PURPOSE:Healthy lifestyle behaviors, including regular exercise and balanced nutrition, affect quality of life in cancer survivors. However, barriers to adopting these behaviors across the cancer continuum are poorly understood. We evaluated barriers to adopting healthy lifestyle behaviors in a national cohort of patients and survivors of cancer. METHODS:ASCO distributed an online survey to adult patients with cancer in the United States from March to June 2020. In this secondary analysis, we evaluated the perceived barriers to incorporating healthy lifestyle behaviors after cancer diagnosis and how they differ by disease stage and treatment status. Descriptive statistics summarized barriers to lifestyle changes. Comparisons across disease stage and treatment status were assessed using Rao-Scott chi-square tests, and weighted multivariable logistic regression modeling identified associated factors. RESULTS:Of 2,419 survey respondents, 1,987 were included in this analysis and grouped by disease stage: early stage on-treatment (n = 461), early stage post-treatment (n = 916), and metastatic on-treatment (n = 610). The most common barriers to healthy behaviors included lack of energy (58.7%) and physical limitations (52.0%), with significant differences (P < .05) in barriers related to time, logistics, cancer effects, and physical limitations across disease stages and treatment groups. Among those not meeting lifestyle guidelines, lack of motivation (51.3%-62.0%) and lack of energy (59.5%-77.0%) were major barriers, with barriers related to time, cancer effects, and physical limitations varying significantly by disease stage and treatment status. CONCLUSION:Patients with cancer face multiple barriers to adopting healthy lifestyle behaviors after diagnosis. Targeted interventions based on disease stage and treatment status may help address these challenges.

BACKGROUND:Up to 30% of women with breast cancer experience cancer-related cognitive impairment (CRCI) even before they receive treatment. The authors conducted a post hoc analysis to examine the relationship between neighborhood socioeconomic disadvantage and CRCI in treatment-naive postmenopausal women with early stage breast cancer. METHODS:The Exercise Program in Cancer and Cognition was a single-blind, 6-month, randomized controlled trial evaluating moderate-intensity aerobic exercise versus usual activity on neurocognitive function. By using baseline data from treatment-naive participants (n = 100), neighborhood socioeconomic disadvantage was assessed using the Area Deprivation Index (national percentile). Cognitive function was measured using composite domain scores. Associations were examined using correlation and linear regression analyses, adjusting for potential covariates/confounders. RESULTS:On average, participants were aged 63 years and had 16 years of education. Greater neighborhood disadvantage was associated with poorer cognitive function in domains of verbal memory (p = .032), working memory (p = .043), mental flexibility (p = .049), and processing speed (p = .026). In adjusted analyses, working memory remained associated with the Area Deprivation Index (p = .019) with adjustment for age; however, associations with the Area Deprivation Index were attenuated for verbal memory after adjustment for education (p = .067), for mental flexibility after adjustment for depressive symptoms (p = .175), and for processing speed after adjustment for age and body mass index (p = .065). CONCLUSIONS:Neighborhood socioeconomic disadvantage may contribute to cognitive vulnerability before cancer treatment. However, these findings suggest that years of education and depressive symptoms should be factored into the consideration of neighborhood-level factors when assessing CRCI risk among women with breast cancer (Clinicaltrials.gov identifier NCT02793921).

PURPOSE:To explore caregivers' perspectives on cancer-related cognitive impairment (CRCI) experiences in older adults with acute myeloid leukemia receiving chemotherapy. PARTICIPANTS & SETTING:Eight caregivers, including adult children and spouses, of older adults with acute myeloid leukemia receiving chemotherapy from the control arm of a clinical trial were interviewed. METHODOLOGIC APPROACH:Semistructured interviews were conducted at the second, fourth, and seventh cycles of chemotherapy. All interviews were audio recorded and transcribed verbatim. Two researchers independently analyzed 16 transcripts using thematic analysis. FINDINGS:Four themes were identified: (a) CRCI experiences, (b) impact of CRCI, (c) CRCI coping strategies, and (d) perceived CRCI-related factors. Caregivers observed changes in memory, concentration, and information processing in their loved ones and developed various strategies to better support or cope with CRCI. In addition, CRCI influenced caregivers' emotions, lives, and relationships with their loved ones. IMPLICATIONS FOR NURSING:Caregivers of older adults with acute myeloid leukemia play a vital role in CRCI symptom monitoring. The impact of CRCI on caregivers highlights the importance of supporting caregivers, and the identified coping strategies can provide guidance for future intervention development.

Women with breast cancer often experience cognitive decline, an accelerated aging phenotype. While aerobic exercise may mitigate this decline, effects are inconsistent by domains, and the molecular mechanisms remain unknown. Given the brain-derived neurotrophic factor (BDNF)’s responsiveness to exercise and role in cognition, we investigated BDNF methylation and rs6265, its functional SNP, with cognitive responses to aerobic exercise. Leveraging data from a randomized clinical trial which found cognitive function improved with a six-month aerobic exercise than control group in women with breast cancer, we included sub-samples with either pre-randomization or post-intervention M-values. CpG-site level M-values (higher positive value = greater methylation) of BDNF, rs6265 genotype (CC/CT/TT), composite scores for each cognitive domain (higher scores = better performance), and linear mixed-effect modeling were used. Women (N = 117, 75 https://BioRender.com/931pay3

BACKGROUND:The accessibility and outcomes of cyclin-dependent kinase 4 and 6 inhibitors (CDKi) in metastatic breast cancer (MBC) according to demographic factors are unknown. RESEARCH DESIGN AND METHODS:Retrospective review of patients with ER+ MBC prescribed first-line CDKi therapy from January 2015 through December 2022. Abstraction included time from CDKi prescription to drug initiation (TTI), time from CDKi initiation to progression (TTP), time from CDKi initiation to death or 6/30/2022, and variables (age, race, partner status, insurance type, BMI, number of comorbidities). Descriptive, comparative, and correlational statistics are used. RESULTS:N = 173 patients. No significant demographic differences in TTI or TTP. In the multivariate model TTI to death, patients with Medicaid insurance had significantly shorter overall survival than patients with private insurance. CONCLUSIONS:Medicaid insurance is associated with worse outcomes of MBC therapy, not attributed to TTI delay. Personalization of support may be helpful.

Context Limited research has examined racial disparities in symptom burden prior to chemotherapy initiation, during and at the chemotherapy completion. Objective To describe and compare the symptom burden (fatigue, pain, and physical functioning) and change over time between Black and White women receiving Early-Stage Breast Cancer (ESBC) chemotherapy while considering social determinants of health. Methods A longitudinal, repeated measures comparative design was employed. Time points of symptom measurement (PROMIS domains) at baseline, mid and end point were adjusted as per patient chemotherapy schedule. Linear mixed models were applied. Results There were 149 patients, 36% Black 64% White (54 ± 12 years) recommended to receive ESBC chemotherapy with adequate data for symptom analysis. Pain Main effect of race was significant (F(1, 390) = 29.43, P < .001) for pain.Black patients experienced significantly higher pain scores compared to White patients at pretherapy (Mean Difference; MD = 3.7, P = .034), midpoint (MD = 5.8, P = .002), and endpoint (MD = 7.8, P < .001). In the adjusted model, Black race and higher BMI were significant predictors of higher pain scores. Black patients experienced significant deterioration in pain over time. Fatigue The scores for fatigue increased significantly from baseline for Black patients by endpoint (MDT1-T3 = 8.7, P < .001) and for White patients at midpoint (MDT1-T2 = 5.7) and at endpoint (MDT1-T3 = 10.1, P < .001). In the adjusted model, higher BMI predicted worse fatigue scores. Physical function Black patients had significantly lower physical function scores compared to White patients at midpoint (MD = 4.0, P = .027). Physical function decreased by endpoint in Black (MDT1-T3 = 7.8, P < .001), and White patients (MDT1-T3 = 7.7, P < .001). In the adjusted model, only higher BMI and cardiopulmonary comorbidities significantly predicted worse physical function. Conclusion Symptom burden significantly increased over the course of chemotherapy for all patients. Scores for pain and physical function were higher overall for Black patients and deteriorated at a greater rate for Black vs. White women over the course of chemotherapy. BMI was a significant predictor of pain, fatigue, and physical function, this assessment holds implications for proactive assessment and mitigation strategies.

BACKGROUND:Approximately one-third of breast cancer (BC) patients show poorer cognitive function (CF). Using DNA methylation (DNAm) data, here we aimed to identify genes and biological pathways associated with CF in postmenopausal women with early-stage hormone receptor-positive (HR+) BC. METHODS:Epigenome-wide association studies (EWAS) and differentially methylated region analyses were performed for each CF phenotype (seven objective domains and one subjective phenotype) using DNAm data from whole blood samples (n = 109) taken at the time of enrollment. RESULTS:When adjusting for age, verbal IQ scores, and global DNAm signature, cg10331779 near CTNND2 (p-value = 9.65×10-9) and cg25906741 in MLIP (p-value = 2.01×10-8) were associated with processing speed and subjective CF, respectively, while regions in/near SLC6A11, PRKG1/CSTF2T, and FAM3B for processing speed, and regions in/near PI4KB and SGCE/PEG10 for mental flexibility were differentially methylated. In addition, beta-estradiol was identified as a common upstream regulator for all the CF phenotypes, suggesting an essential role of estrogen in explaining variation in CF of HR+ BC patients. CONCLUSIONS:In our EWAS of 8 CF phenotypes, we found two epigenome-wide significant signals, one for processing speed and the other for subjective CF. We also found three differentially methylated regions associated with processing speed and two associated with mental flexibility. CLINICAL TRIAL REGISTRATION:www.clinicaltrials.gov identifier is NCT02793921.

OBJECTIVES:To evaluate how reproductive decision-making in women with a known BRCA pathogenic variant is influenced by emotional states and individual factors. SAMPLE & SETTING:85 women with a BRCA pathogenic variant from a familial cancer registry at a local university hospital system in Pennsylvania. METHODS & VARIABLES:This exploratory, descriptive study used the validated Appraisal of Life Events Scale to measure emotional states. Binary logistic regression was used to analyze the relationships among emotional states, BRCA pathogenic variant status, and individual factors in reproductive decision-making. RESULTS:Age at genetic testing and number of children significantly predicted decisions about having more children. Among women with family history of ovarian cancer, perceived loss/benefit was significantly associated with reproductive decision-making. Loss/benefit was significantly related to reproductive decision-making among women with family history of ovarian cancer. IMPLICATIONS FOR NURSING:Recognizing the emotional impact of reproductive decision-making in women at risk for hereditary cancer could aid in improving their overall health and psychosocial outcomes.

BACKGROUND:Communication is an important tool in combatting racial and economic healthcare disparities in cancer care. The ability to communicate treatment-related distress and troubling symptoms can allow proactive symptom mitigation and adherence to a prescribed cancer treatment. Few studies have explored how racial and economic differences in patient-clinician interactions in cancer care influence symptom distress and chemotherapy adherence. OBJECTIVES:This study aimed to examine racial differences in interpersonal processes of care and their association with symptom distress and optimal chemotherapy dose among women diagnosed with early-stage breast cancer (ESBC). METHODS:Black and White women newly diagnosed with ESBC and prescribed chemotherapy for a diagnosis of invasive breast cancer were recruited. The Interpersonal Processes of Care Survey and Symptom Distress Scale were included in this analysis. Ratios of prescribed chemotherapy to received chemotherapy were recorded as total chemotherapy percentage. RESULTS:Persons who were Black perceived worse scores in communication, including "lack of clarity," "discrimination due to race/ethnicity," and "disrespectful office staff." Participants who lived in areas of greater deprivation perceived worse levels of "discrimination due to race/ethnicity" compared to those living in areas of less deprivation. Participants who perceived higher "discrimination due to race/ethnicity" were less likely to achieve optimal chemotherapy doses. Those who perceived worse scores for "lack of clarity," "discrimination due to race/ethnicity," "disrespectful office staff," and "compassion" had significantly higher levels of symptom distress. DISCUSSION:Symptom distress during ESBC chemotherapy must be communicated via patient-provider interaction. Patients' perceptions of discrimination and bias may inhibit this process. This interaction requires further interrogation to develop an inclusive symptom communication protocol.

BACKGROUND:Neoadjuvant and adjuvant breast cancer chemotherapy have been shown to improve survival outcomes, highlighting the importance of timely therapy. OBJECTIVE:The study described the time to initiation of neoadjuvant or adjuvant chemotherapy among women with early-stage breast cancer and identified correlates of delay, including demographics, social determinants of health, patient factors, and symptom distress. METHODS:The study utilized baseline data from the Symptom Experience and Management of cancer Outcomes According to Race and Social Demographics of Health, a multisite, longitudinal study that racially compared the time to chemotherapy initiation with consideration of social determinants of health. Logistic regression models analyzed the factors influencing chemotherapy initiation within the recommended timeframes (35 days for neoadjuvant therapy and 60 days for adjuvant therapy) after biopsy (neoadjuvant) or surgery (adjuvant). RESULTS:Of the 256 patients included in the study, 56.5% (n = 145), received neoadjuvant therapy, and among them, 55.2% (n = 80) initiated chemotherapy within 35 days of biopsy. In the study, 43.4% (n = 111) received adjuvant therapy, with 77.5% (n = 86) initiating chemotherapy within 60 days. In univariate analysis, patients who began neoadjuvant therapy within 35 days had significantly higher Interpersonal Support Evaluation List appraisal scores. In multivariate regression analysis, symptom distress emerged as a significant predictor of the delay in initiation of adjuvant chemotherapy. CONCLUSION:Social support and symptom distress are considerations in chemotherapy initiation delay. IMPLICATIONS FOR PRACTICE:Targeted interventions to alleviate symptom distress and enhance interpersonal support may facilitate timely chemotherapy initiation.

Background and Purpose:This study evaluates the Pittsburgh Sleep Quality Index (PSQI) in terms of factor structure and measurement invariance (MI). The sample included postmenopausal breast cancer (BC) survivors (n= 101) and matched healthy controls (n= 60).Methods:Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed on PSQI’s seven component scores. MI was tested between groups and across time using Bayes factor (BF).Results:Two factors were identified: sleep efficiency and perceived sleep quality. MI is evidenced between groups (BF < 0.007) and over time (BF > 150).Conclusions:PSQI scores with two subscales are comparable between postmenopausal BC survivors and controls over a 1-year period, providing some validation of PSQI for researching sleep quality in this population.

Women receiving aromatase inhibitors (AIs) for breast cancer frequently experience musculoskeletal symptoms (AIMS) including joint pain, stiffness, and muscle weakness. Aerobic exercise may reduce AIMS, but the evidence is inconclusive. This investigation examined whether aerobic exercise reduces pain in women with breast cancer. Pain was a secondary outcome of a randomized controlled trial where postmenopausal women with breast cancer receiving AIs (N = 136) with or without pain were randomized to 6 months of moderate-intensity aerobic exercise (n = 70) or usual care (n = 66). The primary (Brief Pain Inventory severity, interference and worst pain) and secondary (SF-36 Bodily Pain and Breast Cancer Prevention Trial Symptom Checklist Musculoskeletal Pain) pain outcomes were assessed at pre-randomization (T1) and post-intervention (T2). Linear mixed modeling with linear contrasts was used to examine the effect of group assignment on outcomes. Participants were a median = 4.7 months post-breast cancer diagnosis at T1. Group-by-time interactions were observed for pain severity ( x = 0.848, 95 x = 0.997, 95 x = 1.371, 95

DNA methylation affects gene expression. While the Apolipoprotein E (APOE) genotype impacts cardiovascular risk, APOE methylation impact remains unknown, particularly in women with breast cancer (BC). This study explored associations of APOE methylation with hypertension history and cardiovascular fitness (CVF) and whether APOE genotype and methylation moderate exercise effects over 6 months. This study leveraged data from a 6-month exercise randomized clinical trial in postmenopausal women with BC. Using peripheral blood, methylation M-values (Illumina Infinium Methylation EPIC Beadchip) and 13 CpG sites within and 2kb 5' and 3' to APOE were abstracted post data quality checks. Outcome variables: self-reported hypertension and CVF (peak oxygen consumed per kilogram per minute [VO2max/kg/min] and peak metabolic equivalents [METs] through graded exercise testing). Participants completed 150 min/week of aerobic exercise or usual care for 6 months. Logistic and linear regression examined associations between CpG M-values and hypertension, VO2max/kg/min and METs. Baseline M-value and APOE genotype were interaction terms for longitudinal analyses. This study included 102 women (Mean = 62 yrs). APOEε4 carriers had increased methylation of cg06750524 (p = 0.04) and cg19514613 (p = 0.03), but lower methylation of cg21879725 (p = 0.04). Increased cg06750524 methylation was associated with higher hypertension odds (p = 0.022, OR = 2.813) and lower VO2max/kg/min and METs (p = 0.005). Increased cg05501958 methylation (M = 4.539, SD = 0.17) was associated with lower hypertension odds (p = 0.02, OR = 0.035) and higher VO2max/kg/min and METs (p = 0.022). Neither APOE ε4 nor baseline methylation moderated exercise effects. APOE methylation, differentially by ε4 carriage, may impact cardiovascular outcomes and serve as a biomarker of risk in women with BC.

Cancer-related cognitive impairment is a broad term encompassing subtle cognitive problems to more severe impairment. The severity of this impairment is influenced by host, disease, and treatment factors, and the impairment affects patients before, during, and following cancer treatment. The National Cancer Institute (NCI) Symptom Management and Health-Related Quality of Life Steering Committee (SxQoL SC) convened a clinical trial planning meeting to review the state of the science on cancer-related cognitive impairment and develop phase II/III intervention trials aimed at improving cognitive function in cancer survivors with non-central nervous system disease and longitudinal studies to understand the trajectory of cognitive impairment and contributing factors. Participants included experts in the field of cancer-related cognitive impairment, members of the SxQoL SC, patient advocates, representatives from all 7 NCI Community Oncology Research Program research bases, and the NCI. Presentations focused on the following topics: measurement, lessons learned from pediatric and geriatric oncology, biomarker and mechanism endpoints, longitudinal study designs, and pharmacological and behavioral intervention trials. Panel discussions provided guidance on priority cognitive assessments, considerations for remote assessments, inclusion of relevant biomarkers, and strategies for ensuring broad inclusion criteria. Three clinical trial planning meeting working groups (longitudinal studies as well as pharmacological and behavioral intervention trials) convened for 1 year to discuss and report on top priorities and to design studies. The meeting experts concluded that sufficient data exist to advance phase II/III trials using selected pharmacological and behavioral interventions for the treatment of cancer-related cognitive impairment in the non-central nervous system setting, with recommendations included herein.

OBJECTIVES:Processing speed is a cognitive domain and a crucial predictor of cognitive aging. It frequently deteriorates in patients with cancer, co-occurring with declines of other domains, including attention, executive function, and memory, and negatively impacts health outcomes. However, lack of clarity of the concept limits the development of precise assessments and effective nursing interventions to improve processing speed. Therefore, this concept analysis aims to thoroughly analyze and clarify processing speed with nuanced defining attributes, antecedents, and consequences in the cancer context. METHODS:Walker and Avant's method was used. Records were identified from PubMed, CINAHL, and APAPsycINFO. RESULTS:Defining attributes of processing speed include the proficiency and speed to recognize given sensory stimuli, to make decisions based on the recognition, and to implement the decision with movement. Antecedents of processing speed include aging, brain connectivity, fine motor function, and health conditions, with cancer and cancer treatment. Consequences of processing speed include cognitive capability. CONCLUSIONS:With the clarified concept of processing speed, assessment tools and nursing interventions can be refined to ensure comprehensively capturing its full scope and facilitating communication in the care of patients with cancer. IMPLICATIONS FOR NURSING PRACTICE:This analysis confirms processing speed is a critical domain of cognitive function in cancer care, requiring tailored assessment and intervention strategies. The findings highlight the need to update clinical nursing practices with refined tools to evaluate processing speed, enabling oncology nurses to implement targeted interventions that address cancer-related cognitive decline and enhance health outcomes of patients with cancer.

OBJECTIVES:To determine associations among DNA methylation of brain-derived neurotrophic factor (BDNF) and RAS p21 protein activator 2 (RASA2) genes with processing speed and perceived cognitive function. SAMPLE & SETTING:This was a cross-sectional, secondary analysis of baseline data from a randomized controlled trial, the Exercise Program in Cancer and Cognition Study. METHODS & VARIABLES:Data included M values for DNA methylation of the BDNF and RASA2 genes; processing speed, objectively measured using the Grooved Pegboard and Digit Vigilance Test scores; and perceived cognitive function, self-reported using the Patient Assessment of Own Functioning Inventory. Regression analysis was conducted. RESULTS:Greater methylation of cg21291635 of the BDNF gene (p = 0.01) and cg20247102 of the RASA2 gene (p = 0.013) were associated with poorer processing speed, whereas greater methylation of cg20108357 of the BDNF gene (p < 0.001) and cg00567892 of the RASA2 gene (p = 0.019) were associated with better perceived cognitive function. IMPLICATIONS FOR NURSING:Gene methylation variations were demonstrated, suggesting the genes' potential roles and two possible distinct mechanisms of cognitive function in cancer.

ObjectivePhysical exercise may increase brain volume and cortical thickness in late adulthood. However, few studies have examined the possibility for exercise to influence brain morphology in women treated for breast cancer. We conducted a nested sub-study within a randomized clinical trial to examine whether 6 months of moderate-intensity aerobic exercise in postmenopausal women with early-stage breast cancer influences brain morphology.MethodsWe included twenty-eight postmenopausal women newly diagnosed with Stage 0-IIIa breast cancer (M age = 62.96 ± 5.40) who were randomized to either 45–60 min of supervised aerobic exercise 3 days/week (n = 16) or usual care (n = 12). Before beginning aromatase inhibitor aromatase inhibitor therapy, and the exercise intervention, and again at 6-month follow-up, volumetric and cortical thickness measures were derived from magnetic resonance imaging scans.ResultsThere were no significant intervention effects on brain volume and cortical thickness. However, greater average exercise intensity (%) during the intervention was associated with greater post-intervention cortical volume, mean cortical thickness, precentral gyrus thickness, and superior parietal thickness (all p < 0.05). Finally, total supervised exercise time was associated with higher precentral gyrus thickness after the intervention (p = 0.042, R2 = 0.263).ConclusionThe exercise intervention did not significantly affect brain volumes and cortical thickness compared to the control group. However, positive associations were found between exercise intensity and brain morphology changes after the 6-month intervention, indicating that exercise may reduce the vulnerability of the brain to the deleterious effects of breast cancer and its treatment.

Objective:The Exercise Program in Cancer and Cognition (EPICC) Study was a randomized controlled trial (RCT) designed to determine whether six months of moderate-intensity aerobic exercise improves neurocognitive function in women with breast cancer (BC) receiving endocrine therapy (ET). Methods:Postmenopausal women with hormone receptor+, early-stage BC, within two years post-primary therapy were randomized to the exercise intervention (six months, ≥150 minutes of moderate-intensity aerobic exercise/week) or usual care control condition. Outcomes were assessed at pre-randomization and after intervention completion. Groups were compared using linear mixed-effects modeling. Results:Participants (N=153) were X ¯ = 62.09 ± 8.27 years old, with stage I BC (64.1%) and a median of 4.7 months post-diagnosis. We found a group-by-time interaction (p=0.041) and a trend for the main effect of time (p=0.11) for processing speed with improved performance in the exercise group and no change in the controls. Similar main effects of time were observed for learning and memory (p=0.024) and working memory (p=0.01). Better intervention adherence was associated with improved processing speed (p=0.017). Conclusions:Six months of moderate-intensity aerobic exercise improves processing speed in postmenopausal women with BC receiving ET who initiate exercise within two years of completing primary therapy (surgery +/- chemotherapy). This is the first large-scale study to examine the effects of aerobic exercise on neurocognitive function in women with BC. Additional research is needed to address the long-term effects of aerobic exercise on cognitive function.

This study explored economic hardship (EH) in 248 women who were prescribed chemotherapy for earlystage BC prior to or at their first chemotherapy treatment (baseline) and whether there are differences by race, area deprivation, stress, symptom distress, and social support. Black race, area of greater deprivation, higher perceived, and lower social support can predict higher EH. Screening for EH can identify at risk patients. Introduction: Economic hardship (EH) can negatively influence cancer outcomes. Little is known about the factors that are associated with higher levels of EH among patients with breast cancer (BC). This paper describes EH in women with early-stage BC prior to or at their first chemotherapy treatment (baseline) and explores whether there are differences by race, area deprivation, stress, symptom distress, and social support. Patients and Methods: A descriptive comparative/correlational design was employed using baseline data of a multisite, longitudinal, multimethod study comparing the symptom experience and management prior to prescribed chemotherapy for women with earlystage BC. Participants completed measures for EH, perceived stress, symptom distress, and social support. Race was measured by self-report. Area depr ivation indices (ADI) measur ing neighborhood economic factors were calculated from publicly available websites. Results: Participants (N = 248; age = 52.9 + 12.3 years) were 62% White and 38% Black, 54% partnered, and 98% insured. Compared to White patients, Black patients reported higher (worse) EH (1.2 + 3.0 vs. -0.7 + 2.4), lived in areas of greater deprivation (80.1 + 2.1 vs. 50.5 + 23.5),and were more likely to report inadequate household income (Black: 30.5%; White: 11.1%). Adjusting for race and age, being Black (P< .001), living in an area of greater deprivation (P = .049), higher perceived stress (P = .008), lower perceived appraisal (P = .040), and less tangible support (P < .001) contributed to greater EH. Worse symptom distress trended toward greater EH (P = .07). Conclusions: This study emphasizes the importance of incorporating baseline holistic assessment to identify patients most likely to exper ience EH dur ing ear ly-stage BC treatment.