With the increasing number of breast cancer survivors, there is a need to enhance health education to help survivors make informed decisions about maximizing their quality of life. YouTube is one of the most popular video applications that can be used for public health education. Nonetheless, there is little research on the content of health-related information that is uploaded to YouTube relevant to breast cancer survivors. This study was intended to help fill that gap in knowledge by describing the sources, formats, and content conveyed in the most widely viewed YouTube videos on breast cancer. YouTube was searched with a cleared browsing history using the key search term “breast cancer.” The resulting videos were sorted by view count. Videos were then screened for inclusion and exclusion criteria, yielding a sample of 100 videos with the most views. Video title, link, number of views, and date of upload were coded along with content included in each video. The inter- and intra-rater reliability was acceptable (Kappa’s = .79 and .97, respectively). The sample of 100 videos was collectively viewed 135,311,626 times, suggesting that the subject of breast cancer is a popular topic on YouTube. Nearly half of the sample videos (n = 45) were uploaded by television news/media agencies. Combined/multiple formats were the most popular format (n = 61), followed by still images/text (n = 48). General information on cancer was found to be the most common (n = 71), followed by screening for breast cancer occurrence/ recurrence (n = 62), and cancer treatments/breast cancer treatments (n = 45). Several of the content categories were rarely covered in the most-watched videos—for example, cancer rehabilitation recommendations, returning to work after cancer treatment, and financial burden/management of cancer. Thus, while topics such as breast cancer screening are widely covered, topics for breast cancer survivors regarding maximizing their quality of life are less widely covered. Few videos (n = 3) contained misinformation, but these videos were viewed millions of times, emphasizing the need for ongoing monitoring to identify and remove misinformation. The findings of this study indicated that YouTube videos on breast cancer gained over 135 million views. YouTube can be a great media channel for public health education. Nonetheless, there is significant need for more high-quality YouTube videos to be created to help breast cancer survivors navigate their cancer journey.

The adverse effects of cancer treatment on health-related quality of life (HRQL) are the primary concern of elderly women diagnosed with breast cancer. The interplay of transient and progressive functional impairments caused by cancer therapies, alongside the accelerated physical declines associated with the normal aging process, are all negatively correlated to HRQL. This study compared the HRQL trajectories between cases and controls for ten years after diagnosis. The cancer group included 1467 women (age ≥ 65), diagnosed with primary breast cancer, registered in the Surveillance Epidemiology and End Results (SEER) cancer registry, and completed the Medicare Health Outcomes Survey (MHOS) before and after diagnosis. Controls were frequency-matched to cases with a 1:1 ratio on age and socio-economic variables. Participants reported their HRQL using SF-36/VR12 questionnaire, which was summarized into two summary scores (physical component summary (PCS) and mental component summary (MCS) and eight domain scores: physical functioning (PF), general health (GH), bodily pain (BP), role-limitation physical (RP), social functioning (SF), mental health (MH), role-limitation emotional (RE), and vitality (VT). Hierarchical Linear Modelling was utilized to assess the fixed effects of time, group, and the interaction between time and group (Time*Group) on HRQL trajectories. At the time of cancer diagnosis, cases fared worse than controls in all of the HRQL domains and summary scores. Group and time were majorly significant for PCS, PF, GH, BP, and RP, while only group was predominantly significant for mental domains (MCS, SF, MH, RE, VT). Time was also significant for SF and VT, while Time*Group was only significant for RE. Cases showed remarkable gains over controls across time in MCS, RE, MH, VT, SF, and PF. The need for intervention in improving physical health iii HRQL among older women is validated. On the other hand, the remarkable gains of cases over controls on mental domains of HRQL provoke future research to explore further patient perception on benefit-finding caused by the diagnosis and experience of cancer.

This study used a qualitative research design to explore and identify, from participant's perspective, the aspects of a breast cancer support group that facilitate a quality experience of support.

This research examines the coping processes of African American women with breast cancer and how those processes relate to low usage of cancer support groups by these women. Prior coping research has utilized predominantly White samples. The limited research on African American coping responses is conflicting and characterized by small samples and non-probability sampling techniques. In this study, 26 respondents from Central and North Texas metropolitan areas were interviewed, including 9 key informants, 9 African American breast cancer survivors, and 8 White survivors. The data suggest that African American and White women cope with breast cancer in significantly different ways. Culture appears to account for the differences. All African American breast cancer survivors identified faith as their primary coping strategy. In contrast, only half of the White survivors claimed faith as their primary coping strategy, but like the other White survivors, tended to rely on multiple coping strategies. The African American survivors conceptualized God as an active member of their support network. Most prayed for healing, and several attributed examples of healing to God's intervention. The White survivors found God's presence in the actions of other people. They prayed for strength, peace, and courage to endure the illness. The use of faith as a coping strategy was the most significant difference between the African American and White breast cancer survivors, but different social support needs were also evident. White survivors readily disclosed the details of their illness and actively sought the assistance of other people. African American women were much less likely to discuss their illness with other persons and expressed a greater inclination to rely on themselves. This study indicates that cancer support groups must be structured to consider cultural coping differences for wider African American usage. Coping research conducted on primarily African American samples is necessary to develop interventions intended to serve African Americans.

published_or_final_version / abstract / Pathology / Doctoral / Doctor of Philosophy

published_or_final_version / abstract / Social Work and Social Administration / Doctoral / Doctor of Philosophy

The purpose of the present study was to examine the role that specific factors play in the quality of life (QL) for women with recurrent breast cancer.

Current literature regarding caregiver bereavement adjustment has advanced two competing models explaining adjustment in relation to caregiver interrole conflict: the Relief Model and Complicated Grief Model. This research has primarily focused on the experience of those providing care to dementia patients. This study tests these competing models of bereavement adjustment for husband and daughter caregivers of breast cancer hospice patients. For husbands, greater psychological strain and health strain were predictive of greater difficulty with bereavement adjustment, supporting the Complicated Grief Model of bereavement adjustment. For daughters, strain was not a significant predictor of bereavement adjustment, and thus did not support either bereavement adjustment model. While daughter caregivers experienced more role strain than husband caregivers during patient care, the degree of role strain was predictive of bereavement adjustment for husbands but not for daughters, suggesting that relationship type (husbands versus daughters) between caregiver and patient impacts which factors influence bereavement adjustment.

Currently, there are an estimated 2.8 million breast cancer survivors in the United States. Due to modern screening practices and raised awareness, the majority of these cases will be diagnosed in the early stages of disease where highly effective treatment options are available, leading a large proportion of these patients to fail from causes other than breast cancer. The primary cause of death in the United States today is cardiovascular disease, which can be delayed or prevented with interventions such as lifestyle modifications or medications. In order to identify individuals who may be at high risk for a cardiovascular event or cardiovascular mortality, a number of prognostic models have been developed. The majority of these models were developed on populations free of comorbid conditions, utilizing statistical methods that did not account for the competing risks of death from other causes, therefore it is unclear whether they will be generalizable to a cancer population remaining at an increased risk of death from cancer and other causes. Consequently, the purpose of this work is multi-fold. We will first summarize the major statistical methods available for analyzing competing risk data and include a simulation study comparing them. This will be used to inform the interpretation of the real data analysis, which will be conducted on a large, contemporary cohort of breast cancer survivors. For these women, we will categorize the major causes of death, hypothesizing that it will include cardiovascular failure. Next, we will evaluate the existing cardiovascular disease risk models in our population of cancer survivors, and then propose a new model to simultaneously predict a survivor's risk of death due to her breast cancer or due to cardiovascular disease, while accounting for additional competing causes of death. Lastly, model predicted outcomes will be calculated for the cohort, and evaluation methods will be applied to determine the clinical utility of such a model.

Background: Advanced breast cancer (ABC) is affecting substantial number of Chinese women in Hong Kong. Understanding their unmet supportive care needs (SCNs) is important for health care system to precisely allocate resources to areas demanded for help the most and for patients to achieve better quality of life. Objectives: (1) To validate Chinese version of Supportive Care Needs Survey Questionnaire (SCNS-SF34), (2) to address the prevalence of unmet SCNs at baseline (newly diagnosis of ABC) and explore relevant factors associating with baseline unmet SCNs, (3) to identify the trajectories of unmet SCNs from baseline, 6-week, 12-week, 18-week to one-year post-diagnosis of ABC among Hong Kong Chinese women and identify the predictors related to individual resources. Methods: The study consisted of two phases. In Phase I, breast cancer (BC) patients were recruited from six public hospitals and the SCNS-SF34 (which covers five domains of needs) was administered concurrently with measures of psychological distress CHQ-12 (Chinese Health Questionnaire-12), HADS (Hospital Anxiety and Depression Scale), symptom distress (MSAS-SF), and patient satisfaction (ChPSQ-9) to explore factor structure by using Exploratory Factor Analysis (EFA) and to examine internal consistency, and convergent, divergent and discriminant validities of the identified factor structure. In phase II, women newly diagnosed with ABC were recruited and followed up to assess their unmet SCN trajectories one year after diagnosis. Prevalence of initial baseline SCNs and associated demographic, medical and psychological factors were identified. Linear Mixed Modeling (LMM) was performed to assess trajectories for each SCNs domain. Hypothesized variables reflecting personal and social resources (optimism, trait hope, social support, psychological distress and patient satisfaction) were examined for association with the changes of unmet SCNs after adjusting for demographic and medical characteristics. Results: Instead of five-factor structure identified in the original SCNS-SF34, a four-factor structure with 33 items was identified, comprising: 1) Health system, information and patient support needs (HSIPS), 2) Psychological needs (PSYC), 3) Physical and daily living needs (PDL) and 4) Sexuality needs (SEX). The SCNS-SF33-C demonstrated moderate-to-good internal consistency (Cronbach’s alphas=0.75-0.92) across all domains. Acceptable convergent and divergent validity were demonstrated. Discriminant validity was demonstrated in the SCNS-SF33-C’s ability to differentiate between clinically distinct patient groups (ABC vs. localized BC and active treatment vs. no active treatment). Of the top 15 unmet SCNs, all belonged to the HSIPS domain. There were significant linear declines in unmet HSIPS and PSYC needs over the year after diagnosis, but not in PDL and SEX. After adjusting for demographic and medical factors, LMM identified symptom distress, patient satisfaction and patient satisfaction x time are predictors of HSIP. Total symptom distress, optimism, anxiety and anxiety x time predicted PSYC. Total symptom distress was predictor of PDL. Anxiety was predictor of SEX. Conclusions: The SCNS-SF33-C has a suitable factor structure and psychometric properties for the use in assessing unmet psychosocial SCN among Chinese women with BC. Generally, unmet HSIP and PSYC tended to decline, while levels of unmet PDL and SEX tended to persist over time. Specific individual resources predicted the future change of unmet SCNs. / published_or_final_version / Community Medicine / Master / Master of Philosophy