The Community Impact of Breast Cancer: The Social Context

Overview: California is a unique mixture of diverse communities, and our state offers tremendous opportunities to uncover the basis for disparities and the unequal burden that breast cancer places on different groups. What is the influence of poverty, race/ethnicity, and environmental factors on breast cancer? What are the sociocultural, behavioral, and psychological issues of those affected by breast cancer and what services are needed to reduce suffering? We encourage health policy, health services, and sociocultural, behavioral, and psychological research that address the needs of California.s diverse communities.

The CBCRP's focus on the Community Impact of Breast Cancer has changed during the first ten years of the program, and a survey of grants funded in the early years would show a different profile from those funded in our last two or three cycles. In the psychosocial and behavioral areas we are seeing more applications that attempt to find biological correlates of the emotional, psychological, and spiritual states of breast cancer patients. While the connection between severe emotional trauma and subsequent physical health has long been known, investigators are now going far beyond broad descriptions of these associations to looking at things such as stress hormones and immune system functioning, biological responses to cognitive therapy, and mapping brain activity and impairment. Such work can begin to measure the impact of psychological interventions along pathways that lend themselves to clinical interpretation, to strengthening interventions, and to improve health outcomes. In the health services area, our applications deal with topics that used to be largely outside of traditional research concerns. These include acupuncture, use of herbal remedies, return to work issues, and patient-oriented studies such as the impact of lymphedema on quality of life.

Funding Data:
 

Proportion of Total

Community Impact grants awarded in 2004:

11

26%

Funded amount:

$3,080,437

21%

Community research planning grants:

3

 

Funded amount:

$30,000

 

Community Impact Portfolio Summary:

Three of CBCRP.s research topics are represented in this section:

In the Health Policy and Health Services topic we funded a postdoctoral fellowship to Michael Johnston at the University of California, Los Angeles. Dr. Johnson will undertake a project to enhance health services for breast cancer patients by developing an educational program that will empower acupuncturists to initiate care coordination with oncology clinicians treating the same patients. This research attempts to bridge gaps in care coordination and to enhance collaboration and communication among acupuncturists and oncology providers for this widely used treatment.

Increasingly within the last decade scientists have joined the traditional concepts of epidemiology, whereby differences between populations are examined for clues to explain differences in disease and disease outcomes, with the techniques of molecular biology. In the Disparities topic the CBCRP funded two such grants in 2004. Vinona Bhatia at the University of California, San Francisco, will evaluate the different subtypes (called isoforms) of estrogen and progesterone receptors (proteins that bind estrogen and progesterone to cells) of different ethnic groups to determine if the distributions of these isoforms account for varying aggressiveness of cancers and in survival. This study will focus on defining characteristics of a multiethnic population of low socioeconomic status, and which had similar treatment at San Francisco General Hospital. Koie Chen also at the University of California, San Francisco, will look for differences in breast cancer mortality between African American and Caucasian women by comparing chromosomal abnormalities from breast tumors in the two ethnic groups.

In the Sociocultural, Behavioral, and Psychological topic we funded five career development and investigator-initiated grants, all of which go beyond typical psychological assessments to also consider the physical and psychobiological aspects of breast cancer. David Wellisch at the University of California, Los Angeles, received IDEA funding to look at women at high-risk for breast cancer, who have lost a sister and/or a mother to breast cancer and for whom grief has been possibly traumatic, to see whether such grief confers increased psychobiological risk for breast cancer. Using fMRI brain scanning and salivary cortisol levels, Dr. Wellisch will study whether grief-driven activation of the brain's emotion centers leads to cortisol dysregulation. The effects of the chronic stress of traumatic grief, brain activation, and cortisol dysregulation may be a pathway to immune system compromise and higher risk for breast cancer. This model has never before been integrated and tested. Annette Stanton also at the University of California, Los Angeles, received an IDEA grant to examine the quality of life of women with advanced breast cancer. Using established questionnaires, interviews, and a biological marker of stress (cortisol-obtained through saliva collection), Dr. Stanton will examine factors such as hope, approach-oriented involvement in goal-related activities, mood, and quality of life in 140 women with advanced disease. She hypothesizes that active engagement in pursuing cherished life goals will contribute to positive outcomes during the study. Hopefully, this research will help develop interventions to bolster well-being and health of women with advanced breast cancer. Hillary Klonoff-Cohen at the University of California, San Diego, will investigate the role of sex hormones (menstrual phase at time of surgery), psychological distress, cortisol, and natural killer cell activity (NKCA) in predicting subsequent breast cancer. The hypothesis is that scheduling breast cancer surgery for the luteal phase of the menstrual cycle, low levels of emotional distress, and good NKCA will improve breast cancer survivorship. Meredith Edwards of the University of California, San Francisco, is funded to complete her dissertation work by developing a method to measure the neurological side effects caused by Taxol or Taxotere. The ultimate goal is to identify the onset of the effects before they have detrimental physical or quality of life consequences. Joan Bloom at the University of California, Berkeley, will study young breast cancer survivors (50 or younger at diagnosis) ten years after diagnosis in order to disentangle the effects of treatment and chemotherapy from the normal effects of aging. The aim is understand the extent to which time has ameliorated the physical, psychological and emotional impact of their diagnosis and treatment. This will be the first population-based study of the long-term impact of breast cancer in younger women.

Three Community Research Collaboration pilot studies were funded in 2004. These projects bring together traditional researchers with representatives of community organizations to tackle research questions of common interest. John Link at Long Beach Memorial Medical Center, Michele Rakoff with Breast Friends, a peer support group, and Annette Maxwell at the University of California, Los Angeles, aim to develop new ways to increase women.s participation in breast cancer clinical trials. They will use breast cancer survivors, who themselves have participated in such trials, to provide peer support for patients considering participation in clinical trials and will assess whether it results in higher clinical trial participation. Mary Ann Kreshka, from Sierra College; Susan Ferrier, at the Northern Sierra Rural Health Network; and Cheryl Koopman from Stanford University will examine the feasibility, acceptability, and effectiveness of using videoconferencing to reduce urban/rural inequities in access to psychosocial support for women diagnosed with breast cancer. Sara O'Donnell from the Mendocino Cancer Resource Center, Julie Ohnemus at the Humboldt Community Breast Health Project, and Jeff Belkora with the University of California, San Francisco, plan to evaluate a decision support approach, called Consultation Planning (CP) in a rural setting. This group had previously shown CP as being effective at improving satisfaction/quality in treatment decision-making among newly diagnosed breast cancer patients. This study will test the feasibility of extending the reach of CP, previously delivered in person, to a telephone intervention, and to test its acceptability among Native American and Latina breast cancer patients.

The CBCRP awarded planning grants to three teams of community groups and scientists to further develop applications submitted this year. These small awards enable these groups to improve their methodology, strengthen the collaboration, and gather pilot data as appropriate. Janice Barlow with Marin Breast Cancer Watch and Scott Fendorf from Stanford University will further develop the hypothesis that the high incidence of breast cancer in Marin County is due in part to exposures to certain cancer-causing trace elements which are found in serpentinites, soils formed from these rocks, and in related water sources. Shelly Adler at the University of California, San Francisco, and Beverly Burns with the Charlotte Maxwell Complementary Clinic wish to develop a patient-centered model of culturally appropriate, end-of-life care for underserved women with breast cancer. They propose to design a narrative intervention aimed at enhancing meaning at the end of life. Specifically, they plan to describe and examine the ways in which critical end-of-life issues are approached and understood by underserved women with breast cancer, their main physicians, their lead CAM providers, and their informal caregivers. Zul Surani at South Asian Cancer Foundation and Roshan Bastani at the University of California, Los Angeles, intend to conduct an assessment aimed at understanding the psychosocial and concrete needs of the growing and underserved population of South Asian women (e.g., Indian, Pakistani, Sri Lankan, Bangladeshi) with breast cancer, so that future interventions are more culturally relevant.

Community Impact Grants Funded in 2004:

Health Policy and Health Services

Empowering Acupuncturists to Cooperate with Oncologists
Michael Johnston, Ph.D.
University of California, Los Angeles
Award type: Postdoctoral Fellowship
Duration: 2 years
$89,728

Disparities

Socioeconomics and Ethnicity Affect Tumor Endocrine Status
Vinona Bhatia, M.D.
University of California, San Francisco
Award type: Postdoctoral Fellowship
Duration: 2 years
$90,000

Assessment of Recurrent Genomic Aberrations Linked to Ethnicity
Koie Chen, M.D., Ph.D.
University of California, San Francisco
Award type: IDEA
Duration: 1.5 years
$100,000

Sociocultural, Behavioral, and Psychological Issues

Decision Support in Rural Underserved North Coast Counties
1Jeff Belkora, Ph.D., 2Sara O'Donnell, and 3Julie Ohnemus
1University of California, San Francisco, 2Mendocino Cancer Resource Center, and 3Humboldt
Community Breast Health Project
Award type: CRC Pilot
Duration: 1 year
$115,000

Young Breast Cancer Survivors: Ten Years Later
Joan Bloom, Ph.D.
University of California, Berkeley
Award type: RFA
Duration: 3 years
$944,961

The Functional Implications of Taxane-induced Neuropathy
Meredith Edwards University of California, San Francisco Award type: Dissertation Duration: 2 years $54,713

Expanding Rural Access: Distance Delivery of Support Groups
1Susan Ferrier, R.N.; 2Cheryl Koopman, Ph.D.; and 3,1Mary Anne Kreshka, M.A.
1Northern Sierra Rural Health Network, 2Stanford University, and 3Sierra College
Award type: CRC Pilot
Duration: 1 year
$138,914

Hormone, Psychologic, and Immunologic Factors and Breast Cancer Survivorship
Hillary Klonoff-Cohen, Ph.D.
University of California, San Diego
Award type: RFA
Duration: 3 years
$1,196,166

Peer Mentors Promoting Breast Cancer Clinical Research
1Annette Maxwell, Dr.P.H., 2,3Michele Rakoff; and 3John Link, M.D.
1University of California, Los Angeles; 2Breast Friends; and 3Long Beach Memorial Medical Center
Award type: CRC Pilot
Duration: 1.5 years
$162,344

Faith Fancher Research Award

Living Well with Advanced Breast Cancer: a Predictive Model
Annette Stanton, Ph.D.
University of California, Los Angeles
Award type: IDEA
Duration: 1.5 years
$99,982

Psychobiological Concomitants of Bereaved Women at Breast Cancer Risk
David Wellisch, Ph.D.
University of California, Los Angeles
Award type: IDEA
Duration: 1.5 years
$118,755

Community Research Collaboration (CRC) planning grants

Underserved Women with Breast Cancer at End of Life
1Shelley Adler, Ph.D., and 2Beverly Burns
1University of California, San Francisco; and 2Charlotte Maxwell Complementary Clinic
Duration: 1 year
$10,000

Serpentinites & the High Incidence of Breast Cancer in Marin
1Janice Barlow, and 2Scott Fendorf, Ph.D.
1Marin Breast Cancer Watch; and 2Stanford University
Duration: 1 year
$10,000

South Asian Women with Breast Cancer: What are Their Needs?
1Roshan Bastani, Ph.D., and 2Zul Surani
1University of California, Los Angeles, and 2South Asian Cancer Foundation
Duration: 1 year
$10,000