Paper Session 14: Cancer

Background
Over half of cancer survivors do not adhere to their oral anticancer medications (OAMs), leading to early relapse, hospitalizations and higher medical cost. Prior studies on health beliefs revealed that although cancer survivors perceive a higher need for treatment, concerns about cancer medicines and negative perceptions of cancer may lead to medication nonadherence. This study used a person-centered approach to categorize individual’s schemas regarding their health beliefs to understand the intricate decision process related to medication-taking behaviors.

Methods
A total of 323 cancer survivors currently taking OAMs completed a survey via two online crowdsourcing panels. The survey included validated scales assessing beliefs about cancer and OAMs, as well as medication adherence. Latent profile analysis (LPA) was conducted using Mplus v.8.10 to categorize survivors into latent subgroups based on their distinct health beliefs. One-way ANOVA and multiple linear regression were used to examine the associations between these latent subgroups and adherence to OAMs as well as health-related quality of life (HRQoL).

Results
Three health belief profiles were identified: (1) optimistic and adaptive (n=43, 13%), (2) conscious but hesitant (n=99, 31%), and (3) overwhelmed and unaware (n=181, 56%), with significant differences in belief patterns. Regression analysis showed that health belief profiles explained 49.1% of the variance in medication adherence and 28.6% in HRQoL, adjusted for patient clinical and demographic factors. Survivors in the overwhelmed and unaware group had the lowest medication adherence (mean=20.98, SD=9.0, P<.01) and HRQoL (mean=14.45, SD=7.8, P<.01), with Risk of Recurrence (β=-.15, p=.01), Cancer Consequences (β=-.17, p=.01), and Personal Control (β=-.12, p=.05) as significant strong predictors of nonadherence.

Conclusion
LPA provided a more comprehensive understanding of the types and prevalence of health belief subgroups and identified specific negative beliefs contributing to medication nonadherence among cancer survivors. To enhance medication taking behaviors and HRQoL, future studies should explore the underlying mechanisms on how major cancer consequences, risk of cancer recurrence and lower perceived personal control cause barriers to taking OAMs. Future interventions could tailor their delivery, educational content, and support to align with patients’ beliefs, ultimately promoting medication adherence and HRQoL.

Presenter - Meng-Jung Wen, BPharm, MS,
University of Wisconsin-Madison School of Pharmacy

Co-Author - Olayinka O. Shiyanbola, PhD, BPharm,
University of Michigan

Background: Prostate cancer (PC) accounts for nearly half of all male cancer survivors. Patients with PC often struggle with chronic and debilitating treatment side effects that can lead to poor psychosocial functioning, such as heightened stress and social isolation. Hispanic PC survivors experience greater perceived stress and unmet needs for social support from friends and family relative to non-Hispanic survivors. While evidence suggests that family conflict can be associated with poorer psychosocial functioning, work evaluating this association among Hispanic PC survivors remains limited. This study examined the relationship between perceived stress management skills, family conflict, and social disruption in Hispanic PC survivors.

Methods: Hispanic men (N=198; M age=65.7 years, M time since treatment=22 months) who completed treatment for localized PC enrolled in a stress management intervention and completed a baseline assessment of perceived stress management skills (The Measure of Current Status Part A), family conflict (Family Environment Scale-Family Conflict), and social disruption (Sickness Impact Profile-Social Interaction). We used general linear modeling to test the relationship between perceived stress management skills and social disruption and whether family conflict moderated this relationship, adjusting for age, treatment type (i.e., surgery or radiation), and time since treatment.

Results: Poorer perceived stress management skills were associated with greater social disruption (B=-0.14, SE=0.02, p<.001). Further, family conflict moderated the association between perceived stress management skills and social disruption (B=-0.05, SE=0.02, p=.004), such that the relationship between perceived stress management skills and social disruption was stronger among men with high family conflict (+1 SD: B=-0.19, SE=0.03, p<.001) versus low family conflict (-1 SD: B=-0.07, SE=0.03, p=.031).

Conclusions: Family conflict moderates the effects of perceived stress management skills on social functioning. These findings reflect that the relationship between poor perceived stress management skills and high social disruption among Hispanic PC survivors may be exacerbated in individuals experiencing high family conflict. Further research is needed to examine the longitudinal implications of these associations and explore these factors as potential intervention targets for improving social functioning.

Presenter - Maria Lopes, BA,
University of Miami

Co-Author - Emily A. Walsh, MS,
University of Miami

Co-Author - Maia A. Chester, BS,
University of Miami

Co-Author - Alesha Cid-Vega, MA,
University of Miami

Co-Author - Michael H. Antoni, PhD, FSBM,
University of Miami

Co-Author - Lara Traeger, PhD,
University of Miami

Co-Author - Dolores M. Perdomo, MSW, PhD,
University of Miami

Co-Author - Betina R. Yanez, PhD, FSBM,
Northwestern University Feinberg School of Medicine

Co-Author - Frank J. Penedo, PhD, FSBM,
University of Miami

Purpose: Patients with advanced lung cancer (LC) face significant physical, psychological, and functional challenges, increasing their reliance on their caregivers, who are often their spouses/partners or other close family or friends. This study evaluates the efficacy of CareSTEPS, a six-week telephone-delivered intervention designed to improve psychological functioning (depression and anxiety symptoms) and reduce caregiver burden among the family caregivers of advanced LC patients.
Methods: In this multisite, parallel group randomized controlled trial, 174 caregivers (74.1% female, 40.2% from a racial or ethnic minority group) of patients with stage IIIB or IV non-small cell or extensive-stage small cell LC completed baseline surveys and were randomly assigned to CareSTEPS (n=87) or usual care (UC; n=87) using stratified block randomization. Caregivers in the CareSTEPS arm received a manual with information on self-care, stress management, symptom management, effective communication, problem-solving, and social support. They also participated in six weekly telephone sessions with Masters-level trained interventionists with a mental health background, who provided psychoeducation, skills training, and support. Eight weeks after baseline, caregivers completed a follow-up survey.
Results: Using an intent-to-treat framework, analyses of covariance were conducted to assess the efficacy of CareSTEPS, with p-values <.05 indicating significant differences. Caregivers who received CareSTEPS reported improved psychological functioning and lower burden compared to those who received UC, with effect sizes ranging from small to large (depression d = -0.55, anxiety d = -0.81, caregiver burden d = -0.37).
Conclusion: The CareSTEPS intervention shows great promise in meeting the critical support needs of the family caregivers of advanced LC patients, significantly improving caregivers' psychological functioning and reducing their burden. Overall, the findings emphasize the importance of incorporating caregiver support into the comprehensive management of advanced LC.

Author - Hoda Badr,
Baylor College of Medicine

Co-Author - Karen Kayser, Ph.D., Ph.D.,
University of Louisville

Co-Author - Kathrin Milbury, PhD, PhD,
University of Texas MD Anderson Cancer Center

Co-Author - maria rangel, DrPH,
Baylor College of Medicine

Co-Author - Robert T Ripley, MD,
Baylor College of Medicine

Co-Author - Elizabeth Kvale, MD,
Baylor College of Medicine

Background: As artificial intelligence (AI) gains popularity and researchers explore its application in the medical context, it is important to understand how current patient-provider dynamics involving high technology (e.g., telehealth communication) may shape patients’ perceptions of future use of AI, especially in the context of cancer care where patient satisfaction and sense of care continuity play essential roles.

Objective: We explore how different aspects of patient-centered communication (PCC) may directly or indirectly predict patients’ preferences for AIs vs. human medical professionals (HMP), based on the stimulus-organism-response (SOR) model.

Method: In June 2024, we collected survey data from an online panel of 500 Chinese cancer patients, representative of the gender and age distribution of the overall Chinese population due to quota sampling. Structural equation modeling (SEM) analyzed the relationships among variables, including six PCC dimensions (i.e., exchanging information, fostering healing relationships, making decisions, managing uncertainty, responding to emotions, and enabling patient self-management), communication outcomes (i.e., patient satisfaction, sense of care continuity), and patients’ preference of AIs vs. HMPs.

Result: Direct predictors of preference for replacing HMPs with AIs included lower patient satisfaction (β = -11, p < .05), lower ease of use (β = -.1, p < .05), better care continuity (β = .15, p < .01), providers’ attending to emotions (β = .17, p < .05), and less enablement in self-management (β = -.17, p < .01). Patient satisfaction, ease of use, and care continuity mediated the relationships between different PCC dimensions and patients’ preferences for AI use.

Conclusion: PCC and communication outcomes are associated with cancer patients’ preferences in future AI use. Our study contributes to the growing research on AI application in patient care. Also, it sheds light on how clinicians may improve their communication to educate patients on navigating the cancer care continuum using AI technology.

Author - Qiwei Wu, PhD,
Cleveland State University

Author - Yue Liao, MPH, PhD, CPH, MPH, PhD, CPH,
University of Texas at Arlington

Author - Grace Brannon, PhD,
University of Texas at Arlington