Culturally Adapted Cognitive Behavioral Stress and Self-Management (C-CBSM) Intervention for PC

针对 PC 的文化适应认知行为压力和自我管理 (C-CBSM) 干预

基本信息

批准号：
9194597
负责人：
MICHAEL Howard ANTONI
金额：
$ 66.19万
依托单位：
NORTHWESTERN UNIVERSITY AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-07-01 至 2021-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9194597
关键词：
Accounting Acculturation Address Adverse effects Aftercare Atlas of Cancer Mortality in the United States Attention Attitude Behavioral Breast Cancer survivor Cancer Survivor Cause of Death Chicago Chronic Cognitive Diagnosis Disadvantaged Discrimination Disease Effectiveness Emotional Evidence based treatment Family Fatigue Functional disorder Gender Role Gene Expression Glucocorticoid Receptor Glucocorticoids Health Hispanics Inflammation Inflammatory Intervention Intestines Knowledge Lead Linguistics Lipids Malignant neoplasm of prostate Mediating Mediator of activation protein Minority Groups Modeling Molecular Molecular Profiling Neuroimmunomodulation Not Hispanic or Latino Operative Surgical Procedures Outcome Pain Pathway interactions Patients Personal Satisfaction Physical Function Physiological Physiological Adaptation Pilot Projects Population Process Radiation therapy Radiosurgery Randomized Recovery Regulation Reporting Research Design Resistance Sample Size Self Management Severity of illness Social Functioning Specificity Staging Stress Survival Rate Survivors Symptoms Testing Time Factors Translating Translations Work active method base behavioral clinical trial bilingualism cancer diagnosis cytokine design disturbance in affect efficacy testing ethnic minority population fasting glucose follow-up health related quality of life improved intimate behavior leukocyte activation male men post intervention primary outcome psychological distress psychosocial receptor sensitivity reduce symptoms stress management symptomatic improvement urinary

项目摘要

Project Summary:This 5-year study evaluates the effects of a 10-week group-based linguistically translated and culturally adapted cognitive-behavioral stress and self management (C-CBSM) intervention on symptom burden and health related quality of life (HRQOL) in Hispanic men treated for localized prostate cancer (PC). About 80% PC cases are diagnosed as early disease and have a 5- and 10-year survival rate of almost 100% and 99%, respectively. Most patients receive active treatment (~70%) leading to prolonged treatment-related side effects and dysfunction persisting well beyond primary treatment. Survival is offset by chronic side effects such as sexual and urinary dysfunction, pain and fatigue that can lead to poor psychosocial functioning, impaired intimacy and social functioning, and masculinity concerns. Hispanic PC survivors report lower physical and social functioning, poorer emotional well-being and greater sexual and urinary dysfunction, even after accounting for SES and disease severity. This sequela can lead to elevated glucocorticoid release and inflammatory cytokines that have a direct effect on these symptoms and can interfere with physiological pathways necessary for recovery of sexual and urinary functioning. We have shown that CBSM reduces symptom burden and improves HRQOL in bilingual Hispanic PC survivors. In a pilot we showed that a linguistic translation of CBSM with attention to sociocultural processes improved symptom burden and HRQOL in Spanish monolingual PC survivors. We have also shown that CBSM is associated with reduced glucocorticoid resistance and inflammatory gene expression pathways in breast cancer survivors. We propose to (a) deliver a culturally adapted C-CBSM intervention in Spanish that places greater emphasis on salient sociocultural determinants of symptom burden and HRQOL in Hispanics (e.g., fatalistic attitudes, family interdependence, perceived discrimination, machismo), (b) incorporate a neuroimmune model of symptom regulation and management, and (c) test the efficacy of C-CBSM, relative to standard non-culturally adapted CBSM, in two diverse Hispanic communities (Chicago & Miami). We will test our aims in 260 Hispanic men post-treatment for localized PC with elevated symptom burden in a 2 x 4 randomized design with condition (C- CSBM vs. CBSM) as the between groups factors, and time (baseline, post-intervention & 6- and 12-months post baseline) as the within groups factor. Our Primary Aim is to determine whether randomization to C- CBSM, relative to standard CBSM, is associated with reduced symptom burden and improved HRQOL. Our Secondary Aims evaluate whether C-CBSM leads to greater improvements in the intervention targets (e.g., stress management, psychological distress & interpersonal disruption), and physiologic adaptation (i.e., glucocorticoid receptor sensitivity & inflammatory gene expression). We will also evaluate psychosocial and physiological mechanisms as mediators of C-CBSM's effects on our primary outcomes. We will explore moderators (e.g., SES, Hispanic origin) of C-CBSM's effect and C-CBSM's effects on cardiometabolic health.

项目摘要：这项为期5年的研究评估了基于10周的语言翻译的效果以及文化适应的认知行为压力和自我管理（C-CBSM）干预症状在西班牙裔男性中接受局部前列腺癌（PC）治疗的西班牙裔男性的负担和与健康有关的生活质量（HRQOL）。约80％的PC病例被诊断为早期疾病，5年和10年的存活率几乎为100％和99％。大多数患者接受主动治疗（〜70％），导致治疗延长副作用和功能障碍持续远远超出了初级治疗。慢性副作用抵消了生存例如性和尿功能障碍，疼痛和疲劳，会导致社会心理功能不佳，亲密和社会功能受损以及男子气概的关注。西班牙PC幸存者报告较低身体和社会功能，情绪健康较差以及更大的性和尿功能障碍，甚至在考虑了SES和疾病严重程度之后。该续集可导致糖皮质激素释放升高，并且对这些症状有直接影响的炎性细胞因子，可能会干扰生理恢复性功能所需的途径。我们已经证明CBSM减少了症状负担并改善了双语西班牙裔PC幸存者中的HRQOL。在飞行员中，我们证明了 CBSM的语言翻译，对社会文化过程的关注改善了症状负担和HRQOL 在西班牙单语PC幸存者中。我们还表明，CBSM与减少有关乳腺癌幸存者中的糖皮质激素耐药性和炎症基因表达途径。我们建议（a）以西班牙语进行文化适应的C-CBSM干预，以更加重视显着西班牙裔症状负担和HRQOL的社会文化决定因素（例如，宿命论态度，家庭相互依存，感知的歧视，大男子主义），（b）结合了症状的神经免疫模型监管和管理，以及（c）相对于标准非文化适应的C-CBSM的功效 CBSM，在两个不同的西班牙裔社区（芝加哥和迈阿密）中。我们将在260名西班牙裔男子中测试我们的目标在2 x 4随机设计中，局部PC的局部PC治疗升高，状况（C-） CSBM与CBSM）作为两组因素和时间（基线，干预后以及6个月和12个月）基线后）作为内部因素。我们的主要目的是确定是否随机分配给c- 相对于标准CBSM，CBSM与症状负担减轻和HRQOL改善有关。我们的次要目的评估C-CBSM是否导致干预靶标的改善（例如，压力管理，心理困扰和人际破坏）和生理适应（即糖皮质激素受体敏感性和炎症基因表达）。我们还将评估社会心理和生理机制是C-CBSM对我们主要结果的影响的介体。我们将探索 C-CBSM效应和C-CBSM对心脏代谢健康的影响的主持人（例如SES，西班牙裔起源）。