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

项目摘要：这项为期5年的研究评估了一项为期10周的基于小组的语言翻译的效果。 文化适应性认知行为应激和自我管理（C-CBSM）干预 在接受局限性前列腺癌（PC）治疗的西班牙裔男性中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，5年和10年生存率几乎为100%。 分别为99%。大多数患者接受积极治疗（约70%），导致治疗相关的 副作用和功能障碍持续超过主要治疗。存活率被慢性副作用抵消 例如性功能和泌尿功能障碍、疼痛和疲劳，这些可能导致不良的心理社会功能， 亲密关系和社会功能受损，以及男性气质问题。西班牙裔PC幸存者报告较低 身体和社会功能，更差的情绪健康和更大的性和泌尿功能障碍，甚至 在考虑了SES和疾病严重程度之后。这种后遗症可导致糖皮质激素释放增加， 炎症细胞因子对这些症状有直接影响，并可干扰生理 恢复性功能和泌尿功能所需的途径。我们已经表明，CBSM减少了 双语西班牙裔PC幸存者的症状负担和HRQOL改善。在一个试点中，我们表明， 注意社会文化过程的CBSM的语言翻译改善了症状负担和HRQOL 在西班牙语单语PC幸存者。我们还表明，CBSM与减少 乳腺癌幸存者的糖皮质激素抵抗和炎症基因表达途径。我们提出 （a）以西班牙语提供适应文化的C-CBSM干预措施， 西班牙裔美国人症状负担和HRQOL的社会文化决定因素（例如，听天由命的态度、家庭. 相互依赖、感知歧视、大男子主义），（B）结合症状神经免疫模型 监管和管理，以及（c）测试C-CBSM相对于标准非文化适应的功效 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 在一项2 x 4随机设计中，对症状负荷升高的局部PC进行治疗后研究，条件为（C- CSBM与CBSM）作为组间因素，以及时间（基线、干预后6个月和12个月 基线后）作为组内因素。我们的主要目的是确定是否随机分配到C- 相对于标准CBSM，CBSM与症状负担减轻和HRQOL改善相关。我们 次要目的评价C-CBSM是否导致干预目标的更大改善（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性基因表达）。我们还将评估社会心理和 生理机制作为C-CBSM对我们的主要结果的影响的介质。我们将探讨 主持人（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.