Supplement: The Association Between Stigma and Wellbeing among Kaposi sarcoma and Lymphoma Patients in Malawi

摘要 本申请是为了回应被确认为非CA-CA的特殊利益通知(NOSI)而提交的 23-036.耻辱阻碍了癌症护理的连续体，导致延迟提交护理，提高 发病率和死亡率降低，生活质量下降，特别是艾滋病毒相关癌症患者。 定性研究阐明了癌症患者中耻辱的生活经历及其不良影响 这一污名对精神健康、自我隔离和参与护理的影响。然而，在这方面仍然存在差距 量化癌症相关污名的流行和分布及其对健康相关结果的影响 适用于HIV相关癌症患者。作为回应，我们目前正在制定和验证以下措施 马拉维实行的、预期的、内在化的耻辱(P30CA042014-33S5，Lead Kimani)。有了这份补充材料， 总体目标是将这些新的癌症污名措施植入马拉维现有的癌症患者队列中。 为了更好地了解癌症污名在一家非洲公立癌症医院的流行情况和影响。 我们的长期目标是利用这项研究的结果，为有针对性的、多层次的R01级赠款制定 旨在解决非洲癌症污名问题并最终改善癌症结果的干预措施。在本建议中 补充，我们将通过利用U54预期，在家长奖(U54CA254564，Pi Damania)的基础上再接再厉 卡波西肉瘤(KS)和淋巴瘤队列经验探讨与癌症相关的耻辱，其对 临床结果，及其与艾滋病毒耻辱的交集。具体地说，我们将调查新诊断的成年人 接受或有资格接受积极癌症治疗的经活检证实的KS或淋巴瘤患者，并登记 在母公司的研究中，测量癌症和艾滋病毒的污名并从U54中提取癌症和患者数据 常规研究评估。然后我们将量化KS和淋巴瘤中癌症污名的流行率 马拉维的患者(目标1)。我们还将确定关键癌症(特征、治疗和结果) 以及与癌症污名相关的患者(生活质量、心理健康、韧性)因素，并评估 艾滋病毒与癌症污名的交叉(目标2)。最终，这项创新的研究将产生新的发现 这将刺激和加强全球癌症污名，建设当地开展癌症污名研究的能力， 并为未来实施和评估多层次干预措施的R01提案奠定了基础 解决非洲的癌症污名问题，并最终改善癌症护理和结果。

ABSTRACT This application is being submitted in response to the Notice of Special Interest (NOSI) identified as NOT-CA- 23-036. Stigma hampers the cancer care continuum, leading to delayed presentation to care, elevated morbidity and mortality, and reduced quality of life, particularly for patients with HIV-associated cancers. Qualitative research has elucidated the lived experience of stigma among cancer patients and the adverse impact of this stigma on mental health, self-isolation and engagement in care. However, there remains a gap in quantifying the prevalence and distribution of cancer-related stigma and its impact on health-related outcomes for patients with HIV-associated cancers. In response, we are currently developing and validating measures of enacted, anticipated, internalized stigma in Malawi (P30CA042014-33S5, Lead Kimani). With this supplement, the overall goal is to embed these new cancer stigma measures in existing cohorts of cancer patients in Malawi in order to better understand the prevalence and impact of cancer stigma in an African public cancer hospital. Our long-term goal is to use the results from this study to develop R01-level grants for targeted, multi-level interventions to address cancer stigma in Africa and ultimately improve cancer outcomes. In this proposed supplement, we will build on the parent award (U54CA254564, PI Damania) by leveraging the U54 prospective Kaposi sarcoma (KS) and lymphoma cohorts to explore the experience of cancer-related stigma, its impact on clinical outcomes, and its intersection with HIV stigma. Specifically, we will survey newly diagnosed adult patients with biopsy-proven KS or lymphoma, who are receiving or eligible for active cancer care, and enrolled in the parent study to measure cancer and HIV stigma and abstract cancer and patient data from the U54 routine study assessments. We will then quantify the prevalence of cancer stigma among KS and lymphoma patients in Malawi (Aim 1). We will additionally identify key cancer (characteristics, treatment and outcomes) and patient (quality of life, mental health, resilience) factors correlated with cancer stigma, and assess the intersectionality of HIV and cancer stigma (Aim 2). Ultimately, this innovative research will generate findings that will stimulate and strengthen global cancer stigma, build local capacity to conduct cancer stigma research, and lay the ground-work for future R01 proposals to implement and evaluated multi-level interventions that address cancer stigma in Africa and ultimately improve cancer care and outcomes.