Rationale. Systemic Sclerosis (SSc, scleroderma) is a rare and progressive rheumatic disease of unknown etiology and heterogeneous presentation that results in fibrosis of the skin and internal organs. A common and distressing symptom of SSc is disfigurement in visible and socially relevant areas of the body (i.e., face and hands). Disease-related changes in appearance have been associated with body image dissatisfaction and social anxiety. Although there have been studies identifying correlatesof body image dissatisfaction, there is a need for an examination that considers the complex relationships among the personal and social aspects of appearance changes. The present study used latent profile analysis (LPA) to identify body image typologies. Identified groups were then compared on key sociodemographic, medical, and psychosocial variables.

Design. The sample consisted of 942 patients with physician-confirmed SSc enrolled in the Scleroderma Patient-centered Intervention Network (SPIN) Cohort who completed study questionnaires from April 2014 through October 2016. Patients in the SPIN Cohort were enrolled at 28 centers from Canada, the United States, and the United Kingdom. Prior to running the analysis, the sample was randomized into two different groups that were treated as independent samples (N = 469 in Sample 1 and N = 473 in Sample 2); this randomization was completed to allow for a replication analysis of the findings. For the first aim, exploratory LPA was used to derive categorical latent variables that signified profiles of similarly scoring individuals using one indicator of objective skin involvement, three indicators of subjective body image, and three indicators of social anxiety. For the second aim, group differences were examined, using the Lanza three-step method for modeling auxiliary variables, for selected sociodemographic, medical, and psychosocial variables.

Results. In both samples, a two-profile solution was derived. These two classes were substantively analyzed for patterns of scores and termed the Appearance Comfortable (n = 334 and n = 375 in Sample 1 and Sample 2, respectively) and Appearance Distressed (n = 135 and n = 98 in Sample 1 and Sample 2, respectively) groups. In both samples, younger age, diffuse disease subtype, and the presence of hypo/hyper-pigmentation were associated with membership in the Appearance Distressed group. Additionally, patients in the Appearance Distressed group had significantly higher scores on measures of depressive and anxious symptoms and physical disability.

Conclusions. The present study was the first to use LPA in the context of body image in SSc, and the first study to identify typologies of patients based on indicators of body image in any disfiguring condition. Two distinct groups were identified distinguishing between an Appearance Comfortable group, comprised of patients with lower objective skin involvement, better body image, and lower social anxiety and an Appearance Distressed group including patients who had higher objective skin involvement, poorer body image, and higher social anxiety. Interestingly, although the differences in objective skin involvement were relatively small, the differences in body image and social anxiety scores were relatively large. This suggests that the body image experience in SSc is driven by psychosocial factors beyond objective appearance. The results also elucidated variables that can indicate likely group membership and help identify which individuals may be most vulnerable to poorer body image-related outcomes.

Rationale. Secondary to breast cancer and its treatment, fatigue has been identified as one of the most commonly reported symptoms by patients at all stages along the cancer continuum. In addition, sleep disruption has been shown to be notably elevated among cancer patients as compared to the general population. Sleep disruption and cancer-related fatigue have often been evaluated as components of larger symptom clusters, along with other cancer-related medical and psychosocial symptoms. While many studies have evaluated symptom clusters in breast cancer, few have examined symptom clusters that consider multiple indicators of sleep disruption and fatigue, and most have utilized suboptimal statistical strategies. The present project identified sleep and fatigue symptom cluster groups of breast cancer patients using Latent Profile Analysis (LPA) based on two indicators of objective sleep, one measure of subjective sleep quality, and five dimensions of cancer-related fatigue. Groups were then compared on sociodemographic, medical, and psychosocial characteristics.

Design. Participants were 152 women with newly diagnosed stage I-III breast cancer with no prior exposure to chemotherapy who were scheduled to receive at least four cycles of anthracycline-based chemotherapy. Participants were recruited through two separate studies with identical protocols, recruitment techniques, and inclusion criteria. Across both studies data were collected prior to the initiation of chemotherapy treatment (i.e., T1), and again at the last week of the fourth cycle of chemotherapy (i.e., T2). Exploratory LPA was used to derive categorical latent variables at T1 and T2 representing groups of individuals who scored similarly on percent of the day spent asleep and percent of the night spent asleep based on actigraphy (i.e., objective sleep), the Pittsburgh Sleep Quality Index total score (i.e., subjective sleep quality), and the General fatigue, Physical fatigue, Emotional fatigue, Mental fatigue, and Vigor subscales of the Multidimensional Fatigue Symptom Inventory-Short Form (i.e., five dimensions of cancer-related fatigue). Logistic regression analyses then evaluated if sociodemographic, medical, and psychosocial characteristics at T1 significantly predicted group membership at both time points. Analyses of covariance (ANCOVAs) evaluated if groups identified at both time points had different means on psychosocial variables at T2. The psychosocial characteristics explored included depression, climacteric symptomatology, and mental, physical, and breast cancer specific health-related quality of life.

Results. At T1 (N = 152) three groups were identified, and at T2 (n = 128) five groups were identified. Bivariate logistic regression analyses demonstrated that T1 values on select sociodemographic, select medical, and all psychosocial variables significantly predicted group membership at T1 and at T2. ANCOVAs identified that, after controlling for covariates, groups identified at T1 did not significantly differ on any psychosocial variables measured at T2. Conversely, after controlling for covariates, groups identified at T2 had different means on all psychosocial variables measured at T2.

Conclusions. Distinct groups with unique sleep and cancer-related fatigue experiences were found among breast cancer patients prior to the initiation of chemotherapy, and again at the last week of the fourth cycle thereof. Results identify T1 sociodemographic, medical, and psychosocial variables that can be used to indicate likely group membership, and clarify which groups may be at heightened risk for poor psychosocial outcomes at T2. These results can inform the development of assessments and interventions to improve breast cancer patients’ overall experience of disease.

Rationale. Patient, brain-tumor, and brain-tumor-treatment factors may negatively impact brain tumor patients’ health-related quality of life (HRQOL) and executive functioning (EF). Yet, in order to inform clinical decisions, more information is needed about what factors influence HRQOL and EF, the trajectories of HRQOL and EF overtime, and potential causal relationships between HRQOL and EF.

Methods. Adults with primary brain tumors (N = 53) were enrolled in a prospective, longitudinal study evaluating the effects of radiation therapy (RT) over the first year following RT. All patients completed a self-report measure of HRQOL and objective EF assessments at baseline (pre-RT), and three months, six months, and 12 months following RT. Descriptive statistics and general linear model regression with contrast coding were used to characterize HRQOL and EF at baseline based on patient factors, tumor factors, and treatment factors. Linear mixed effects models were used to examine the trajectories of HRQOL and EF over time, controlling for significant characteristics previously identified. Cross-lagged panel model path analysis was used to examine the interrelationships between HRQOL and EF over time.

Results. Patients in this study were primarily middle-aged, married, well-educated White men and women. Seizures, steroid use, and future RT type were related to HRQOL at baseline. Marital status, seizures, tumor laterality, steroid use, antiepileptic drug use, and future chemotherapy use were related to EF at baseline. HRQOL did not exhibit a trend over time. EF exhibited a cubic trend over time. There was one statistically causal pathway between HRQOL and EF; EF performance at six-month follow-up was predictive of HRQOL at 12-month follow-up.

Conclusions. Findings suggest that patients who receive steroids and experience seizures prior to RT and who have left-sided tumors may benefit from HRQOL and EF monitoring and possibly intervention. Additionally, there was complex pattern of change in EF over time, with early deleterious effects being followed by improvement. Patients’ EF six months after RT may impact their HRQOL one-year post-RT completion. Although the mechanisms underlying this relationship remain unclear, it is possible that interventions to improve or preserve EF prior to six-months post RT may facilitate later improvements in HRQOL.

Rationale. Distress screening is recognized as a standard of practice to address the psychosocial needs of distressed cancer patients. Experts point to receipt of psychosocial care as a critical factor in successful implementation of distress screening programs; however, research in this area is limited. The current study evaluated receipt of psychosocial care following distress screening at a comprehensive cancer center by documenting rates at which distressed cancer patients received psychosocial contacts and services, documenting time to receipt of contacts and services, and identifying which patient, clinical, and health system factors predict receipt and timing of contacts and services following distress screening.

Design. A retrospective secondary data analysis of clinical and medical record data for 149 cancer patients routinely screened for distress during a one-month period in 2016 at a comprehensive cancer center was conducted.

Results. Of the 149 patients included in this study, 146 (97.99%) were identified as distressed. All 146 distressed patients received automated printed educational materials and at least one automated notification for a psychosocial provider. Of the 103 patients identified as needing follow-up by a psychosocial provider, 61.17% and 10.68% received at least one appropriate psychosocial contact and service, respectively; 44.66% and 4.85% received at least the majority of appropriate psychosocial contacts and services, respectively; and 17.48% and 2.91% received all appropriate psychosocial contacts and services, respectively. On average, patients received contacts and services in 8.19 and 4.82 days, respectively. Number of automated notifications and type of first appropriate psychosocial contact predicted receipt of at least one appropriate psychosocial contact and time to receipt of first appropriate psychosocial contact, respectively.

Conclusions. The current study addressed major gaps in the distress screening literature by evaluating receipt of appropriate aftercare following distress screening. While all patients screened and identified as distressed received automated printed educational materials, only some patients received appropriate psychosocial contacts, and few received appropriate psychosocial services following distress screening. It is imperative that future research evaluate receipt, timing, and predictors of psychosocial contacts and services following distress screening, in order to improve distress screening processes nationwide and better meet the psychosocial needs of distressed cancer patients.

Rationale. Studies demonstrate that acculturation is critical to the understanding of health and well-being among Hispanic Americans. Dependent on how acculturation is measured, however, the relationship between acculturation and health-related quality of life is inconsistent. In addition, studies often use proxy measures of acculturation that preclude an understanding of the complex process of acculturation and its relationship to health. Research using latent variables of acculturation based on several cultural indicators has been suggested as a way to advance the study of acculturation in the field. Furthermore, research is needed that goes beyond studying individual characteristics and their impact on health. Studies have shown that aspects of the neighborhood environment (e.g., park density, access to public transit) impact health-related quality of life, but few of these studies have been conducted in Hispanic Americans, or have considered neighborhood environment in combination with individual cultural variables. Studies that consider both individual cultural and environmental characteristics simultaneously allow for the assessment of interactions. Examination of cross-level interactions may provide information on whether cultural variables are more or less important to health-related quality of life in different contexts.

In an effort to advance the study of acculturation and health-related quality of life, the present study had four aims: 1) derive person-level latent acculturation variables from multiple individual indicators of acculturation using exploratory factor analysis; 2) identify person-level latent acculturation variables that are associated with health-related quality of life; 3) identify neighborhood-related variables (e.g., proximity to open spaces, food environment) that are associated with health-related quality of life; and 4) determine how person-level acculturation variables interact with neighborhood variables to predict health-related quality of life among Hispanic Americans.

Design. Exploratory factor analysis and multi-level modeling were used to explore correlates of mental and physical health-related quality of life in a sample of 383 Hispanic American men and women living in a metropolitan border city. Participants completed health-related questionnaires as part of a larger study developing a clinical trials education program for Hispanic Americans. For this study, person-level acculturation variables were included at the lowest level of the model, and were hierarchically nested within participants’ residential neighborhood data. Neighborhoods were defined using census tracts, considered to be relatively homogeneous units based on population characteristics.  Individual acculturation and health-related quality of life data were gathered from participant responses on measures included in the survey packet from the parent study. Participants’ neighborhood-level data were obtained from the United States Census database, the Healthy Communities Data and Indicators Project, and the California State Board of Equalization.

Results. Exploratory factor analysis showed support for three acculturation latent variables named: Religiosity, Subjective Social Status, and Traditional Acculturation. The Subjective Social Status latent variable was significantly, positively associated with mental and physical health-related quality of life. The Religiosity and Traditional Acculturation latent variables were not significantly associated with mental or physical health-related quality of life. Neighborhoods with a greater percentage of the population within close proximity to an alcohol outlet were associated with better physical health-related quality of life. In addition, the relationship between the Subjective Social Status latent variable and physical health-related quality of life was stronger in neighborhoods with a higher density of tobacco retailers as compared to neighborhoods with a lower density of tobacco retailers.

Conclusions. This study suggests that subjective social status and neighborhood characteristics may play an important role in the health-related quality of life of Hispanic Americans. Subjective social status, or an individual’s belief about where he or she stands in a social hierarchy, was associated with mental and physical health-related quality of life. Findings from the present study suggest that this relationship was stronger in more disadvantaged neighborhoods. Although the study was cross-sectional, the findings identify potentially modifiable individual and neighborhood variables that may play important roles in determining overall quality of life.

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