Culturally Adapted Cognitive Behavioral Stress and Self-Management (C-CBSM) Intervention for PC

项目摘要：这项为期5年的研究评估了为期10周的以小组为基础的语言翻译的效果 文化适应认知-行为应激与自我管理(C-CBSM)对症状的干预 接受局限性前列腺癌(PC)治疗的西班牙裔男性的负担和健康相关生活质量(HRQOL)。 约80%的PC病例被诊断为早期疾病，其5年和10年存活率几乎为100% 和99%。大多数患者接受积极治疗(~70%)，导致延长治疗相关时间 副作用和功能障碍会持续很久，远远超过最初的治疗。存活率被慢性副作用所抵消 比如性功能障碍和排尿功能障碍，疼痛和疲劳会导致心理社会功能低下， 亲密关系和社交功能受损，以及对男子气概的担忧。拉美裔个人电脑幸存者报告较低 身体和社会功能，更差的情绪健康和更严重的性和排尿功能障碍，甚至 在考虑了SES和疾病严重程度后。这种后遗症会导致糖皮质激素释放增加，并 对这些症状有直接影响并可干扰生理的炎性细胞因子 恢复性功能和尿路功能所必需的途径。我们已经证明，CBSM减少了 双语西语裔PC幸存者的症状负担和改善的HRQOL。在一次试验中，我们展示了一个 关注社会文化过程的CBSM语言翻译改善了症状负担和HRQOL 西班牙语中的单语PC幸存者。我们还表明，CBSM与降低 乳腺癌幸存者的糖皮质激素抵抗和炎症基因表达途径。我们建议 (A)在西班牙语中提供文化适应的C-CBSM干预，更加强调突出 拉美裔美国人症状负担和HRQOL的社会文化决定因素(例如，宿命论态度、家庭 相互依赖、感觉到的歧视、男子气概)，(B)纳入症状的神经免疫模型 监管和管理，以及(C)测试C-CBSM相对于标准的非文化适应的效力 CBSM在两个不同的西班牙裔社区(芝加哥和迈阿密)。我们将在260名西班牙裔男性中测试我们的目标 症状负担增加的局限性PC的治疗后，采用2×4随机设计，有条件(C- CSBM和CBSM)作为组间因素，以及时间(基线、干预后和6个月和12个月 基线后)作为组内因素。我们的主要目标是确定随机化到C- 与标准的CBSM相比，CBSM与减轻症状负担和改善HRQOL有关。我们的 次级目标评估C-CBSM是否导致干预目标的更大改进(例如， 压力管理、心理困扰和人际关系中断)和生理适应(即， 糖皮质激素受体敏感性和炎症基因表达)。我们还将评估心理社会和 作为C-CBSM影响初级结果的中介的生理机制。我们将探索 C-CBSM作用的调节剂(例如，SES，西班牙裔)和C-CBSM对心脏代谢健康的影响。

Project Summary:This 5-year study evaluates the effects of a 10-week group-based linguistically translated and culturally adapted cognitive-behavioral stress and self management (C-CBSM) intervention on symptom burden and health related quality of life (HRQOL) in Hispanic men treated for localized prostate cancer (PC). About 80% PC cases are diagnosed as early disease and have a 5- and 10-year survival rate of almost 100% and 99%, respectively. Most patients receive active treatment (~70%) leading to prolonged treatment-related side effects and dysfunction persisting well beyond primary treatment. Survival is offset by chronic side effects such as sexual and urinary dysfunction, pain and fatigue that can lead to poor psychosocial functioning, impaired intimacy and social functioning, and masculinity concerns. Hispanic PC survivors report lower physical and social functioning, poorer emotional well-being and greater sexual and urinary dysfunction, even after accounting for SES and disease severity. This sequela can lead to elevated glucocorticoid release and inflammatory cytokines that have a direct effect on these symptoms and can interfere with physiological pathways necessary for recovery of sexual and urinary functioning. We have shown that CBSM reduces symptom burden and improves HRQOL in bilingual Hispanic PC survivors. In a pilot we showed that a linguistic translation of CBSM with attention to sociocultural processes improved symptom burden and HRQOL in Spanish monolingual PC survivors. We have also shown that CBSM is associated with reduced glucocorticoid resistance and inflammatory gene expression pathways in breast cancer survivors. We propose to (a) deliver a culturally adapted C-CBSM intervention in Spanish that places greater emphasis on salient sociocultural determinants of symptom burden and HRQOL in Hispanics (e.g., fatalistic attitudes, family interdependence, perceived discrimination, machismo), (b) incorporate a neuroimmune model of symptom regulation and management, and (c) test the efficacy of C-CBSM, relative to standard non-culturally adapted CBSM, in two diverse Hispanic communities (Chicago & Miami). We will test our aims in 260 Hispanic men post-treatment for localized PC with elevated symptom burden in a 2 x 4 randomized design with condition (C- CSBM vs. CBSM) as the between groups factors, and time (baseline, post-intervention & 6- and 12-months post baseline) as the within groups factor. Our Primary Aim is to determine whether randomization to C- CBSM, relative to standard CBSM, is associated with reduced symptom burden and improved HRQOL. Our Secondary Aims evaluate whether C-CBSM leads to greater improvements in the intervention targets (e.g., stress management, psychological distress & interpersonal disruption), and physiologic adaptation (i.e., glucocorticoid receptor sensitivity & inflammatory gene expression). We will also evaluate psychosocial and physiological mechanisms as mediators of C-CBSM's effects on our primary outcomes. We will explore moderators (e.g., SES, Hispanic origin) of C-CBSM's effect and C-CBSM's effects on cardiometabolic health.