Stress Inflammation Mechanisms of Survivorship Disparities Experienced by Hispanic Women After Breast Cancer

总结 使用不同方法的多项研究发现，与非西班牙裔白人（NHWs）相比， 乳腺癌幸存者中的西班牙裔女性更有可能报告与健康相关的损害。 生活质量（hr-QOL）归因于情绪功能（抑郁和痛苦增加），身体 功能（疲劳）和社会功能。这增加了“生存负担”，或 已经发现即使在控制癌症治疗因素时也存在不同的hr-QOL域。证据 表明社会经济因素，社会文化因素和炎症可能参与了 生存负担关于后者，PI和其他人已经表明炎症与 与NHW乳腺癌幸存者抑郁和疲劳的严重程度相关。基于压力的健康理论 这表明，除了社会经济因素，社会文化因素也是重要的理解 生存负担。这些包括文化适应和文化适应压力，社会地位，污名化， 社会支持和家庭主义低文化适应与儿童的情绪功能差有关， 西班牙裔乳腺癌幸存者有趣的是，文化适应压力也与增加 其他种族群体的炎症，这表明与社会文化因素有关的压力可能会影响 西班牙裔乳腺癌幸存者hr-QOL损伤的生物学。压力与 使用短期心理应激研究了与生存负担有关的炎症 实验室里的挑战具体而言，对短期实验室检查的过度炎症反应 在社会经济地位较低的个体中发现了压力，这表明实验室中的压力 可能揭示hr-QOL损害的病理生理学的独特方面， 休息PI和其他人使用了类似的程序（特里尔社会压力测试[TSST]），以揭示增加 抑郁症患者的炎症。本提案的首要目标是确定人力资源部是否- 西班牙裔乳腺癌幸存者经历的生活质量损害与压力有关- 相关炎症的方式，涉及社会文化因素。因此，目前 建议有两个具体目标。首先，这项研究将致力于确定炎症是否对短时间的反应， 在实验室中使用TSST进行长期心理应激挑战可预测以下患者经历的hr-QOL差异： 西班牙裔与非西班牙裔白色乳腺癌幸存者的比较。第二，研究将探讨 应激相关炎症和社会文化因素之间的关系，以预测hr-QOL差异 西班牙裔乳腺癌幸存者的经历。这些目标的实现将提供关键的洞察力， 可能的压力炎症病理生理机制和社会文化因素参与了 西班牙裔乳腺癌幸存者所经历的生存负担，并可能最终导致新的风险 为这一重要而得不到充分服务的群体制定筛查战略和干预措施。

SUMMARY Multiple studies using different methodologies have found that compared to non-Hispanic whites (NHWs), Hispanic women who are survivors of breast cancer are more likely to report impairments in health-related quality of life (hr-QOL) attributable to emotional functioning (increased depression and distress), physical functioning (fatigue), and social functioning. This increased "survivorship burden" or the combination of different hr-QOL domains has been found to exist even when controlling for cancer treatment factors. Evidence suggests that socioeconomic factors, socio-cultural factors, and inflammation may be involved in the survivorship burden. With respect to the latter, the PI and others have shown that inflammation is associated with the severity of depression and fatigue in NHW breast cancer survivors. Stress-based theories of health suggest that in addition to socioeconomic factors, socio-cultural factors are also important for understanding the survivorship burden. These include acculturation and acculturation stress, social status, stigmatization, social support, and familism. Low acculturation has been associated with poor emotional functioning in Hispanic breast cancer survivors. Interestingly, acculturation stress has also been linked to increased inflammation in other racial groups, suggesting that stress related to socio-cultural factors may impact the biology of hr-QOL impairments in Hispanic breast cancer survivors. Connections between stress and inflammation involved with the survivorship burden have been studied using short-term psychological stress challenges in the laboratory. Specifically, exaggerated inflammation responsiveness to short-term laboratory stress has been found in individuals of low socioeconomic status, suggesting that stress in the laboratory may reveal unique aspects of the pathophysiology of hr-QOL impairments not otherwise apparent at rest. The PI and others have used similar procedures (the Trier Social Stress Test [TSST]), to reveal increased inflammation in individuals with depression. The overarching goal of this proposal is to determine if hr- QOL impairments experienced by Hispanic breast cancer survivors are associated with stress- associated inflammation in a manner that involves socio-cultural factors. Accordingly, the current proposal features two specific aims. First, the study will work to determine if inflammation in response to short- term psychological stress challenge in the laboratory with the TSST predicts hr-QOL disparities experienced by Hispanic compared to non-Hispanic white breast cancer survivors. And second, the study will explore the relationships among stress-related inflammation and socio-cultural factors to predict hr-QOL disparities experienced by Hispanic breast cancer survivors. Accomplishment of these aims will provide critical insight into the likely stress pathophysiological mechanisms of inflammation and socio-cultural factors involved in the survivorship burden experienced by Hispanic breast cancer survivors, and may eventually result in novel risk screening strategies and interventions for this important and underserved group.