions for these specific ethnic groups. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B5.