Annette L. Stanton’s research while affiliated with University of California, Los Angeles and other places

The supportive care needs of people with metastatic cancer, particularly Asian Americans, are understudied. Distinct psychosocial support needs may exist across ethnocultural groups with Confucian-heritage values and norms. Cultural factors may shape how adults approach their oncologic care. This qualitative study represents the perspectives of 15 experienced health care professionals, about the supportive care needs of Chinese-, Korean-, and Vietnamese-heritage (CKV) adults with metastatic solid cancers. Reflexive thematic analysis was conducted with transcripts from three semistructured focus groups and five parallel-format individual interviews. Inductive coding and iterative theme development resulted in four themes describing the types of needs (basic, care-related, mental health, relational trust) that should be met for CKV patients with metastatic cancer, which may fall through the gaps when health care systems’ and patients’ differing cultural contexts collide. In conclusion, greater involvement of psychosocial care specialists with cultural expertise is essential to promote patients’ and families’ well-being, prevent care disparities, and to better support the health care team. Systemic changes that increase workforce diversity, reduce language and insurance barriers, and allow health care professionals to build relational trust with patients are needed to improve the quality of life of CKV patients with metastatic cancer.

Objective This study tested sleep disturbance as a mediator through which stigma and discrimination predict psychological distress and physical symptom burden in adults with lung cancer. Methods Lung cancer patients on active oncological treatment ( N = 108; 74.1% Stage IV) completed questionnaires on lung cancer stigma, sleep, distress, and physical symptoms at study entry and at 6- and 12-week follow-up. Mediation analyses were conducted to investigate whether stigma and discrimination predicted distress and physical symptoms at study entry and across 12 weeks through disrupted sleep. Results Higher discrimination (b = 5.52, 95% CI [2.10, 8.94]) and constrained disclosure (b = 0.45, 95% CI [0.05, 0.85]) were associated significantly with higher sleep disruption at study entry. Sleep disruption, in turn, was associated with higher distress (b = 0.19, 95% CI [0.09, 0.29]) and physical symptoms (b = 0.28, 95% CI [0.17, 0.40]) at study entry. Sleep disruption significantly mediated relationships between higher discrimination and the outcomes of distress (indirect effect = 1.04, 95% CI [0.13, 1.96]) and physical symptoms (indirect effect = 1.58, 95% CI [0.37, 2.79]) at study entry. Sleep disruption also mediated relationships between constrained disclosure and the outcomes of distress (indirect effect = 0.85, 95% CI [<0.01, 0.17]) and physical symptoms (indirect effect = 0.13, 95% CI [0.01, 0.25]). Conclusions Lung cancer patients evidenced pronounced sleep disruption, which mediated relationships between indicators of lung cancer stigma and distress and physical symptoms at study entry. Research is needed to test additional mechanisms through which lung cancer stigma predicts these outcomes longitudinally.

Objetivo: Se realizó una revisión sistemática y un metaanálisis para examinar las asociaciones entre los intentos de afrontar los factores estresantes a través de las dos facetas del afrontamiento con enfoque emocional (EAC, por sus siglas en inglés; es decir, procesar y expresar emociones relacionadas con los factores estresantes) y los indicadores de salud física y mental. Métodos: Se realizaron búsquedas en las bases de datos de EBSCO, incluidas MEDLINE, PsycINFO y Cochrane Collections, desde el inicio hasta noviembre de 2022. En total, se incluyeron 86 estudios en una evaluación meta analítica utilizando un modelo de efectos aleatorios y análisis de meta regresión. Resultados: EAC se asoció con una mejor salud general (r = .05; p = .04; intervalo de confianza del 95% = [.003, .10]). La expresión emocional y el procesamiento emocional también se asociaron positivamente con una mejor salud general, aunque estas relaciones no fueron estadísticamente significativas. En meta regresiones que examinaron dominios de salud específicos, la EAC se vinculó con una mejor salud en los dominios de psicológicos de ajuste biológicos/fisiológicos, físicos, y relacionados a resiliencia, así como con peores resultados en los dominios de ajuste psicológico relacionado con el riesgo y angustia mental/emocional. Los resultados de expresión emocional y procesamiento emocional reflejaron este patrón; sin embargo, sólo el procesamiento emocional se asoció con una mayor participación en conductas que promueven la salud. Conclusiones: Hacer frente a los factores estresantes a través de un enfoque emocional parece estar asociado con una mejor salud física y mental, observándose algunas diferencias en la expresión y el procesamiento emocional. La literatura sobre EAC y la salud está marcada por la heterogeneidad entre las metodologías y medidas de estudio.

Background There is limited understanding of how risk perceptions changed as the US population gained experience with COVID-19. The objectives were to examine risk perceptions and determine the factors associated with risk perceptions and how these changed over the first 18 mo of the pandemic. Methods Seven cross-sectional online surveys were fielded between May 2020 and October 2021. The study included a population-weighted sample of 138,303 US adults drawn from a market research platform, with an average 68% cooperation rate. Respondents’ risk perception of developing COVID in the next 30 days was assessed at each time point. We examined relationships between 30-day risk perceptions and various factors (including sociodemographic features, health, COVID-19 experience, political affiliation, and psychological variables). Results COVID risk perceptions were stable across the 2020 surveys and showed a significant decrease in the 2021 surveys. Several factors, including older age, worse health, high COVID worry, in-person employment type, higher income, Democratic political party affiliation (the relatively more liberal party in the United States), low tolerance of uncertainty, and high anxiety were strongly associated with higher 30-d risk perceptions in 2020. One notable change occurred in 2021, in that younger adults (aged 18–29 y) had significantly higher 30-d risk perceptions than older adults did (aged 65 y and older) after vaccination. Initial differences in perception by political party attenuated over time. Higher 30-d risk perceptions were significantly associated with engaging in preventive behaviors. Limitations Cross-sectional samples, risk perception item focused on incidence not severity. Conclusions COVID risk perceptions decreased over time. Understanding the longitudinal pattern of risk perceptions and the factors associated with 30-d risk perceptions over time provides valuable insights to guide public health communication campaigns. Highlights The study assessed COVID-19 risk perceptions at 7 time points over 18 mo of the pandemic in large samples of US adults. Risk perceptions were fairly stable until the introduction of vaccines in early 2021, at which point they showed a marked reduction. Higher COVID-19 30-d risk perceptions were significantly associated with the preventive behaviors of masking, limiting social contact, avoiding restaurants, and not entertaining visitors at home.

Background Asian Americans with metastatic cancer are an understudied population. The Describing Asian American Well-Being and Needs in Cancer (DAWN) Study was designed to understand the supportive care needs of Chinese-, Vietnamese-, and Korean-descent (CVK) patients with metastatic cancer. Objective This study aims to present the DAWN Study protocol involving a primarily qualitative, convergent, mixed methods study from multiple perspectives (patients or survivors, caregivers, and health care professionals). Methods CVK Americans diagnosed with solid-tumor metastatic cancer and their caregivers were recruited nationwide through various means (registries, community outreach newsletters, newspapers, radio advertisements, etc). Potentially eligible individuals were screened and consented on the web or through a phone interview. The study survey and interview for patients or survivors and caregivers were provided in English, traditional/simplified Chinese and Cantonese/Mandarin, Vietnamese, and Korean, and examined factors related to facing metastatic cancer, including quality of life, cultural values, coping, and cancer-related symptoms. Community-based organizations assisted in recruiting participants, developing and translating study materials, and connecting the team to individuals for conducting interviews in Asian languages. Health care professionals who have experience working with CVK patients or survivors with metastatic solid cancer were recruited through referrals from the DAWN Study community advisory board and were interviewed to understand unmet supportive care needs. Results Recruitment began in November 2020; data collection was completed in October 2022. A total of 66 patients or survivors, 13 caregivers, and 15 health care professionals completed all portions of the study. We completed data management in December 2023 and will submit results for patients or survivors and caregivers to publication outlets in 2024. Conclusions Future findings related to this protocol will describe and understand the supportive care needs of CVK patients or survivors with metastatic cancer and will help develop culturally appropriate psychosocial interventions that target known predictors of unmet supportive care needs in Chinese, Vietnamese, and Korean Americans with metastatic cancer. International Registered Report Identifier (IRRID) DERR1-10.2196/50032

BACKGROUND Asian Americans with metastatic cancer are an understudied population. The Describing Asian American Well-Being and Needs in Cancer (DAWN) Study was designed to understand the supportive care needs of Chinese-, Vietnamese-, and Korean-descent (CVK) patients with metastatic cancer. OBJECTIVE This study aims to present the DAWN Study protocol involving a primarily qualitative, convergent, mixed methods study from multiple perspectives (patients or survivors, caregivers, and health care professionals). METHODS CVK Americans diagnosed with solid-tumor metastatic cancer and their caregivers were recruited nationwide through various means (registries, community outreach newsletters, newspapers, radio advertisements, etc). Potentially eligible individuals were screened and consented on the web or through a phone interview. The study survey and interview for patients or survivors and caregivers were provided in English, traditional/simplified Chinese and Cantonese/Mandarin, Vietnamese, and Korean, and examined factors related to facing metastatic cancer, including quality of life, cultural values, coping, and cancer-related symptoms. Community-based organizations assisted in recruiting participants, developing and translating study materials, and connecting the team to individuals for conducting interviews in Asian languages. Health care professionals who have experience working with CVK patients or survivors with metastatic solid cancer were recruited through referrals from the DAWN Study community advisory board and were interviewed to understand unmet supportive care needs. RESULTS Recruitment began in November 2020; data collection was completed in October 2022. A total of 66 patients or survivors, 13 caregivers, and 15 health care professionals completed all portions of the study. We completed data management in December 2023 and will submit results for patients or survivors and caregivers to publication outlets in 2024. CONCLUSIONS Future findings related to this protocol will describe and understand the supportive care needs of CVK patients or survivors with metastatic cancer and will help develop culturally appropriate psychosocial interventions that target known predictors of unmet supportive care needs in Chinese, Vietnamese, and Korean Americans with metastatic cancer. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/50032

Hematopoietic stem cell transplantation (hereafter “HCT”) is a physically and psychologically difficult treatment for patients with hematological cancers. This study examined relationships among patients’ reports of pre-transplant social isolation, social constraints, and psychological distress. We used baseline data from a multisite randomized controlled trial evaluating the effects of expressive helping writing to reduce physical and emotional symptoms in HCT patients. We collected data prior to randomization and before either allogenic or autologous HCT using validated scales to assess social constraints, social isolation, anxiety, and depressive symptoms. We analyzed data using bivariate analysis and multivariate linear regression. We also explored whether social isolation mediated the effect of social constraints on both of our outcomes: anxiety and depressive symptoms. Among 259 adults recruited prior to transplant, 43.6% were women (mean age = 57.42 years, SD = 12.34 years). In multivariate analysis controlling for relevant covariates, both social isolation (β = 0.24, p < 0.001) and social constraints (β = 0.28, p < 0.001) were associated with anxiety. When both social constraints and social isolation were in the model, only greater social isolation (β = 0.79, p < 0.001) was associated with depressive symptoms. Social isolation fully mediated the association between social constraints and anxiety and depressive symptoms. For patients awaiting either allogenic or autologous HCT, the negative association between social constraints and anxiety and depressive symptoms may be related, in part, to the mechanism of perceived social isolation. Interventions prior to and during HCT are needed to support patients’ psychological health and sense of social connectedness.

Background A rare cancer, uveal melanoma (UM) affects 5 in 1 million adults annually. Research on predictors of mental health in UM survivors is scarce. Purpose In this prospective study, we tested models that postulate interactions between illness perceptions and coping processes in predicting depressive symptoms 1 year following UM diagnosis. Methods Participants’ approach- and avoidance-oriented coping processes and illness perceptions specific to control and chronicity were assessed. Participants (N = 107) completed assessments prior to diagnosis (T0), and 1 week (T1), 3 months (T2), and 12 months after UM diagnosis (T3). Results At T1, a significant avoidance coping × chronicity perception interaction (b = 1.84, p = .03) indicated that the link between higher avoidance coping and greater T3 depressive symptoms was stronger for participants with prolonged chronicity perceptions (b = 17.13, p < .001). Chronicity perceptions at T2 interacted significantly with approach-oriented coping at all time points; the link between higher approach coping and lower T3 depressive symptoms was stronger for participants with prolonged chronicity perceptions at T2. Interactions between control perceptions and coping did not significantly predict T3 depressive symptoms. Conclusions Findings lend partial support to predictive models that consider the combined, interacting influence of chronicity perceptions and coping processes on depressive symptoms in survivors of eye cancer.

We conducted a nationwide, randomized controlled trial to evaluate the impact of Healing Choices, a novel interactive education and treatment decision program rooted in the self-regulation theory framework, on decisional conflict and psychological distress at 2-month post-intervention in women with early-stage breast cancer. Patients were randomized to receive the National Cancer Institute's standard print material (control) or standard print material plus Healing Choices (the intervention). The final sample at 2-month post-intervention consisted of N = 388 participants (intervention: n = 197; control: n = 191). There were no significant differences in decisional conflict or its subscales; however, psychological distress was higher in the intervention group (16.09 ± 10.25) than in the control group (14.37 ± 8.73) at follow-up, B = 1.88, 95% CI [-0.03, 3.80], t(383) = 1.94, p = .05. Upon further examination, we found that engagement with the intervention was low-41%-prompting as-treated analyses, which showed no difference in distress between users and nonusers and a positive impact of Healing Choices on decisional conflict: decisional support subscale: users (35.36 ± 15.50) versus nonusers (39.67 ± 15.99), B = -4.31 (s.e. = 2.09), p = .04. Multiple recommendations for moving ahead stem from this work: (i) intent-to-treat analyses appeared to cause distress, cautioning against interventions that may lead to information overload; (ii) engagement with the intervention is low and future work needs to focus on increasing engagement and monitoring it throughout the study; and (iii) in studies with low engagement, as-treated analyses are critical.

Background: Black women have the highest mortality from breast cancer compared with other racial/ethnic groups. Black women with breast cancer also evidence compromised quality of life in some domains. Culturally relevant aspects of their experience are understudied. Purpose: The goal of this qualitative study was to examine the relevance of the Strong Black Woman schema in the cancer context. Methods: Three Gatherings (i.e., culturally curated focus groups) were conducted with Black women who had been diagnosed with breast cancer and recruited from cancer-related listservs and events. A five-person team conducted reflexive thematic analysis of Gathering transcripts. Results: The 37 participants ranged in age (30 to 94 years) and in diagnosis duration (2 months to 29 years). Reflexive thematic analysis yielded six themes that characterized the women's experience: historical legacy of the Strong Black Woman, navigating intersecting Strong Black Woman identities, everyday challenges encountered on the battlefield by Strong Black Women, Strong Black Woman in action during the breast cancer journey, the complexities of seeking and accepting support, and the liberated Strong Black Woman. The schema's negative consequences included the oncologic team and others expecting the participants to be strong and not to need support. Expectations to suppress emotions and continue caring for others to the neglect of the self also were evident. Positive consequences included engaging in self-advocacy in the oncologic context and redefining strength to include expressing emotions and accepting help. Conclusions: The Strong Black Woman schema is highly relevant in the breast cancer context and could be addressed in culturally centered interventions.