Hispanic/Latinos (HL) are the largest and fastest-growing minority population in the nation. HLs generally have lower survival rates for most cancers, even after accounting for differences in age and stage distribution, which may reflect less access to fimely, high-quality treatment. They also experience disproportionately higher disparities in quality of care and access to care. The experience of cancer survivorship is often characterized by significant challenges. Despite these challenges and significant disparities observed among HLs, there is very limited knowledge of survivorship-related issues and priorifies among HLs, specifically the effectiveness of using promotores/patient navigators (PN) in linking HL cancer survivors with unmet psychosocial needs to appropriate psychosocial services. The existing community-based infrastructure of the Lance Armstrong Foundafion (LAF) LIVESTRONG SurvivorCare (LSSC) program provides an excellent opportunity to evaluate its efficacy in improving QOL among HLs. This proposed 5-year Redes En Accidn research study involves a mixed-methods approach that occurs in two phases across two disfinct and diverse HL communifies. Phase I will use a community-based participatory research (CBPR) approach to engage community-based partners that provide services to breast, colorectal and prostate HL cancer survivors. In this phase, we will gather community partners for action-oriented group meetings at each site to present components and targets of the combined PN and LSSC program (PN+LSSC). Through this CBPR approach to generate valuable community feedback, we will enhance the role of the PN, develop and extend existing cooperative relafionships to facilitate participant recruitment, and prepare community-based partners to disseminate and implement the PN+LSSC program upon the established efficacy of the proposed randomized controlled trial (RCT) of Phase II. Phase II will test a RCT to evaluate the efficacy of a culturally tailored PN+LSSC program on improving general and disease-specific quality of life (QOL) and treatment follow-up compliance among breast, colorectal and prostate HL cancer survivors. Phase II also will evaluate the extent to which intervention-associated improvements in these outcomes are mediated by targets of the PN+LSSC program (e.g., communication with medical team, meeting unmet needs and improving health behaviors). The RCT involves a 2 X 4 randomized repeated measures design with experimental condition (combined patient navigafion [PN] over 3 months with access to LSSC telephone-based counseling [PN+LSSC] vs. a usual care [UC] control condition) as the between-groups factor, and fime-point (baseline/pre-randomizafion [Tl];post-PN [3-months post-TI;T2], and 6- [T3] and 12-months [T4] follow-up post-T2) as the within-groups factor. We will compare the effects ofthe PN+LSSC and UC condifions on QOL and treatment follow-up compliance in 300 (after attrition;n=150, South Florida and n=150, Texas'Lower Rio Grande Valley) breast, colorectal and prostate HL cancer survivors with no evidence of metastatic disease. To understand the mechanisms by which the PN+LSSC significantly impacts QOL and treatment compliance outcomes, we also will examine changes in unmet cancer needs, communicafion with the medical team and health behaviors as potential mediators of the intervention effects. Study findings will fill a significant gap in our understanding of the extent to which PN programs and existing community-based resources targefing survivors can improve the QOL of a growing number of HL cancer survivors who experience an unequal burden of unmet needs after cancer treatment. The efficacy of the proposed RCT will provide a conceptually sound and clinically relevant approach to address the needs of HL cancer survivors by integrating evidence-based practice into existing community resources and infrastructure, thus facilitating the dissemination and translafion of study findings through Phase I's CBPR process.
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