California Cancer Research Program
Completed Projects
The following Principal
Investigators have completed their research as funded by CRP. Where applicable,
publications resulting from CRP funding are also included.
CYCLE II FINAL LAY
ABSTRACTS
[PSYCOSOCIAL/CULTURAL ASPECTS]
Investigator-Initiated
Awards
Kimlin T. Ashing-Giwa, Ph.D.: Psychosocial Aspects; a Controlled Prospective Study
of Cervical Cancer in a Multiethnic Sample
Peter R. Carroll, M.D.: Psychosocial Counseling to Improve Outcomes in Men With Prostate
Cancer
Deborah P. Lubeck, Ph.D.: Measurement of Patient Preferences for Treatment of Prostate Cancer
Alexis D. Abernethy, Ph.D.: Religiousness and Prostate Screening in African
American Men
Judith M.E. Walsh, M.D., M.P.H.: Barriers to Colon Cancer Screening in Minority
Populations
Religiousness and Prostate
Screening in African American Men
Alexis D. Abernethy, Ph.D.
Fuller
Theological Seminary
$158,993.00
/ 24 months
Prostate
Cancer
Pilot
and Feasibility Study Award
African American men are more
likely to have prostate cancer and are twice as likely to die from prostate
cancer as compared to White men.
Many factors influence African American menÕs openness to prostate
cancer screening. Concerns about
prostate screening and fears related to dying cause some men to avoid prostate
cancer screening. African AmericanÕs views about God and ideas about how God relates
to people when they are ill may influence how open men may be to participating
in prostate cancer screening.
Spirituality plays an important role in the lives of many African
Americans and many turn to God in times of difficulty. This study sought to
understand whether African American menÕs views about God would influence their
openness to prostate cancer screening.
This study had three
phases: baseline, intervention,
and follow-up. Specifically, this
study tested whether certain types of religiousness and fatalism (i.e., a
hopeless view about the possibility of having cancer) affect whether African
American men participate in screening.
This study also tested the effectiveness of a Cultural Intervention that
was designed to increase menÕs openness to screening. Questionnaires were completed on three different occasions
and covered areas related to religiousness, ideas about cancer, emotions, and
screening activity. Six hundred
and fifty-five men were recruited from three churches in the Los Angeles area
and a homeless shelter. From this
larger pool of men, 544 men were eligible to participate in the study. Three to six months later these men
were contacted to particpate in either a Cultural or Standard
Intervention. The Cultural
Intervention involved a presentation by an African American prostate cancer
survivor and a video that highlighted religious and cultural values that might
interfere with and support screening as well as basic information about
prostate screening presented by physicians. The Standard Intervention included a similar presentation by
an African American prostate cancer survivor and basic information about
prostate screening that was presented by physicians and lay educators. The Standard Intervention did not
address cultural and religious factors.
One hundred and seventy men participated in the intervention and
completed questionnaires immediately following the intervention. One year later, 201 men who met the
study criteria completed the follow-up phase by responding to questions. Of these men, 59 men had participated
in all three phases of the study.
We found a relationship
between religiousness and prostate screening. Men who reported that religiousness and spirituality were
central to them intended to get screened for prostate cancer and tended to view
screening as important and effective.
Those men who had fatalistic attitudes toward prostate cancer screening,
including feelings of fear, pessimism, and inevitability of death as a result
of a cancer diagnosis, did not view screening as effective and did not intend
to get screened. These results
suggest that there is a relationship between religiousness, fatalism, and
prostate screening in this sample of African American men. Although these men were recruited from
churches, at least 24% of them did not attend church regularly. Future research will need to clarify
whether this relationship between religiousness and prostate screening is found
in a general community sample. The
results do not support the effectiveness of the Cultural Intervention as no
differences in openness to screening were found as a result of the
intervention. This was the first
pilot of this intervention.
Modifications in the content and technical production of the video
should improve its effectiveness.
This study demonstrated that religiousness and fatalism are related to
African American menÕs participation in screenings. The next step is to determine whether addressing specific
aspects of religiousness and fatalism in informational programs will increase
African American menÕs openness to prostate cancer screening.
Psychosocial Aspects; a Controlled Prospective
Study of Cervical Cancer in a Multiethnic Sample
Kimlin T. Ashing-Giwa, Ph.D.
University
of California, Los Angeles
$1,010,464.00
/ 36 months
Cervical
Cancer
Investigator-Initiated
Award
Cervical cancer accounts for
6% of all cancers in women in the US. In 2003 approximately 13,000 women
nationally and 1600 women in California will be diagnosed with invasive
cervical cancer (Cancer Facts & Figures, 2004; California Cancer Facts
& Figures, 2004). California (particularly Los Angeles County) has the
highest cervical cancer rate and accounts for over 12% of the cases in the US.
There is a lack of research addressing the psychological and medical care
issues among cervical cancer survivors (CCS). In addition, given the fact that ethnic minority groups are
the fastest-growing populations in the U.S., and that these women have a higher
incidence and lower five-year survival rate, extra attention should be paid.
The research questions to be addressed in this study are: Are there any ethnic
differences in HRQOL? What factors
influence HRQOL?
The
scientific accomplishment for this year is the completion of about 40% surveys
for the study. During this year an
additional 331 survivors participated. We have conducted preliminary data
analyses on the first 497 participants. Latinas reported the lowest overall
HRQOL and the lowest physical, functional, emotional, and social/family wellbeing
(p<0.008). Most CCS reported
adequate medical care regardless of insurance coverage, income level, and
ethnicity. Better HRQOL was related to no radiation treatment, better health perceptions, higher SES,
private insurance, and satisfaction with their relationship with their doctors
and health care services
(p<0.05).
The cervical cancer diagnosis
and its treatments left most survivors very burdened. There were persistent concerns about medical issues (e.g.,
bowel and bladder dysfunction, chronic pain, numbness in the leg, survival,
cancer recurrence or disease progression), psychosocial issues (e.g.,
isolation, anxiety, depression, lack of friendship relationships and support),
spiritual concerns (punishment); marital and relational concerns (e.g.,
fidelity, quality, longevity of relationship and family stability); fertility,
sexuality (e.g., sexual
self-evaluation, desire and enjoyment), womanhood (e.g., self-definition,
lacking uterus) and body image concerns. CCS reported a lack of resources including
timely, quality, affordable primary and follow-up cancer-related care and
psychosocial services. Delay in
seeking care and receiving treatment was due to financial problems, health care
system delays and fear of finding cancer. Additionally, these survivors were
concerned that there were not more media and public health attention to
cervical cancer. They expressed a need for more resources (e.g., education,
primary and follow-up medical care, research, clinical trials and support
groups for women with cervical cancer and dysplasia).
The results of this study
will inform the medical and research community about the psychosocial aspects
and HRQOL impact of cervical cancer.
Additionally, the findings of the study were shared with the health care
community, community health agencies, advocates and legislators at a meeting
co-sponsored by the Los Angeles County Office of WomenÕs Health. More
importantly, this study may address some of the health-related issues of the
more than 200,000 women in the U.S living with a cervical cancer diagnosis and
the concerns of their families and friends who are affected by this
illness. Further, the results of
this study will inform an intervention study to reduce the burden of cancer
among underserved women. This study will be submitted to the National Institute
of Health for review in October 2004 for funding.
1.
Ashing-Giwa
KT, Kagawa-Singer M, Padilla GV, Tejero JS, Hsiao E, Chhabra R, Martinez L,
Tucker MB. The impact of cervical cancer and dysplasia: a qualitative,
multiethnic study. Psychooncology. 2004 Oct;13(10):709-28.
2. Ashing-Giwa, KT. Can a Culturally Responsive Model
for Research Design Bring Us Closer to Addressing Participation Disparities?.
Lessons Learnt from Cancer Survivorship Studies. In Press, Ethnicity &
Disease
3.
Ashing-Giwa, KT.
Enhancing the HRQOL Framework. In Press, Quality of Life Research.
Psychosocial Counseling to Improve Outcomes in Men
With Prostate Cancer
Peter R. Carroll, M.D.
University
of California, San Francisco
$486,495.00
/ 36 months
Prostate
Cancer
Investigator-Initiated
Award
Prostate cancer is a major
health care issue in the United States due to its increasing incidence (most
common cancer detected in American men), its mortality (second leading cause of
cancer death), the fact that no consensus has been reached on the optimal
management of any stage of the disease, and the incerasing costs associated
with its detection, staging and treatment. For the most part, only biomedical endpoits, death, physical diability or cure, have been assessed following the
diagnosis and treatment of prostate. Relatively little effort has been placed
on assessing the impact of this disease, its diagnosis and subsequent
treatment, on health-related-quality-of-life (HRQOL). This is especially
relevant for patients with prostate cancer as survival for most currently
managed patients is high, the natural history of the disease may be very
protracted, there is a significant risk of treatment-induced side effects, and
a substantial number of patietns may fail to be cured even with standard
therapy. Innovative psychosocial intervention may reduce the physical,
emotional and psychological well being of patients with prostate cancer. We
proposed a randomized trial of short-term psychosocial intervention emphasizing
improved coping skills in men with newly diagnosed prostate cancer to determine
whether such intervention will imporve HRQOL and satisfaction with care before
and after treatment. We investigated the relationships between patient characteristics (age,
disease stage, treatment modality, marital status, general coping style, and
baseline emotioal status) and the outcomes listed above as well as determine
whether short-term psychosocial intervention results in an imporved ability ot
cope with biochemical or clinical recurrence of disease. It was concluded that
short-term psychosocial intervention can significantly influence
attitudes/behavior related to coping with cancer and emotional well-being.
Therefore it could be be incorporated into a comprehensive treatment regimen.
These findings can have important implication in understanding the process of
recovery after radical prostatectomy and providing the necessary services.
1. Lubeck DP, Grossfeld GD, and Carroll PR. A review
of measurement of patient preferences for treatment outcomes after prostate
cancer. Urology. 2002. 60(3 Suppl 1): p. 72-7; discussion 77-8.
Measurement of Patient Preferences for Treatment of
Prostate Cancer
Deborah P. Lubeck, Ph.D.
University
of California, San Francisco
$460,516.99
/ 24 months
Prostate
Cancer
Investigator-Initiated
Award
No final report submitted.
1.
Lubeck DP,
Grossfeld GD, and Carroll PR. A review of measurement of patient preferences
for treatment outcomes after prostate cancer. Urology. 2002. 60(3 Suppl 1): p.
72-7; discussion 77-8.
Barriers to Colon Cancer Screening in Minority
Populations
Judith M.E. Walsh, M.D., M.P.H.
University
of California, San Francisco
$210,187.00
/ 24 months
Colorectal
Cancer
Pilot
and Feasibility Study Award
The goal of this project was
to assess barriers to colon cancer screening in Vietnamese, Latino and low
income white populations.
To achieve this goal, we
conducted a telephone survey of 775 individuals (29% Latino, 31% Vietnamese,
40% low income white) regarding currents rates of screening and barriers and
facilitators to colon cancer screening.
We first conducted focus groups to learn more about the potential
barriers and facilitators to colon cancer screening in this population, and
used the focus group results to develop the telephone survey.
Overall 23% of respondents
reported receipt of fecal occult blood testing (FOBT) in the past year, 28%
reported sigmoidoscopy in the past 5 years and 37% reported colonoscopy in the
past 10 years. Screening rates were generally lower in Vietnamese and Latinos
than in whites. In addition,
Vietnamese and Latinos reported different barriers and facilitators to colon
cancer screening than did whites.
Latinos frequently stated that embarrassment and discomfort were potential
barriers, whereas Vietnamese were less likely to state these as barriers. The biggest factor influencing
individualsÕ plans to undergo colon cancer screening was physician
recommendation.
We are using the results of
this survey to develop an intervention that will be implemented in San Jose
California to increase rates of colon cancer screening in Latinos and
Vietnamese. The intervention will
be a culturally and educationally tailored brochure with or without the
addition of telephone counseling.
1.
Walsh
JM, Kaplan CP, Nguyen B, Gildengorin G, McPhee SJ, Perez-Stable EJ. Barriers to
colorectal cancer screening in Latino and Vietnamese Americans. Compared with
non-Latino white Americans. J Gen Intern Med. 2004 Feb;19(2):156-66.
California Cancer Research Program
(916) 449-5550
E-mail crp@dhs.ca.gov