Theresa A Hastert

Wayne State University | WSU · Barbara Ann Karmanos Cancer Institute

Background Black women with epithelial ovarian cancer (EOC) have worse survival and a higher burden of comorbid conditions compared with other racial groups. This study examines the association of comorbid conditions and medication use for these conditions with survival among Black women with EOC. Methods In a prospective study of 592 Black women...

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) cancer survivors disproportionately experience physical and mental health comorbidities compared with their heterosexual and cisgender counterparts. A recent study by Waters and colleagues evaluates associations between LGBTQ+ identity and physical and mental health comorbidities and activity...

Importance Ovarian cancer survival among Black women is the lowest across all racial and ethnic groups. Poor dietary quality also disproportionately affects Black populations, but its association with ovarian cancer survival in this population remains largely unknown. Objective To examine associations between dietary patterns and survival among Bl...

Non-Hispanic Black (NHB) patients face the highest colorectal cancer (CRC) mortality rates in the US, heavily influenced by social determinants of health (SDOH). Neighborhood quality, a key SDOH, impacts both socioeconomic factors and exposure to cancer-related environmental contaminants. Thus, in studying the role of environmental justice on healt...

Advances in cancer screening and treatment have improved survival after a diagnosis of cancer. As the number of cancer survivors as well as their overall life-expectancy increases, investigations of health-related quality of life (HRQOL) are critical in understanding the factors that promote the optimal experience over the course of survivorship. H...

Colorectal cancer (CRC) is the third most diagnosed cancer in the United States and the third leading cause of cancer-related deaths. Non-Hispanic Black (NHB) individuals have the highest rates of CRC incidence and mortality in the United States. These disparities are highly influenced by social determinants of health (SDOH). Neighborhood quality,...

Introduction: Black women with epithelial ovarian cancer (EOC) have worse survival compared to other racial groups, and the causes of these poor outcomes remain unclear. Compared to other racial groups, Black women are disproportionately affected by comorbid conditions which can adversely impact cancer care and outcomes. Thus, we examined the assoc...

Addressing social risks in cancer prevention and control presents a new opportunity for accelerating cancer health equity. As members of the American Society of Preventive Oncology (ASPO) Cancer Health Disparities Special Interest Group, we describe the current state of science on social risks in oncology research and practice. To reduce and elimin...

Background Social risks are common among cancer survivors who have the fewest financial resources; however, little is known about how prevalence differs by age at diagnosis, despite younger survivors’ relatively low incomes and wealth. Methods The authors used data from 3703 participants in the Detroit Research on Cancer Survivors (ROCS) cohort of...

Purpose As health care systems seek to screen for and address housing instability in patient populations, robust evidence linking unstable housing to patient-reported outcomes is needed. Housing instability may increase psychological distress in cancer survivors, potentially more so among African American cancer survivors who are also likely to exp...

Background: An association was observed between an inflammation-related risk score (IRRS) and worse overall survival (OS) among a cohort of mostly White women with invasive epithelial ovarian cancer (EOC). Herein, we evaluated the association between the IRRS and OS among Black women with EOC, a population with higher frequencies of pro-inflammato...

Objectives: This study describes the communication-related concerns of oncology providers in addressing financial issues with patients. Methods: We conducted semi-structured interviews with 17 providers (9 clinicians, 5 social workers/navigators, 3 attorneys) who addressed financial concerns with cancer patients and analyzed resulting transcript...

Background: Neighborhood deprivation is associated with both race and cancer incidence, but there is a need to better understand the effect of structural inequities on racial cancer disparities. The goal of this analysis was to evaluate the relationship between a comprehensive measure of neighborhood-level social disadvantage and cancer incidence...

Low circulating vitamin D levels are more prevalent in Black than White individuals. We analyzed the Women's Health Initiative (WHI) calcium plus vitamin D (CaD) randomized clinical trial extended follow‐up data to evaluate associations between calcium plus vitamin D supplementation and incident cancer, cardiovascular disease (CVD), and cause‐speci...

Background: Racial segregation is linked to poorer neighborhood quality and adverse health conditions among minorities, including worse cancer outcomes. We evaluated relationships between race, neighborhood social disadvantage, and cancer survival. Methods: We calculated overall and cancer-specific survival for 11,367 non-Hispanic Black (NHB) an...

The role of socioeconomic status and race on cancer survivorship has been identified, however, the role of neighborhood disadvantage and race in cancer survivorship has not been well studied. This analysis aimed to evaluate the relationship between a comprehensive measure of neighborhood-level social disadvantage and cancer survivorship in the raci...

Purpose People with cancer commonly rely on loved ones as informal caregivers during and after treatment. Costs related to caregiving and their association with caregiver financial burden are not well understood. Methods Results include data from 964 caregivers of African American cancer survivors in the Detroit Research on Cancer Survivors (ROCS)...

Background Lesbian, gay, bisexual, transgender, and other LGBTQIA cancer patients experience significant disparities in cancer-related outcomes. Their relationships may not be acknowledged in care systems designed to serve primarily heterosexual and cisgender (H/C) patients, and resources for partners and caregivers of H/C patients may not address...

Background: Epidemiological studies of cancer survivors have predominantly focused on non-Hispanic White, elderly patients, despite the observation that African Americans have higher rates of mortality. Therefore, we characterized cancer survivorship in younger African American survivors using the Detroit Research on Cancer Survivors (ROCS) study...

As leaders with the American Society of Preventive Oncology (ASPO) Cancer Health Disparities Special Interest Group, we describe the role of structural racism in perpetuating cancer health inequity historically, and potential implications of COVID-19 in exacerbating the effects of structural racism on patients with cancer seeking screening, diagnos...

Background: Financial hardship is most common among cancer survivors with the fewest financial resources at diagnosis; however, little is known about the financial outcomes of young adult (YA) survivors (ages 20-39 at diagnosis), despite their having fewer financial reserves than older adults. Methods: We utilized data from 3,888 participants in...

Background: Increasing attention is being paid to understanding and addressing the financial consequences of cancer and cancer treatment; however, in addition to the direct and indirect costs of cancer care, survivors with few financial resources also face social needs such as food insecurity and housing instability. On average, young adults have f...

Objective Financial toxicity affects 30–50% of people with cancer in the US. Although experts recommend patients and physicians discuss treatment cost, cost discussions occur infrequently. We pilot-tested the feasibility, acceptability and influence on outcomes of the DIScussions of COst (DISCO) App, a multi-level communication intervention designe...

Background Coronavirus disease 2019 (COVID‐19) has had profound effects on population health to date. African American cancer survivors are particularly vulnerable to developing severe consequences; therefore, understanding the impact of the virus on this patient population is critical. Methods The Detroit Research on Cancer Survivors cohort is a...

Background Extant evidence links neighborhood walkability with obesity‐related health in the general population. This association likely exists in cancer survivors, but research is limited. Furthermore, a disproportionate obesity burden in African American cancer survivors warrants subgroup‐specific analyses. Methods This study analyzed data from...

Background Many of the 3.8 million breast cancer survivors in the United States experience long-term side effects of cancer therapy including peripheral neuropathy (PN). We assessed the prevalence and predictors of PN among women with breast cancer followed in the Women's Health Initiative's Life and Longevity After Cancer survivorship cohort. Met...

PurposeRelatively little is known about caregivers of African American cancer survivors. Our goal was to identify the extent of burden among this group of caregivers.Methods Responses from 560 informal caregivers of African American participants of the Research on Cancer Survivors (ROCS) study in Detroit, MI, were analyzed including demographics, a...

12129 Background: COVID-19 has had profound direct and indirect effects on population health to date and long-term effects are anticipated. Vulnerabilities to the most serious consequences of infection include older age, obesity, African American race and the presence of comorbid conditions. African American cancer survivors represent a particularl...

Purpose: Financial hardship due to cancer is more common among African American than White survivors. The COVID-19 pandemic and its economic fallout have also disproportionately affected African Americans. The purpose of this study is to describe the financial and employment impacts of COVID-19 in a population of African American cancer survivors a...

Background: Financial toxicity affects 30-50% of people with cancer in the US. Although experts recommend patients and oncologists discuss treatment cost, cost discussions occur infrequently. Using a non-randomized pre-test post-test design, we pilot-tested the feasibility, acceptability and preliminary effectiveness of the DIScussions of COst (DIS...

Background: Many employed cancer survivors have difficulty maintaining employment during and after cancer treatment, potentially contributing to financial hardship related to cancer and lower health-related quality of life (HRQOL). The objective of this study is to estimate associations between work changes and decreased work participation and fina...

p>Background: Financial hardship is common among cancer survivors, particularly those with fewer financial resources at the time of diagnosis. Previous work suggests that working age adults (usually <65 at diagnosis) have worse financial outcomes than older adults (ages 65+); however, little is known about the financial outcomes of young adult (age...

Background Social needs may affect cancer survivors' health‐related quality of life (HRQOL) above and beyond sociodemographic and cancer‐related factors. The purpose of this study was to estimate associations between social needs and HRQOL. Methods Results included data from 1754 participants in the Detroit Research on Cancer Survivors cohort, a p...

African American cancer survivors disproportionately experience financial difficulties after cancer. Decreased work participation (going from being employed full time to part time or from employed to not employed) can contribute to financial hardship after cancer but employment outcomes among African American cancer survivors have not been well des...

Background Cardiometabolic abnormalities are a leading cause of death among women, including women with cancer. Methods This study examined the association between prediagnosis cardiovascular health and total and cause‐specific mortality among 12,076 postmenopausal women who developed local‐ or regional‐stage invasive cancer in the Women's Health...

1 Background: Financial toxicity, the burden of treatment cost, affects 30-50% of people with cancer in the US. Although experts recommend patients and oncologists discuss treatment cost to identify patients who need assistance, cost discussions occur in fewer than half of cancer treatment discussions. We pilot-tested the feasibility and efficacy o...

Background: While the primary role of central cancer registries in the United States is to provide vital information needed for cancer surveillance and control, these registries can also be leveraged for population-based epidemiologic studies of cancer survivors. This study was undertaken as a pilot project to assess the feasibility of using the N...

Background: Financial hardship (FH) is common among cancer survivors and prevalence is often higher in non-white survivors. It is not known whether specific forms of FH are stronger predictors of financial distress than others, or if predictors of distress differ by race. Methods: We utilized data from 500 (196 white, 304 African American) particip...

Background: Cardiovascular disease (CVD) is common among cancer survivors and is a leading cause of death among survivors of several forms of cancer. Race disparities exist in the prevalence of several forms of CVD, and these may have implications for the health-related quality of life (HRQOL) of cancer survivors. The current study estimates the as...

Background: Cancer-related financial hardship is common and is associated with lower health-related quality of life, particularly among African American cancer survivors. Employment outcomes during and after cancer treatment may represent modifiable risk factors to reduce financial hardship and improve wellbeing among cancer survivors, but employme...

For many cancers, African Americans are diagnosed at a later stage and have poorer cancer outcomes than whites. Based on few studies, informal caregivers for African Americans are nearly all female, less than 65 years old, and provide assistance mostly with Instrumental Activities of Daily Living (IADLs). We surveyed a larger number of caregivers t...

e24093 Background: There are over 3.8 million breast cancer survivors in the United States, and many experience long-term side effects from chemotherapy. Factors associated with peripheral neuropathy (PN), one troubling side effect, following breast cancer among women are unknown. Methods: We included 2,420 women enrolled in the Women’s Health Init...

e24197 Background: Financial toxicity, the burden of treatment cost, affects 30-50% of people with cancer in the United States. Although experts recommend patients and oncologists discuss treatment cost to identify patients who need assistance, cost discussions occur in fewer than half of cancer treatment discussions. We pilot-tested the feasibilit...

Background African American women (AAW) die more frequently from estrogen receptor (ER) positive breast cancer than European American women (EAW). We investigated the relationship between race, percent ER staining, treatment, and clinical outcomes.Methods Percent ER staining (weakly ER+: 1–10%, moderately ER+: 11–50%, strongly ER+: > 50%) was abstr...

Background and Objective: Both periodontal disease and inflammatory bowel disease (IBD), are chronic inflammatory conditions, which are mediated by a complex interplay among a dysbiotic microbiota, dysregulated host immune-inflammatory responses, and lifestyle factors. Despite substantial differences in physical and chemical environments, rather st...

Purpose We explored how lifetime comorbidities and treatment-related cancer symptoms were associated with quality of life (QOL) in rural cancer survivors. Methods Survivors (n = 125) who were rural Illinois residents aged 18+ years old were recruited from January 2017 to September 2018. We conducted 4 multivariable regressions with QOL domains as...

Background The benefit of regular exercise in improving cancer outcomes is well established. The American Cancer Society (ACS) released a recommendation that cancer survivors should engage in at least 150 minutes of moderate to vigorous physical activity (PA) per week; however, few report meeting this recommendation. This study examined the pattern...

Social connectedness generally buffers the effects of stressors on quality of life. Is this the case for cancer-related debt among rural cancer survivors? Drawing on a sample of 135 rural cancer survivors, we leverage family/friend informal caregiver network data to determine if informal cancer caregivers buffer or exacerbate the effect of cancer-r...

175 Background: Cancer patients commonly rely on loved ones to act as informal caregivers during and after treatment. Caregivers may need to take time off work or make other employment changes to handle caregiving demands. Employment changes due to caregiving and their impacts on psychological outcomes are not well understood, especially among care...

Purpose: Caregivers of cancer survivors may need to take time off work or make other employment changes to handle caregiving demands. Work impacts of caregiving, financial burden, and psychosocial outcomes of caregivers are not well understood. Methods: Results include information from surveys completed by 202 employed caregivers of participants...

Purpose Estimate prevalence of types of cancer-related financial hardship by race and test whether they are associated with limiting care due to cost. Methods We used data from 994 participants (411 white, 583 African American) in a hospital-based cohort study of survivors diagnosed with breast, colorectal, lung, or prostate cancer since January 1...

1556 Background: Features associated with metabolic syndrome have been connected to both risk and poorer outcomes for certain cancers. Methods: We used data on 12,107 women enrolled in the Women’s Health Initiative diagnosed prospectively with either local or regional stage cancer to evaluate the association between cardiometabolic risk factors ide...

Background: Financial hardship is common among cancer survivors and is associated with both limiting care due to cost and with poor health-related quality of life (HRQOL). This study estimates the association between limiting care due to cost and HRQOL in a diverse population of cancer survivors and tests whether limiting care mediates the associat...

Background: African Americans are often diagnosed with advanced stage cancer and experience higher mortality compared with whites in the United States. Contributing factors, like differences in access to medical care and the prevalence of comorbidities, do not entirely explain racial differences in outcomes. Methods: The Detroit Research on Canc...

Background Increasing attention is being paid to financial burdens of cancer survivorship, but little is known about the prevalence and predictors of these burdens in older, long‐term survivors. Methods We used data from 6012 participants diagnosed with cancer since enrolling in the Women's Health Initiative, and who participated in the Life and L...

Background: Cancer survivors commonly face serious financial hardships that can impact their physical and financial health. African-American survivors, who are at greater risk of experiencing financial hardship than whites, and survivors in rural areas are often under-represented in this research, and ways in which financial hardship might differ b...

Background/objective: Previous research has focused on associations between dietary fat and body mass index (BMI), but the contributions of different types of fat to BMI remain unclear. The purpose of this study is to estimate whether plasma phospholipid omega-3 (n-3), omega-6 (n-6), or trans fatty acids are associated with BMI at baseline and wit...

145 Background: Financial hardship is common among cancer survivors, but its association with health-related quality of life (HRQOL) unknown. Methods: We utilized data from 570 black participants the Detroit Research on Cancer Survivors (ROCS) cohort study diagnosed with breast, colorectal, lung or prostate cancer since 1/1/13 and diagnosed or trea...

177 Background: Although we continue to make progress in reducing the incidence and mortality for most cancers in the United States, African Americans (AA) continue to experience higher cancer incidence rates and have worse survival than other populations. The causes of these poorer outcomes, from higher mortality to poorer quality of life, in AA c...

Although several modifiable risk factors have been independently associated with risk of breast cancer, few studies have investigated their joint association with breast cancer risk. Using a healthy lifestyle index (HLI) score, we assessed the association of a combination of selected modifiable risk factors (diet, alcohol, physical activity, BMI, a...

Background: Few studies have examined the relationship between cardiometabolic risk factors linked to metabolic syndrome and mortality among women with breast cancer. Methods: We used the Women's Health Initiative to evaluate the relationship between cardiometabolic risk factors, including waist circumference (WC), blood pressure, cholesterol le...

Risk factors can drive socioeconomic inequalities in cardiovascular disease (CVD) through differential exposure and differential vulnerability. We show how econometric decomposition directly enables simultaneous, policy-oriented assessment of these two mechanisms. We specifically estimated contributions via these mechanisms of neighborhood environm...

Background: Previous research suggests that financial burdens due to cancer are more common in African-American than white survivors, but it is not known whether or how the types of burdens experienced differ by race. Methods: This study utilizes preliminary data from the Cancer Survivorship in Metropolitan Detroit (CSMD) cohort. African-American a...

PurposeIn 2007, the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) published eight recommendations regarding body weight, physical activity, and dietary behaviors aimed at reducing cancer incidence worldwide. In this paper, we assess whether meeting the WCRF/AICR recommendations is associated with lower colorect...

Background: Recent successes in cancer diagnosis and treatment have led to improved survival overall; however, African-Americans (AA) continue to experience worse survival outcomes than whites for many cancers, and AA survivors in Detroit often experience poorer outcomes than those in other parts of the country. The reasons underlying these differi...

Background: Racial and, to a lesser extent, socioeconomic disparities in breast cancer incidence and mortality have been well documented; however, little is known about whether observed racial disparities differ by socioeconomic status. Methods: We used data from the population-based Metropolitan Detroit Cancer Surveillance System to estimate hazar...

Background Disparities in cancer incidence and mortality have been observed by measures of area-level socioeconomic status (SES); however, the extent to which these disparities are explained by individual SES is unclear. Methods Participants included 60 756 men and women in the VITamins And Lifestyle (VITAL) study cohort, aged 50–76 years at baseli...

In 2007, the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) released eight recommendations related to body fatness, physical activity, and diet aimed at preventing the most common cancers worldwide. The purpose of this paper is to estimate the association between meeting these recommendations and cancer-specific...

Purpose Eating frequency is a modifiable aspect of dietary behavior that may affect risk of colorectal cancer (CRC). Although most previous case–control studies indicate a positive association, two prospective studies suggest an inverse association between eating frequency and CRC risk, with evidence of effect modification by diet composition. We e...

Background: In 2007, the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) released eight recommendations related to body fatness, physical activity, and diet aimed at preventing the most common cancers worldwide. However, limited information exists on the association between meeting these recommendations and...

Hypospadias and cryptorchidism, two relatively common male genital anomalies, may be caused by altered maternal hormone levels, blood glucose levels, or nutritional deficiencies. Maternal obesity, which increases risk of diabetes and could influence hormone levels, may, therefore, be associated with risk of hypospadias and cryptorchidism. The purpo...