Can We Achieve Equity in Cancer Survivorship?

Annette L. Stanton, Ph.D.UCLA

Professor of Psychology and Psychiatry/Biobehavioral Sciences;

Member, Jonsson Comprehensive Cancer Center astanton@ucla.edu

1

Supported by the National Cancer Institute, Breast Cancer Research Foundation, Jonsson Comprehensive Cancer Center,

Hirshberg Foundation for Pancreatic Cancer Research

Commonalities in Survivorship

2

3

Definition of Survivor

An individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life. Family members, friends, and caregivers are also impacted by the survivorship experience and are therefore included in this definition.- National Cancer Institute

4

Institute of Medicine (2005) Findings:Survivorship Care

Survivorship care is a neglected phase of the cancer care trajectory

Survivors are concerned with cancer recurrence and treatment late effects

Few guidelines on follow-up care, and providers lack education and training

Interventions needed for physical and psychological consequences of cancer and treatment

Overall Depressive Symptom Trajectory in 460 Women Recently Diagnosed with Breast Cancer (Stanton et al., 2015, BCRT)

What Areas of Your Life Are Significantly Affected by Metastatic Cancer? (N = 353)

6

Areas of Impact (N = 353)“Had to give up a rewarding job” Employment/Achievement Concerns

“Loss of financial stability” Financial Concerns

“High copays and denial of coverage for tests and treatment” Insurance

“Every day is a roller coaster” Uncertainty/Mortality

“Not being able to do activities with my husband and kids” Activity Disruption

“Sadness because loss of independence” Self-Concept Disruption

“I worry about [my] children.” Concern for Others

“Isolation from former friends” Social Isolation/Withdrawal

“I experience a strong sense of gratitude.” Finding Benefit

8

Majority Find Benefit

◦ Enhanced relationships

◦ Deepened appreciation for life

◦ Increased personal strength

◦ Valued change in life priorities

◦ Greater spirituality

◦ Attention to health-promoting

behaviors

9

Islands of Disruption

◦Diagnosis

◦Treatment

◦Re-Entry

◦Early Survivorship

◦Extended Survivorship

◦Recurrence

◦Advanced Disease

10Stanton, Rowland, & Ganz, 2015

11

Coping CommonalitiesHazards of Cancer-Related Avoidance

At Biopsy

At Diagnosis

Prior to and after Surgery

During Re-Entry

Three Years Later

(Stanton & Snider, 1993; Stanton et al., 2000, 2002; Hack & Degner, 2004)

12

Coping CommonalitiesUseful Approach-Oriented Coping Strategies

Expressing Emotions

Finding Benefit

Seeking Social Support

Actively Accepting Cancer Diagnosis

Using Spiritual Coping (Finding Meaning, Purpose, and Peace)

Engaging in Problem-Focused Coping

Distinctions in Survivorship

13

14

Definition of Survivor

Most adults diagnosed with cancer consider themselves survivors, but not all like the word (Deimling et al., 2007; Kelly et al., 2009)

Areas of Impact (N = 353)“Had to give up a rewarding job” Employment/Achievement Concerns

“Loss of financial stability” Financial Concerns

“High copays and denial of coverage for tests and treatment” Insurance

“Every day is a roller coaster” Uncertainty/Mortality

“Not being able to do activities with my husband and kids” Activity Disruption

“Sadness because loss of independence” Self-Concept Disruption

“I worry about [my] children.” Concern for Others

“Isolation from former friends” Social Isolation/Withdrawal

“I experience a strong sense of gratitude.” Finding Benefit

More Negative Impact in Survivors < Age 50 and Lower Financial Status

Depressive Symptom Trajectory Classes in 460 Women Recently Diagnosed with Breast Cancer(Stanton et al., 2015, BCRT)

Coping Distinctions• Cancer Survivors at Risk for Depression Need Elevated Level of Care

• Avoidance Hazardous in Latinas Recently Diagnosed with Breast Cancer, but Expressing Emotions Not Useful (Moreno et al., 2016)

• Strong Black Woman Schema Avoidance Depression?

17

18

Take-Home Points Commonalities Aspects of Survivorship Care Can Be

Effective across GroupsAssuming Equal Access

Distinctions Distinct Approaches Needed

Community-Researcher Partnerships to Promote Equity

19

Many thanks to:Ph.D. Students

Collaborators

Funding Agencies