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Cancer Control Research

Abstract

DESCRIPTION (provided by applicant): Reproductive health problems are the most troublesome and long-term sequellae of breast cancer treatment. African-American women are at increased risk for breast cancer diagnosis before age 45, and have higher mortality in general compared to Caucasian women. Research is just beginning to examine the impact of ethnicity and socioeconomic status on cancer survivorship, The goal of this project is to evaluate the effectiveness of a peer counseling program to improve the reproductive health knowledge and outcomes (menopause symptoms, sexuality problems, distress about infertility/pregnancy and health of offspring, concern about cancer risk in the family) in African-American breast cancer survivors. The peer counseling program has been highly valued by participants in a pilot feasibility study and produced significant gains in knowledge. We will train 30 peer counselors and 7 regional coordinators in an intensive, 40-hour workshop. Monthly teleconferences will facilitate project communication and quality control thereafter. Nine hundred African-American women will be recruited by 20 chapters of Sisters Network, Inc., a national advocacy organization for African-American breast cancer survivors. Women will be randomized using minimization to receive either the full, 3-session individual peer counseling program or a minimal contact version including just workbook and 30 minutes or less of optional phone contact with the counselor. Questionnaires assessing medical and demographic factors, spiritual well-being, sexual function, menopause symptoms, distress about childbearing issues, relationship satisfaction or dating concerns, knowledge about reproductive health after breast cancer, emotional distress, and utilization of reproductive health services will be sent to women in the mail at baseline, post-treatment, and at 6 and 12 months' follow-up. We hypothesize that both programs will be effective, but the full program will be superior. Secondary goals of the project are to identify correlates of reproductive health outcomes at baseline, including cancer treatment variables, age, menopausal status, socioeconomic status, emotional distress, relationship status and distress, and spiritual well-being. We will also examine the impact of these mediating variables on the effectiveness of the intervention conditions. In addition, we will conduct 50 semi-structured, qualitative phone interviews with survivors diagnosed under age 45, to better identify and characterize concerns of this young, at-risk group.