DESCRIPTION (provided by applicant): Candidate. Dr. Ceballos is a motivated young investigator with the goal of becoming an independent investigator in the field of cancer health disparities. As a biobehavioral health scientist, she is interested in applying her training in psychoneuroendocrinology (PNE) to the development and evaluation of culturally- appropriate behavioral and psychosocial cancer survivorship interventions. While Dr. Ceballos has substantial training and experience in biobehavioral cancer research, the primary objective of this career development plan is to build on Dr. Ceballos's experience with mentored training in qualitative methods, cultural competency, and program development, providing to provide her with the tools needed to achieve her goal of becoming an independent investigator conducting research to address cancer health disparities. To help her achieve the above stated goals her career development plan will consist of didactic training (coursework, seminars, and workshops), participation in scientific conferences, manuscript development, submission of NIH grant applications, and direct mentorship by senior scientists. Dr. Ceballos will receive guidance from her primary mentor, Dr. Beti Thompson, and co-mentors, Dr. Karen Syrjala and Dr. Anne McTiernan. All 3 mentors are accomplished scientists at the Fred Hutchinson Cancer Research Center (FHCRC) and have distinguished themselves as leaders in their fields and successful mentors of junior investigators. Dr. Ceballos's training program will include participation in the FHCRC and University of Washington Biomedical Research Integrity (BRI) Series, online training in the responsible conduct of research, and formal coursework in Social and Ethical Issues in Public Health. Environment. The FHCRC is ideally suited for the development of Dr. Ceballos's research career and the conduct of the proposed research plan. The FHCRC has a long-standing commitment to the development of productive, independent cancer prevention and control scientists through a variety of training programs. In fact, the goals of the current Strategic Plan for the FHCRC include developing effective strategies for mentoring, recruitment, promotion, and retention of excellent scientists, and promoting opportunities for successful interdisciplinary research. Other aspects of the FHCRC environment that make it a particularly attractive choice for the development of Dr. Ceballos's career and the conduct of the proposed research include demonstrated excellence in cancer prevention and control sciences. This is a rich environment in which Dr. Ceballos will have regular contact with scientists who are leaders in a wide range of relevant fields. Research Plan. Among Hispanics, the 5-year cause-specific survival rate across all stages of female reproductive cancers (breast, uterine, cervical, ovarian) has been steadily improving. As the population of U.S. Hispanics grows from 15% in 2009 to a projected 25% of the U.S. population by 2050, there will be a need to develop resources that support the growing number of Hispanic cancer survivors. This is particularly true as the psychosocial well-being of Hispanic survivors tends to be significantly lower than that of non-Hispanic Whites (NHW). Cancer survivors can experience distress from long-term medical (i.e., fatigue), financial (i.e., job loss), and socio-emotional (i.e., fear of recurrence) burdens of survivorship well beyond completion of primary treatment. However, the addition of linguistic and socio-cultural barriers can increase the distress experienced by Hispanic survivors. The importance of addressing psychosocial well-being of Hispanic survivors is further heightened by the well-established link between chronic distress and dysregulation of physiological biomarkers (e.g., cortisol, c-reactive protein) associated with cancer comorbidities and survivorship. While informational and social support resources have emerged as potent attenuators of the psychosocial and potential physiological burdens of cancer survivorship, the availability and uptake of such programs among Hispanic survivors is greatly limited. To address this disparity and potentially ameliorate the physiological implications of prolonged psychosocial distress, the goals of the proposed investigation are to conduct a two-phased investigation in which a culturally-appropriate Spanish-language support program, based on Social-Cognitive Theory, will be developed. Qualitative research techniques will be used to develop the program (Phase 1) and the program will be evaluated using a randomized control trial and biopsychosocial approach (Phase 2). The specific aims of the proposed investigation are to (1) develop and deliver a culturally appropriate Spanish-language support program for Hispanic female survivors of reproductive cancers living in a rural community, (2) evaluate the effect of the Spanish-language support resource on validated measures of quality of life and psychosocial well-being and, (3) evaluate the effect of the support resource on measures of serum c-reactive protein and salivary cortisol. Specific aim 1 will be accomplished during Phase 1 of the study while specific aims 2 and 3 will be accomplished during Phase 2. Phase 1 of the study will utilize 20 one-on- one interviews and 4 focus groups to assess the applicability of psychosocial needs (identified in the survivorship and health disparities literature) to rural Hispanic female survivors, probe for factors unique to the sample demographic (e.g., low education/income, rural), and assess program materials. Phase 2 of the study will include 80 women who underwent treatment for a reproductive cancer within the past 5 years. Participants will be randomized to the support intervention or delayed-intervention control group. A community based participatory research (CBPR) approach will be integrated into the program development and delivery to address the cultural issue of respecto (deference to authority or social status, in an effort to enhance the cultural-appropriateness and sustainability of the program, empower community members, and encourage their participation in research.

The proposed project will address a significant gap in levels of distress and quality of life experienced by Hispanic cancer survivors living in rural communities using a biopsychosocial approach. The project will include development of a culturally-appropriate support program for post-treatment cancer survivors, followed by, a randomized control trial in which the program is implemented and evaluated. Psychosocial and biological outcomes will be used to assess the impact of the program on rural Hispanic cancer survivors.