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

摘要 使用不同方法的多项研究发现，与非西班牙裔白人(NHW)相比， 患有乳腺癌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(增加的抑郁和痛苦)、身体 功能(疲劳)和社会功能。这增加了“生存负担”，或者是 甚至在控制癌症治疗因素时，也发现存在不同的人力资源-生活质量领域。证据 提示社会经济因素、社会文化因素和炎症可能参与了 生存负担。关于后者，PI和其他人已经证明炎症与 与nhw乳腺癌幸存者的抑郁和疲劳的严重程度有关。基于压力的健康理论 认为除了社会经济因素，社会文化因素对理解也很重要 生存的负担。这些问题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。低文化适应与不良的情绪功能有关 西班牙裔乳腺癌幸存者。有趣的是，文化适应压力也与 其他种族群体的炎症，表明与社会文化因素相关的压力可能会影响 西班牙裔乳腺癌幸存者的人力资源-生活质量损害的生物学研究。压力和压力之间的联系 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。具体地说，夸大了炎症对短期实验室的反应 在社会经济地位较低的人身上发现了压力，这表明在实验室里的压力 可能揭示HR-QOL损伤的病理生理学的独特方面，否则在 好好休息。PI和其他人也使用了类似的程序(Trier社会压力测试[TSST])，以揭示 抑郁症患者的炎症反应。这项提案的首要目标是确定人力资源是否-- 西班牙裔乳腺癌幸存者的生活质量受损与压力有关- 以一种涉及社会文化因素的方式引起相关的炎症。因此，当前 提案有两个具体目标。首先，这项研究将致力于确定炎症是否对短期- 使用TSST的实验室中的长期心理压力挑战预测经历的人力资源-生活质量差异 西班牙裔与非西班牙裔白人乳腺癌幸存者相比。第二，这项研究将探索 应激相关炎症和社会文化因素之间的关系预测人力资源-生活质量差异 西班牙裔乳腺癌幸存者的经历。这些目标的实现将为我们提供对 可能的应激、炎症的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经历的生存负担，并可能最终导致新的风险 为这一重要和服务不足的群体筛选战略和干预措施。

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.