Socio–cultural, Psychological & Issues: the Human Side
Translational Research Collaboration (TRC) – Full Research
Awards
Socio–cultural — Request for Applications (RFA)
Awards
Postdoctoral Fellowship Awards
While most research on breast cancer is focused on the biology of the disease, we cannot forget the social and cultural context in which women who are faced with breast cancer live and make decisions. These aspects of human life influence health-related behavior, quality of life, and the biological response to breast cancer. It is the goal of this Priority Issue to explore these socio-cultural factors to allow us to impact the human and economic cost of breast cancer.
Targeted funding in this area was available for the first time in Cycle IV, and 3 grants were awarded. Two of these projects address the needs of women at higher risk of breast cancer. In the first study (Joan Bloom, Marion Lee and Susan Stewart), telephone counseling will be used to reach sisters of young women with breast cancer to educate them, address anxiety and promote screening. In the second study (Nangel Lindberg), the facilitators and barriers to attending a clinic for women at higher risk of breast cancer will be explored, with the goal of informing health service providers and improving the care they deliver to women. The third study, to be conducted by Rose Maly, is focused on a population that receives little attention in research – older women. The study will explore the experience of older women with breast cancer and develop and test interventions to increase quality of life for these women.
The results of each these studies will provide strategies to improve care for women immediately, and to improve their quality of life for the future.
Translational Research Collaboration (TRC) – Full Research Award
Risk Notification for Women at High Risk for Breast Cancer
Joan R. Bloom, Ph.D
University of California, Berkeley
Marion Lee, Ph.D.
University of California, San Francisco
Susan L. Stewart, Ph.D.
Northern California Cancer Center
This study's purpose is to test a telephone counseling strategy for women that are at higher than average risk for breast cancer. The extent to which relatives (sisters) of young women with breast cancer are aware of their heightened risk will be evaluated, as well as the extent to which they seek out breast cancer screening and/or genetic counseling and perform early detection behaviors (breast self examination). Telephone counseling will then be used to assist relatives of breast cancer patients in understanding their probability of developing cancer, to assist them in managing their individual anxieties, to give educational information supporting the beneficial attributes of early detection, and to provide positive motivating conversation stimulating them to seek early detection of the disease. Telephone counseling has been used successfully as an intervention strategy for a variety of health behaviors, such as the use of prenatal care, providing social support to caregivers and patients, and providing specific health information on topics that include cancer screening. Ultimately, the research is expected to be a major benefit to health maintenance organizations and other health care agencies in local communities.
In the first phase of the project, a telephone counseling protocol will be field tested with 400 women. The women involved are sisters of a population-based group of women diagnosed with breast cancer at age 50 or younger, of whom approximately 30% are Asian, Latina, or African American. In the second phase of the project, the telephone risk counseling protocol will be implemented in the Cancer Information Service (CIS) of Northern California and Nevada with 400 women calling about breast cancer who are not diagnosed patients. This National Cancer Institute (NCI) funded service provides the latest, most accurate cancer information to the public and health professionals. It handles about 17,000 inquiries annually through the 1-800-4CANCER telephone service, and has built successful collaborations throughout northern California and Nevada. The CIS previously served as an agent for behavior change through a telephone intervention strategy that focused on increasing consumption of fruits and vegetables.
This study brings together scientists from the fields of genetics, mathematics, oncology, psychology, and sociology, and combines the resources of three major institutions of research. The ultimate goal is to translate the use of this intervention to clinical and community settings in order to reduce the incidence of late-stage breast cancer.
Socio–cultural — Request for Applications (RFA) Award
Improving Quality of Life in Older Women after Breast Cancer
Rose C. Maly, M.D.
University of California, Los Angeles- Department of Medicine
Breast cancer is the most common cancer in older women. Despite the aging of the population, older women with breast cancer remain an understudied population. Older women's illness experience of breast cancer may differ significantly from younger women's in the way they are evaluated and treated by the health care system, and in their personal reactions to, and needs resulting from, the diagnosis. The proposed research is aimed at two targeted areas of BCRP’s emphasis on socio-cultural, psychological and behavioral issues in breast cancer: 1) The patient-physician interaction, specifically with regard to physician provision of information and emotional support to the newly diagnosed older patient, and 2) enhancing quality of life in older breast cancer patients, by improving emotional, social, and informational support at the time of diagnosis.
The study is designed to assess older breast cancer patients’ illness experience, specifically in terms of psychosocial, informational, and health needs arising from the diagnosis, how and whether these needs are met by health care practitioners, and how health, functioning, and quality of life are associated with the degree to which these needs are met. On the basis of these findings, the study will continue with development and testing of the feasibility of potential interventions to improve emotional, social, and informational support given to newly diagnosed older breast cancer patients by physicians and their staff. It is anticipated that completion of the study will provide a detailed understanding of the illness experience of older breast cancer patients, generate innovative interventions that can be easily incorporated in the everyday practice of community physicians to address these patients' psychosocial and emotional needs, and provide the basis for a future clinical trial of the most promising interventions' effectiveness in maintaining or improving health, functioning, and quality of life in older women with breast cancer.
Postdoctoral Fellowship Award
Prediction of Compliance and Retention in High-Risk Patients
Nangel M. Lindberg, Ph.D.
University of California, Los Angeles- Department of Psychiatry
For women at familial risk for breast cancer, early detection and adherence to medical recommendations is particularly critical; however, studies have shown that family history of breast cancer is associated with emotional reactions that may interfere with desirable health practices, including non-participation in prevention and screening programs.
The proposed study addresses the Breast Cancer Research Program's priority issues involving improved access for underserved populations, specifically women at familial risk for developing breast cancer. Having a first-degree relative affected with breast cancer, and being identified as at high risk for developing the disease may be considered traumatic stressors given the perception of life-threat or injury to self, and witnessing the suffering and expression of distress of a close significant other. Clinical observations about women with a family history of breast cancer have shown them to have emotional reactions including fear of death, feelings of guilt, and unresolved grief and depression, all of which have been found to be barriers to screening and preventive behaviors. However, much remains to be done in understanding the factors that affect at-risk women's attendance to preventive, early detection programs, and compliance with medical recommendations regarding preventive behaviors.
The proposed study seeks to: (1) examine the factors associated with attendance to multidisciplinary preventive programs such as the UCLA High Risk Clinic; (2) examine the factors that may affect adherence to medical recommendations and preventive health behaviors; (3) assess compliance and Clinic attendance for different groups of at-risk women. The ultimate goal of the proposed study is to aid in the development and modification of programs that would facilitate and improve access to services for women at familial risk for breast cancer, fostering the development of beneficial health behaviors, including preventive measures and early detection screenings.
The proposed study has the potential to immediately impact prevention and treatment programs for women at high risk for developing breast cancer. The findings from this study may be applied to other at-risk populations. The study is innovative, involving a well-established multidisciplinary team of researchers and practitioners from diverse fields, and presents as an additional strength feasibility of completion, as it involves the participation of a large group of patients, some of whom have been followed at the UCLA High Risk Clinic for several years.
