Evidence-based guidelines recommend four cancer surveillance procedures for breast cancer survivors: physical examination, mammography, breast self-exam (BSE), and gynecologic follow-up. The early detection of recurrent and new cancers can best be achieved through the combined, on schedule use of these four key surveillance procedures. Yet, data suggest that up to 55% of breast cancer survivors do not undergo these four procedures as recommended. This application proposes a program of research and training focused on improving adherence to recommended surveillance in breast cancer survivors, with an emphasis on the recruitment and retention of African American breast cancer survivors. The proposed research includes two studies. Study 1 will develop an Improving Adherence intervention protocol that targets the cognitive, emotional, and behavioral factors that contribute to sustained adherence for each of the four recommended cancer surveillance procedures. Study 1 also seeks to develop the assessment protocol that will be used to evaluate this intervention. Study 2 will test the Improving Adherence intervention protocol developed in Study 1 in a pilot randomized trial. Participants will be recruited from four community hospitals. In Study 1, cognitive interviews will be conducted with 30 breast cancer survivors to pilot and refine the assessment materials. To develop the Improving Adherence intervention protocol, eight focus groups will be conducted with breast cancer survivors (8 women per group), two focus groups with health professionals (8 per group), and one focus group with eight African American women who conduct cancer-related educational outreach in the community. Focus groups will be used to develop the intervention manual and accompanying participant materials. Study 2 will conduct a pilot randomized test of the Improving Adherence protocol;106 breast cancer survivors who have been non-adherent to physical exam, mammography, or gynecologic follow-up will be randomly assigned to: 1) the Improving Adherence protocol, or 2) usual care with printed educational materials. Assessments will be conducted pre- and post-treatment. Subsequent adherence to surveillance will be assessed via medical record review 15 months after the intervention. The proposed studies have the potential to provide valuable, new information that can aid in selecting strategies for helping breast cancer survivors better adhere to recommended surveillance. The career development plan proposed in this application focuses on training in cancer control and survivorship, intervention development and testing, and effectiveness and dissemination research. Through a combination of coursework, seminars, and workshops, the applicant will develop the necessary skills for building an independently funded program of research focused on rigorously evaluating and disseminating interventions that can increase adherence to recommended care in cancer survivors.

Public Health Relevance

The early detection of cancer is critical for reducing mortality rates. Yet, many breast cancer survivors do not undergo cancer surveillance tests as recommended. This project aims to develop intervention strategies that will help breast cancer survivors better adhere to recommended cancer surveillance.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Academic/Teacher Award (ATA) (K07)
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Study Section
Subcommittee G - Education (NCI)
Program Officer
Perkins, Susan N
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Duke University
Schools of Medicine
United States
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Dorfman, Caroline S; Lamb, Eneka; Van Denburg, Alyssa et al. (2018) The relationship between holding back from communicating about breast concerns and anxiety in the year following breast biopsy. J Psychosoc Oncol 36:222-237
Ghazikhanian, S E; Dorfman, C S; Somers, T J et al. (2017) Cognitive problems following hematopoietic stem cell transplant: relationships with sleep, depression and fatigue. Bone Marrow Transplant 52:279-284
Kimmick, Gretchen; Edmond, Sara N; Bosworth, Hayden B et al. (2015) Medication taking behaviors among breast cancer patients on adjuvant endocrine therapy. Breast 24:630-6
Keefe, F J; Porter, L; Somers, T et al. (2013) Psychosocial interventions for managing pain in older adults: outcomes and clinical implications. Br J Anaesth 111:89-94
Miller, Lauren S; Shelby, Rebecca A; Balmadrid, Melissa Hayes et al. (2013) Patient anxiety before and immediately after imaging-guided breast biopsy procedures: impact of radiologist-patient communication. J Am Coll Radiol 10:423-31
Somers, Tamara J; Blumenthal, James A; Guilak, Farshid et al. (2012) Pain coping skills training and lifestyle behavioral weight management in patients with knee osteoarthritis: a randomized controlled study. Pain 153:1199-209
Shelby, Rebecca A; Somers, Tamara J; Keefe, Francis J et al. (2012) Brief Fear of Movement Scale for osteoarthritis. Arthritis Care Res (Hoboken) 64:862-71
Somers, Tamara J; Wren, Anava A; Shelby, Rebecca A (2012) The context of pain in arthritis: self-efficacy for managing pain and other symptoms. Curr Pain Headache Rep 16:502-8
Shelby, Rebecca A; Scipio, Cindy D; Somers, Tamara J et al. (2012) Prospective study of factors predicting adherence to surveillance mammography in women treated for breast cancer. J Clin Oncol 30:813-9
Suh, Sang-Yeon; Leblanc, Thomas W; Shelby, Rebecca A et al. (2011) Longitudinal patient-reported performance status assessment in the cancer clinic is feasible and prognostic. J Oncol Pract 7:374-81