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Using differential, multivariable risk models, we assessed the contribution of substance use and stress/traumatic events to hookah use among African American college students (n = 1,402) using data from the Fall 2012 American College Health Association-National College Health Assessment (ACHA-NCHA) II. Lifetime hookah use was 24.8%, with 34.2% of lifetime users having done so in the past 30 days. Compared to nonusers, hookah users had significantly higher use rates of alcohol, marijuana, other tobacco, and other drugs. Furthermore, hookah use was more likely among those with cumulative stress, yet less likely among older students. An implication is that prevention messages may need to be tailored for African American college students and particularly target younger students, substance users, and those with cumulative stress. These findings also inform policy discussions regarding hookah use on college campuses.
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Negro ou Afro-Americano/etnologia , Trauma Psicológico/etnologia , Cachimbos de Água/estatística & dados numéricos , Estresse Psicológico/etnologia , Estudantes/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/etnologia , Adolescente , Adulto , Feminino , Promoção da Saúde , Humanos , Acontecimentos que Mudam a Vida , Masculino , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Universidades/estatística & dados numéricos , Adulto JovemRESUMO
Although information-motivation-behavioral skills (IMB) adherence model has been successfully used in many illness domains and with other populations, it has not been used in understanding mammogram screening among low-income African-American women. Thus, a qualitative examination is needed to theoretically and collectively understand the barriers to screening, given the disparities in breast cancer mortality rates among this population. Semi-structured telephone interviews were conducted with 28 low-income uninsured and underinsured African-American women, 40 to 70 years, who had not had a mammogram within the past 12 months. Women were recruited from 21 hair and nail salons and Laundromats within the five North St. Louis city zip codes with the highest breast cancer mortality rates. Transcripts were analyzed and rooted in grounded theory. This study found that the individual relevancy of information, behavioral skills-both procedural and systematic-and motivation seemed to affect screening adherence; (the results suggest the importance of reordering traditional IMB components into the following sequential order: information, behavioral skills, and motivation (IBM)). Future analyses should include a larger, more representative sample of unscreened women, in which quantitative statistical analyses could be conducted to assist in strengthening assertions about information, behavioral skills, and motivational aspects and their relationship to screening.
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Negro ou Afro-Americano/psicologia , Mamografia , Motivação , Pobreza , Adulto , Idoso , Neoplasias da Mama/prevenção & controle , Feminino , Teoria Fundamentada , Comportamentos Relacionados com a Saúde/etnologia , Humanos , Mamografia/psicologia , Pessoa de Meia-Idade , Pesquisa Qualitativa , Telefone , Estados UnidosRESUMO
Previously published work finds significant benefit from medical and behavioral health team care among safety-net patients with major depression. This qualitative study assessed clinical social worker, psychiatrist and patient navigator strategies to increase depression treatment among low-income minority cancer patients participating in the ADAPt-C clinical depression trial. Patient care retention strategies were elicited through in-depth, semi-structured interviews with nine behavioral health providers. Using grounded theory, concepts from the literature and dropout barriers identified by patients, guided interview prompts. Retention strategies clustered around five dropout barriers: (1) informational, (2) instrumental, (3) provider-patient therapeutic alliance, (4) clinic setting, and (5) depression treatment. All strategies emphasized the importance of communication between providers and patients. Findings suggest that strong therapeutic alliance and telephone facilitates collaborative team provider communication and depression treatment retention among patients in safety-net oncology care systems.
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Depressão/terapia , Hispânico ou Latino , Grupos Minoritários , Neoplasias/psicologia , Cooperação do Paciente/psicologia , Pacientes Desistentes do Tratamento/psicologia , Pobreza , Atitude do Pessoal de Saúde , California/epidemiologia , Depressão/etnologia , Depressão/etiologia , Depressão/psicologia , Transtorno Depressivo Maior/etnologia , Transtorno Depressivo Maior/etiologia , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/terapia , Feminino , Humanos , Entrevistas como Assunto , Masculino , Neoplasias/etnologia , Cooperação do Paciente/etnologia , Cooperação do Paciente/estatística & dados numéricos , Pacientes Desistentes do Tratamento/etnologia , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Relações Profissional-Paciente , Pesquisa Qualitativa , Estudos Retrospectivos , Provedores de Redes de SegurançaRESUMO
Despite an overall decline in mortality, breast cancer is the most commonly diagnosed cancer and the second most common cause of cancer death among African-American women. As such, clinicians should prepare to address the unique sociocultural and psychological concerns encountered by African-American women breast cancer survivors. The objective of this study is to examine, using qualitative methods, the main coping facilitators used by African-American women as they transition across the cancer continuum. The identification of these facilitators was then aligned with culturally sensitive interventions most useful with women coping with cancer along the cancer continuum. This was a secondary analysis of 20 videotaped stories of African-American breast cancer survivors collected as a part of the Washington University Center for Excellence in Cancer Communications project. The interview began with a discussion of how the survivor first became aware she had breast cancer, followed by a series of open-ended probes used to explore the following themes: coping, relationships, health care system experiences, follow-up care, and quality of life living with breast cancer. Survivors discussed their experiences and advice for targeting needs at each cancer stage from screening to diagnosis, treatment, and then survivorship. Survivor narratives point to key evidence-based clinical intervention strategies at each stage of the cancer trajectory. This study found that survivors see a cyclical cancer course, whereby African-American breast cancer survivors serve an important role in the lives of unscreened women, newly diagnosed women, and women in treatment.
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Adaptação Psicológica , Pesquisa Biomédica , Negro ou Afro-Americano/psicologia , Neoplasias da Mama/psicologia , Qualidade de Vida , Grupos de Autoajuda/estatística & dados numéricos , Sobreviventes/psicologia , Adulto , Idoso , Atitude Frente a Saúde , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Comunicação , Estudos de Avaliação como Assunto , Feminino , Promoção da Saúde , Humanos , Pessoa de Meia-Idade , Narração , Educação de Pacientes como Assunto , PrognósticoRESUMO
Low-income and Latinos use the emergency department (ED) as a primary source of care. Also, the depression prevalence in ED patients is high, making the ED a compelling venue for depression screening and intervention. This study examined barriers and facilitators to depression treatment among low-income, predominantly Latino ED patients. We conducted telephone interviews with 24 ED patients (18-62 years of age, 79 % female) who dropped out of a depression treatment intervention. Using grounded theory, we analyzed perceptions of depression and treatment, and barriers and facilitators to mental health treatment. Although most patients acknowledged signs of depression, there was a lack of readiness to seek help. Patients reported negative perceptions about anti-depressant medication, even if they had no previous use. Barriers to treatment included transportation concerns, employment/unemployment, patient-provider issues, and immigrant documentation. Identified facilitators included consistent provider advice and "talking." This study introduced new misunderstanding and miscommunication barriers.
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Depressão/tratamento farmacológico , Acessibilidade aos Serviços de Saúde , Hispânico ou Latino/psicologia , Pobreza , Adolescente , Adulto , California , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Adulto JovemRESUMO
Although the overall incidence of stroke in the United States has decreased in recent years, the incidence of stroke among Black Americans has not changed. This has resulted in a widening gap between White and Black stroke survivors and their families. A variety of factors contribute to this inequity including social determinants of health (e.g., adverse life events, discrimination, neighborhood deprivation, lack of access to health care). This article uses a "case and frame" approach, through the lens of ecological systems theory, to illustrate how social determinants of health express themselves in two stroke survivor-caregiver dyads living in a large Midwestern city. We draw out implications for practice and policy in social work and related disciplines that focus on recognizing the impact of social determinants of health, developing culturally-specific interventions that mitigate unique stressors but that also leverage unique strengths, and building capacity for cultural competence and cross-cultural health communication within organizations.
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Cuidadores , Acidente Vascular Cerebral , Doença Crônica , Humanos , Fatores Socioeconômicos , SobreviventesRESUMO
Objective: To understand the theoretical framework of how information, motivation, and behavioral skills (IMB) independently and collectively affect cervical cancer screening and testing adherence. Study design: Qualitative study. Methods: Data collected from three focus groups and seven individual interviews, with 33 healthcare providers, ranging from community health navigators, Ob-Gyn MD's, nurses, care coordinators, medical assistants, and outpatient managers, representing a grassroots community health agency, a large cancer center, and a public sector health clinic. We recruited providers over a five-month period in the summer to fall of 2019. Provider interviews and focus groups were structured with four to eleven participants per group and were audio-recorded. This study was rooted in grounded theory, analyzing data using the iterative process of Coding, Consensus, Co-occurrence, and Comparison to identify common themes. Results: Emerging qualitative findings include the relevance of information, the interaction between information and motivation, the role of behavioral skills, and the symbiotic relationship between information, motivation, and behavioral skills (IMB). Most notable is this interdependency between IMB components, with the core of this relationship being the critical link of coordinating adherence. Conclusion: This knowledge will help advance and expand IMB intervention components to improve time to cervical cancer screening and follow-up adherence among at-risk communities. Particularly given COVID-19 barriers, which disproportionately affect at-risk women, this study has practice implications that inform the development of cervical cancer screening practice interventions and strategies to improve adherence, while ensuring safety for both patients and providers.
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Objectives: Asian American subgroups' influenza vaccination is still below the US standards. This study examined the effects of patient-centered communication (PCC) on influenza vaccination and the general health (GH) of Chinese, Vietnamese, and Korean Americans. A group difference between younger and older adults was investigated. Methods: The 2014-2016 California Health Interview Surveys were merged (Chinese [N = 1,680], Korean [N = 514], and Vietnamese [N = 644]; age 18+; younger = 1,629 and older = 1,209). Two path models (PCC [measured by physicians' careful listening], vaccination, and GH; PCC [measured by physicians' clear explanation], vaccination, and GH) were evaluated. Regression maximum likelihood was applied for missing values. Results: Both the first and second models showed good model fit scores (comparative fit index [CFI] = .95, root mean square error of approximation [RMSEA] = .04, and standardized root mean residual [SRMR] = .03; CFI = .93, RMSEA = .04, and SRMR = .03). There were direct effects of PCC on vaccination among younger adults. PCC directly influenced GH for both age-groups. Discussion: A PCC manual for physicians in local or community health centers could enhance both younger and older adults' influenza vaccination.
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Asiático/psicologia , Comunicação , Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Assistência Centrada no Paciente , Adolescente , Adulto , Fatores Etários , Idoso , Asiático/estatística & dados numéricos , California , Autoavaliação Diagnóstica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Vacinação/estatística & dados numéricos , Adulto JovemRESUMO
BACKGROUND: The coronavirus disease (COVID-19) first identified in Wuhan in December 2019 became a pandemic within a few months of its discovery. The impact of COVID-19 is due to both its rapid spread and its severity, but the determinants of severity have not been fully delineated. OBJECTIVE: Identify factors associated with hospitalization and disease severity in a racially and ethnically diverse cohort of COVID-19 patients. METHODS: We analyzed data from COVID-19 patients diagnosed at the University of Cincinnati health system from March 13, 2020 to May 31, 2020. Severe COVID-19 was defined as admission to intensive care unit or death. Logistic regression modeling adjusted for covariates was used to identify the factors associated with hospitalization and severe COVID-19. RESULTS: Among the 689 COVID-19 patients included in our study, 29.2% were non-Hispanic White, 25.5% were non-Hispanic Black, 32.5% were Hispanic, and 12.8% were of other race/ethnicity. About 31.3% of patients were hospitalized and 13.2% had severe disease. In adjusted analyses, the sociodemographic factors associated with hospitalization and/or disease severity included older age, non-Hispanic Black or Hispanic race/ethnicity (compared to non-Hispanic White), and smoking. The following comorbidities: diabetes, hypercholesterolemia, asthma, COPD, chronic kidney disease, cardiovascular diseases, osteoarthritis, and vitamin D deficiency were associated with hospitalization and/or disease severity. Hematological disorders such as anemia, coagulation disorders, and thrombocytopenia were associated with both hospitalization and disease severity. CONCLUSION: This study confirms race and ethnicity as predictors of severe COVID-19. It also finds clinical risk factors for hospitalization and severe COVID-19 not previously identified such a vitamin D deficiency, hypercholesterolemia, osteoarthritis, and anemia.
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OBJECTIVE: This article describes the randomized clinical trial methodology for a population-based study of oncology patients receiving cancer care in a public sector medical center. The primary goal is to test the effectiveness of socioculturally tailored collaborative care intervention in improving depression and quality of life outcomes among low-income ethnic minority patients with major depression and cancer. METHODS: The Patient Health Questionnaire (PHQ-9) depression scale was used to identify patients meeting criteria for major depression (one cardinal depression symptom plus a PHQ-9 score of > or =10). Study-eligible patients were >/=90 days from cancer diagnosis who were receiving acute cancer treatment or follow-up care in oncology clinics. Patients with advanced disease limiting life expectancy to <6 months, acutely suicidal or on antipsychotic medication were excluded. Allowing for attrition due to death or loss to follow-up, the study was powered at the 80% level to detect a 20% difference between study arms in the proportion of patients with >/=50% reduction in PHQ-9 symptoms at 12 months. RESULTS: Of 2330 patients screened, 23.2% met criteria. An 82.4% enrollment rate resulted in 446 primarily women being recruited and randomized to intervention or usual care. CONCLUSION: The study applies methods used in primary care depression trials with adaptations for oncology care clinics and for low-income minority patients.
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Depressão/psicologia , Depressão/terapia , Neoplasias/psicologia , Centros Médicos Acadêmicos , Idoso , Algoritmos , Depressão/complicações , Depressão/etnologia , Feminino , Hispânico ou Latino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/etnologia , Pobreza , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Projetos de PesquisaRESUMO
Human papillomavirus (HPV) vaccination rates remain low, but college student vaccination could offset this trend. This study identifies characteristics that could enhance HPV vaccination among U.S. college students. Data were from the National College Health Assessment II survey (fall 2012, N = 18,919). Univariate and logistic regression analyses were used to examine associations among demographic characteristics, college region and size, health status, receipt of health services, sexual health information, and HPV vaccination status. Among women, ethnic minorities, students attending schools in the South, those not receiving routine gynecological care in the past 12 months, and those unsure of when they last received gynecological care were less likely to report HPV vaccination. Among men, African Americans, students attending schools in the South and West, and those receiving sexually transmitted infection information were more likely to report vaccination. Data suggest that college health education can help to improve U.S. HPV vaccination rates. Campus health practitioners providing sexual health information and referrals are positioned to assist in this effort.
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Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Universidades , Vacinação , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , EstudantesRESUMO
This study aims to explore reasons for depression treatment dropout among low-income, minority women with depression and cancer. Semi-structured telephone interviews are conducted with 20, predominately Latina, patients who dropped out of depression treatment and 10 who completed. Transcripts analyzed using techniques rooted in grounded theory. Treatment completion barriers cluster according to Meichenbaum and Turk's (Facilitating treatment adherence: A practitioner's guidebook, Plenum Press, New York, 1987) five adherence dimensions: (a) Barriers to Treatment (informational, instrumental, cultural [language, discrimination]); (b) Disease Features (emotional burden of cancer/depression); (c) Cancer/Depression Treatment Regimens; (d) Provider-Patient Relationship (depression treatment dissatisfaction); and (e) Clinical Setting (hospital organizational issues). Although both groups describe multiple overlapping dimensions of barriers, completers seem more motivated and satisfied with treatment, possibly due to completers experiencing the positive treatment effects after the first several sessions. More research should be conducted to determine the most effective clinical treatment methods for this population.
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Transtorno Depressivo/psicologia , Transtorno Depressivo/terapia , Hispânico ou Latino/psicologia , Neoplasias/psicologia , Pacientes Desistentes do Tratamento/psicologia , Pobreza/psicologia , Idoso , Antidepressivos/uso terapêutico , Terapia Cognitivo-Comportamental , Terapia Combinada , Comorbidade , Comportamento Cooperativo , Efeitos Psicossociais da Doença , Feminino , Humanos , Comunicação Interdisciplinar , Entrevistas como Assunto , Pessoa de Meia-Idade , Motivação , Multilinguismo , Neoplasias/etnologia , Neoplasias/terapia , Cooperação do Paciente , Satisfação do Paciente , Pobreza/etnologia , Atenção Primária à Saúde , Resolução de Problemas , Estados UnidosRESUMO
BACKGROUND: Callers to 2-1-1 have greater need for and lesser use of cancer control services than other Americans. Integrating cancer risk assessment and referrals to preventive services into 2-1-1 systems is both feasible and acceptable to callers. PURPOSE: To determine whether callers will act on these referrals. METHODS: In a randomized trial, 2-1-1 callers (n=1200) received standard service and those with at least one cancer risk factor or need for screening were assigned to receive verbal referrals only, verbal referrals + a tailored reminder mailed to their home, or verbal referrals + a telephone health coach/navigator. All data were collected from June 2010 to March 2012 and analyzed in March and April 2012. RESULTS: At 1-month follow-up, callers in the navigator condition were more likely to report having contacted a cancer control referral than those receiving tailored reminders or verbal referrals only (34% vs 24% vs 18%, respectively; n=772, p<0.0001). Compared to verbal referrals only, navigators were particularly effective in getting 2-1-1 callers to contact providers for mammograms (OR=2.10, 95% CI=1.04, 4.22); Paps (OR=2.98, 95% CI=1.18, 7.54); and smoking cessation (OR=2.07, 95% CI=1.14, 3.74). CONCLUSIONS: Given the extensive reach of 2-1-1s and the elevated risk profile of their callers, even modest response rates could have meaningful impact on population health if proactive health referrals were implemented nationally.
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Serviços de Informação/organização & administração , Neoplasias/diagnóstico , Serviços Preventivos de Saúde/métodos , Encaminhamento e Consulta/organização & administração , Adulto , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Mamografia/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Neoplasias/prevenção & controle , Medição de Risco/métodos , Fatores de Risco , Abandono do Hábito de Fumar/estatística & dados numéricos , TelefoneRESUMO
BACKGROUND: Adherence is a critical component of clinical intervention utility, but little is known about how cancer patients with depression, particularly low-income, ethnic minority patients, perceive adherence to and drop out from treatment. AIM: To explore low-income, minority cancer patient perspectives about not adhering or dropping out of depression treatment. METHODS: A qualitative substudy was conducted within the Alleviating Depression among Patients with Cancer (ADAPt-C) study. The intervention was an individualized stepped care depression treatment program provided by a clinical social worker in collaboration with a study psychiatrist. Patients randomized to the intervention were offered antidepressant medication and/or 8-10 sessions of problem solving treatment talk therapy. In-depth telephone interviews were conducted with 20 patients who had dropped out of depression treatment, using a grounded theory qualitative methodological approach. RESULTS: Enrolled intervention patients were predominately Latina, Spanish-speaking, and foreign born. Most patients (12/20) acknowledged they had dropped out of treatment for a variety of reasons, including dissatisfaction with treatment, poor patient-provider relations, logistical and financial barriers, cancer treatment commitments, and language barriers. However, other patients (8/20) denied they had dropped out of treatment and/or became confused about being labeled as a "dropout." CONCLUSION: A substantial percentage of low-income, ethnic minority patients who drop out of treatment for depression appear not to realize they have dropped out of treatment. Improving treatment adherence requires explanation of what constitutes adherence and the consequences of failing to do so from the perspective of both patient and provider.
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OBJECTIVE: This study assessed longer-term outcomes of low-income patients with cancer (predominantly female and Hispanic) after treatment in a collaborative model of depression care or in enhanced usual care. METHODS: The randomized controlled trial, conducted in safety-net oncology clinics, recruited 472 patients with major depression symptoms. Patients randomly assigned to a 12-month intervention (a depression care manager and psychiatrist provided problem-solving therapy, antidepressants, and symptom monitoring and relapse prevention) or enhanced usual care (control group) were interviewed at 18 and 24 months after enrollment. RESULTS: At 24 months, 46% of patients in the intervention group and 32% in the control group had a ≥50% decrease in depression score over baseline (odds ratio=2.09, 95% confidence interval=1.13-3.86; p=.02); intervention patients had significantly better social (p=.03) and functional (p=.01) well-being. Treatment receipt among intervention patients declined (72%, 21%, and 18% at 12, 18, and 24 months, respectively); few control group patients reported treatment receipt (10%, 6%, and 13%, respectively). Significant differences in receipt of counseling or antidepressants disappeared at 24 months. Depression recurrence was similar between groups (intervention, 36%; control, 39%). Among patients with depression recurrence, intervention patients were more likely to receive treatment after 12 months (34% versus 10%; p=.03). At 24 months, attrition (262 patients, 56%) did not vary by group; 22% were deceased, 20% declined further participation, and 14% could not be located. CONCLUSIONS: Collaborative care reduced depression symptoms and enhanced quality of life; however, results call for ongoing depression symptom monitoring and treatment for low-income cancer survivors.
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Transtorno Depressivo/terapia , Hispânico ou Latino/psicologia , Neoplasias/psicologia , Pobreza/psicologia , California , Terapia Combinada , Transtorno Depressivo/economia , Transtorno Depressivo/etnologia , Transtorno Depressivo/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/economia , Equipe de Assistência ao Paciente , Satisfação do Paciente , Pobreza/economia , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Prevenção SecundáriaRESUMO
OBJECTIVE: This study examined the effects (affective reactions, cognitive reactions and processing, perceived benefits and barriers and intent to screen) of targeted peripheral+evidential (PE) and peripheral+evidential+socio-cultural (PE+SC) colorectal cancer communications. METHODS: This study was a two-arm randomized control study of cancer communication effects on affective, cognitive processing, and behavioral outcomes over a 22-week intervention. There were 771 African American participants, 45-75 years, participating in the baseline survey related to CRC screening. Three follow-up interviews that assessed intervention effects on affective response to the publications, cognitive processing, and intent to obtain CRC screening were completed. RESULTS: There were no statistically significant differences between PE and PE+SC intervention groups for affect, cognitive processing or intent to screen. However, there were significant interactions effects on outcome variables. CONCLUSIONS: The advantages and disadvantages of PE+SC targeted cancer communications and implications of sex differences are considered. PRACTICE IMPLICATIONS: While there do not appear to be significant differences in behavioral outcomes when using PE and PE+SC strategies, there appear to be subtle differences in affective and cognitive processing outcomes related to medical suspicion and ethnic identity, particularly as it relates to gender.
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Negro ou Afro-Americano , Neoplasias Colorretais/etnologia , Comunicação , Cultura , Educação em Saúde/métodos , Afeto , Idoso , Cognição , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/prevenção & controle , Medicina Baseada em Evidências , Feminino , Seguimentos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
Various psychosocial barriers currently prevent proportional representation of racial and ethnic minority groups in oncology clinical trials. These barriers can be conceptualized into a Social Ecological Model framework, with particular emphasis on the socio-cultural dimension. The barriers to participation can be summarized into six levels of influence: intrapersonal, interpersonal, environmental, socio-cultural, community, and institutional. Given social workers' multi-systemic approach to assessing and intervening in problems, their positioning at micro-, meso-, and macro-levels of practice, education, policy, and research are appropriate and critical to promoting clinical trial participation.
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Ensaios Clínicos como Assunto , Etnicidade/psicologia , Neoplasias , Participação do Paciente , Seleção de Pacientes , Grupos Raciais/psicologia , Humanos , Psicologia , Estados UnidosRESUMO
BACKGROUND: Attention to the economic consequences of cancer has grown as the number of cancer survivors is increasing. Although prevalent among low-income minority survivors, the impact of economic stress on quality of life (QOL) remains largely unexplored. METHODS: Data are reported for 487 predominantly Hispanic low-income women with a primary diagnosis of breast or gynecological cancer and undergoing active treatment or follow-up. Cross-sectional and longitudinal analyses examined the effects of economic concerns on QOL, depression, and anxiety. RESULTS: Rates of unemployment, medical cost and wage concerns, and financial stress were high in this study population, at baseline, respectively, 70%, 68%, 47%, and 49%. The proportions reporting unemployed status and medical cost concerns stayed flat from baseline to 6 months, followed by a pronounced drop at 12 months. Patient reported rates of lost wage worries increased from baseline to 6 months, followed by a moderate decrease. Functional, emotional, physical, and social-family well-being and depression and anxiety scores exhibited consistent linear improvement from baseline to 12 months. Over 12 months, patients reporting economic concerns had significantly poorer functional, emotional, and affective well-being. CONCLUSIONS: Economic stress is negatively associated with QOL, highlighting the importance of addressing economic stress in low-income women with cancer.