Disease Beliefs and Cognition: Effect on Diabetes Management in Older Breast Cancer Survivors

疾病信念和认知：对老年乳腺癌幸存者糖尿病管理的影响

• 批准号: 10219175
• 负责人: Jenny J. Lin
• 金额: $ 68.44万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-18 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10219175
• 关键词: Academic advising; Address; Adherence; Affect; Aftercare; Age; Aging; American; Attention; Behavior; Belief; Breast Cancer survivor; Breast Cancer therapy; Cancer Survivor; Caring; Cause of Death; Chronic; Chronic Disease; Clinical; Cognition; Cognitive; Counseling; Diabetes Mellitus; Disease; Disease Management; Early treatment; Education; Elderly; Goals; Health behavior; Heart Diseases; High Prevalence; Impaired cognition; Impairment; Informal Social Control; Intervention; Interview; Knowledge; Language; Malignant Neoplasms; Mediating; Memory; Modeling; Morbidity - disease rate; Newly Diagnosed; Outcome; Participant; Patients; Pharmaceutical Preparations; Plant Roots; Population; Prospective cohort study; Research; Research Design; Risk Factors; Self Management; Series; Subgroup; Survivors; Testing; Time; Woman; base; behavioral adherence; breast cancer diagnosis; chemobrain; chemotherapy; cognitive change; cognitive function; cognitive skill; comorbidity; diabetes management; diabetes self-management; diet and exercise; dietary adherence; disorder control; executive function; experience; health belief; high risk; hormone therapy; improved; improved outcome; malignant breast neoplasm; medication compliance; mortality; mortality risk; older patient; recruit; theories; therapy adherence; tumor progression

PROJECT SUMMARY/ABSTRACT The impact of disease beliefs on self-management of chronic illness such as diabetes (DM) in the setting of cancer is largely unknown. In addition, little is known about the impact of age- or cancer-related cognitive changes on cancer survivors’ self-management behaviors (SMB) for their other comorbidities. Without this knowledge, our ability to provide optimal self-management support for cancer survivors with comorbidities is limited. The goal of this study is to determine how disease beliefs about cancer and DM and cognitive changes affect older breast cancer survivors’ DM SMB. We will focus on older breast cancer survivors with early-stage cancer who have received chemotherapy or hormonal therapy (HT) since these patients are more likely to have age- or cancer-related cognitive changes and are more likely to die from complications from their comorbidities as from their breast cancer. We will focus on DM due to its high prevalence in cancer survivors, association with worse cancer outcomes and cognitive decline, impact on competing risks of death, and its moderate SMB complexity. The study design is rooted in the Common Sense Self-Regulation Model (CSM), a theory of health behaviors that has been used to develop interventions, but has primarily been applied to research on behaviors around single diseases. By understanding the relationship between disease beliefs about breast cancer and DM and the interrelationship of disease beliefs and cognitive function on survivors’ DM SMB, we will advance both the CSM and care of older breast cancer survivors with comorbidities. The Specific Aims are to: 1) Evaluate the longitudinal interrelationship of beliefs about breast cancer and DM and its effect on survivors’ DM SMB (adherence to medications, diet and exercise); 2) Assess the effect of cognitive function on DM SMB and evaluate whether disease beliefs mediate, in part, an association between cognition and DM SMB; and 3) Develop and pilot an educational and counseling intervention to improve DM SMB among breast cancer survivors with comorbid DM. This prospective cohort study will recruit 320 older (≥55 years) breast cancer survivors with pre-existing DM who have completed first-line chemotherapy or are taking hormonal therapy for treatment of early stage (I-IIIA) breast cancer within the past 5 years. We will first conduct qualitative interviews with 20 survivors to identify DM and cancer health beliefs and to elicit specific strategies and routines used to manage DM. We will then recruit 300 participants and interview them every 6 months for 24 months to assess longitudinal changes in cancer and DM beliefs and in cognition to evaluate their impact on DM SMB. For the subgroup of women currently taking HT, we will also assess the impact of beliefs and cognitive function on HT adherence. We will integrate the information collected in the quantitative and qualitative interviews to create educational and counseling modules and pilot test their impact on SMB on a group of 100 breast cancer survivors with DM. The proposed study addresses the need to develop strategies to optimize SMB for chronic comorbidities in cancer survivors using breast cancer and DM as the paradigm.

项目摘要/摘要 在 癌症在很大程度上是未知的。此外，关于年龄或癌症相关认知的影响知之甚少 癌症存活行为的变化（SMB）的其他合并症。没有这个 知识，我们为合并症提供最佳自我管理支持的能力是 有限的。这项研究的目的是确定疾病如何对癌症和DM和认知变化的看法。 影响较老的乳腺癌生存的DM SMB。我们将专注于较早的乳腺癌生存 接受化疗或荷尔蒙治疗（HT）的癌症，因为这些患者更有可能 具有与年龄或癌症相关的认知变化，更有可能因其并发症而死亡 合并症与他们的乳腺癌。由于DM在癌症存活中的高流行，我们将重点关注DM， 与癌症结局较差和认知能力下降，对竞争的死亡风险的影响及其相关 中度SMB复杂性。研究设计植根于常识自我调节模型（CSM），一个 健康行为理论已用于制定干预措施，但主要应用于 研究单一疾病周围的行为。通过了解疾病信念之间的关系 关于乳腺癌和DM以及疾病信念的相互关系以及生存的认知功能 DM SMB，我们将同时促进CSM的合并症较老的乳腺癌存活。 具体目的是：1）评估关于乳腺癌和DM的信念的纵向相互关系以及 它对生存DM SMB的影响（遵守药物，饮食和运动）； 2）评估认知的影响 DM SMB的功能并评估疾病是否认为介导，部分原因是认知之间的关联 和DM SMB； 3）开发和试行一种教育和咨询干预措施，以改善DM SMB 在合并症DM的乳腺癌存活中。这项前瞻性队列研究将招募320年代（≥55 多年）乳腺癌存活与已有的DM，他们已经完成一线化学疗法或正在接受 在过去的5年中，用于治疗早期（I-IIIA）乳腺癌的荷尔蒙治疗。我们将首先进行 与20种生存的定性访谈，以识别DM和癌症健康信念并引起特定策略 和用于管理DM的例程。然后，我们将招募300名参与者，并每6个月面试一次 评估癌症和DM信念的纵向变化的24个月以及评估其影响的认知 在DM SMB上。对于目前服用HT的妇女的亚组，我们还将评估信念和 HT依从性的认知功能。我们将将收集到定量收集的信息整合到 定性访谈以创建教育和咨询模块和试点测试其对SMB的影响 DM的100组乳腺癌存活。拟议的研究解决了制定策略的需求 用乳腺癌和DM作为范式优化癌症存活中慢性合并症的SMB。

项目成果

Characterizing Beliefs About Breast Cancer and Comorbid Diabetes After Cancer Treatment.

• DOI: 10.1188/22.onf.158-166
• 发表时间: 2022-03-01
• 期刊: ONCOLOGY NURSING FORUM
• 影响因子: 1.9
• 作者: Muellers, Kimberly A.;Prieto, Sarah;Lin, Jenny J.
• 通讯作者: Lin, Jenny J.

The impact of cognitive impairment on self-regulatory styles in breast cancer survivors.

• DOI: 10.1002/pon.5633
• 发表时间: 2021-06
• 期刊: Psycho-oncology
• 影响因子: 3.6
• 作者: Becker JH;Ezratty C;Jahan N;Goel M;Harris YT;Lin JJ
• 通讯作者: Lin JJ

The association of osteoporosis knowledge and beliefs with preventive behaviors in postmenopausal breast cancer survivors.

• DOI: 10.1186/s12905-021-01430-1
• 发表时间: 2021-08-11
• 期刊: BMC women's health
• 作者: Bailey S;Lin J
• 通讯作者: Lin J

Racial and ethnic disparities in post-traumatic stress and illness coherence in breast cancer survivors with comorbid diabetes.

• DOI: 10.1002/pon.5747
• 发表时间: 2021-10
• 期刊: Psycho-oncology
• 影响因子: 3.6
• 作者: Mazor M;Wisnivesky JP;Goel M;Harris YT;Lin JJ
• 通讯作者: Lin JJ