Obesity, related comorbidities, and breast cancer outcomes in African Americans

非裔美国人的肥胖、相关合并症和乳腺癌结果

基本信息

批准号：
9084713
负责人：
Elisa V Bandera
金额：
$ 14.15万
依托单位：
RBHS -CANCER INSTITUTE OF NEW JERSEY
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-09-11 至 2019-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9084713
关键词：
Affect African American Angiotensin-Converting Enzyme Inhibitors Asthma Bioavailable Biological Biological Markers Blood specimen Blood typing procedure Body Composition Body fat Body mass index Breast Cancer Patient Breast Cancer Treatment Breast Cancer survivor Cancer Prognosis Cardiovascular Diseases Caring Case-Control Studies Cause of Death Characteristics Clinical Management Clinical Trials Comorbidity County Data Diabetes Mellitus Diagnosis Diet Dose Economic Factors Ethnic group European Fatigue Fatty acid glycerol esters Genomics Genotype Guidelines Health Health Services Accessibility High Prevalence Home environment Hypertension Immune Immunity Inflammation Inflammatory Insulin Insulin Resistance Intervention Interview Lymphedema Measurement Mediating Medical History Medical Records Metformin Newly Diagnosed Non-Insulin-Dependent Diabetes Mellitus Non-Steroidal Anti-Inflammatory Agents Obesity Outcome Overweight Pathway interactions Patients Pharmaceutical Preparations Physical activity Provider Quality of life Race Recording of previous events Risk Factors Role Saliva Sampling Serum Signal Transduction Somatomedins Staging Stress Surveys Therapeutic Time Treatment outcome United States Update Vital Status Vitamin D Waist-Hip Ratio Weight Woman adaptive immunity adipokines cancer care chemotherapy cohort cost effective cytokine design follow-up improved insulin-related factor low socioeconomic status malignant breast neoplasm medication compliance mortality neoplasm registry obesity management obesity treatment outcome forecast population based prognostic racial difference racial disparity receptor socioeconomics survivorship tumor waist circumference

项目摘要

Poorer breast cancer (BrCa) prognosis among African Americans (AAs) compared to other racial and ethnic groups in the United States is likely multifactorial, including tumor characteristics, socio-economic factors and poor access to care. While there is strong evidence that obesity and obesity-related comorbidities increase BrCa and competing cause mortality among women of European ancestry (EAs), its prognostic role among AAs is uncertain, and potential mediating mechanisms have not been elucidated. We propose to evaluate (1) the impact of body fatness (body mass index, body fat distribution, and body composition) on BrCa treatment received (including chemotherapy dose reduction and delay) and outcomes (BrCa-specific mortality, competing-cause mortality, all-cause mortality, quality-of-life); (2) the impact of obesity-related comorbidities which are more common among AAs, including hypertension and diabetes, in relation to BrCa treatment and outcomes, and whether optimal management of these conditions impact outcomes; and (3) potential mechanistic pathways, including immune factors, vitamin D, adipokines,and indicators of insulin resistance that potentially mediate the effects obesity and obesity-related comorbidities. Estimates of genomic ancestry, obtained using genotypes from Ancestry Informative Markers (AIMs), will be included in all analyses. We propose a cost-effective study that builds upon an ongoing population-based case-control study of BrCa in AA women (P01 CA151135). Rapid case ascertainment by the NJ State Cancer Registry (NJSCR) is used to identify newly diagnosed BrCa cases in ten counties in NJ. Here we propose to extend recruitment of AA cases up to March 2018, increasing the total number to ~1,700, with ~1,100 cases with blood samples collected 18 to 24 months after diagnosis and ~860 blood samples collected 30 to 36 months after diagnosis. We propose to establish a cohort of AA BrCa survivors to assess disparities in care, quality-of-life (QoL), and survival, particularly in relation to obesity. A baseline home interview conducted shortly after diagnosis collects intormation on risk factors, including lifetime weight history. Anthropometric and body composition measurements are taken and a saliva sample is collected. Medical records from multiple providers are obtained and reviewed. We propose to collect blood samples ~12 months and ~24 months after completion of treatment to evaluate obesity-related biomarkers, and to conduct annual active and passive follow-up and obtain detailed medical records. Active follow-up will involve interviews to collect annual updates on anthropometric measurements, diet and physical activity, medical history, including information on comorbidities and their management, as well as survivorship factors (e.g., QoL, lymphedema, perceived stress, fatigue). Passive follow-up will include record linkage with the NJSCR to obtain vital status and time and causes of death for those who are deceased. Findings from this study have great potential to improve clinical management of obese AA BrCa patients to improve the survival and QoL of BrCa survivors.

与其他种族和种族相比美国的群体可能是多因素的，包括肿瘤特征，社会经济因素和无法获得护理。尽管有强有力的证据表明肥胖和肥胖相关的合并症会增加 BRCA和竞争引起欧洲血统妇女的死亡（EAS），其预后的作用 AA是不确定的，并且尚未阐明潜在的介导机制。我们建议评估（1）体内脂肪（体重指数，体内脂肪分布和身体成分）对BRCA治疗的影响接受（包括化学疗法剂量降低和延迟）和结果（BRCA特异性死亡率，竞争原因死亡率，全因死亡率，生活质量）；（2）与肥胖相关的合并症的影响与BRCA治疗以及结果以及这些条件的最佳管理是否会影响结果；（3）潜力机械途径，包括免疫因子，维生素D，脂肪因子和胰岛素抵抗指标，有可能介导肥胖和与肥胖相关的合并症的作用。估计基因组血统，使用祖先信息标记（AIMS）获得的基因型将包括在所有分析中。我们提出了一项具有成本效益的研究，该研究基于BRCA的持续基于人群的病例对照研究 AA妇女（P01 CA151135）。新泽西州癌症注册处（NJSCR）的快速病例确定用于确定新泽西州十个县的新诊断的BRCA病例。在这里，我们建议扩大AA案件的招聘截至2018年3月，将总数增加到〜1,700，〜1,100例收集了18个诊断后24个月，诊断后30至36个月收集了约860个血液样本。我们建议建立一组AA BRCA幸存者，以评估护理，生活质量（QOL）和生存的差异，特别是与肥胖有关。诊断收集后不久进行的基线家庭面试对风险因素的识别，包括终身体重历史。人体测量和身体成分进行测量并收集唾液样本。来自多个提供者的病历是获得并审查。我们建议收集血液样本〜约12个月和〜24个月后评估与肥胖相关的生物标志物的治疗，并进行年度主动和被动随访和获取详细的医疗记录。积极的随访将涉及采访以收集有关的年度最新信息人体测量，饮食和体育锻炼，病史，包括有关合并症及其管理以及生存因素（例如QOL，淋巴水肿，感知到压力，疲劳）。被动随访将包括与NJSCR的记录联系以获得生命状态和时间和死者的死亡原因。这项研究的发现具有改进的巨大潜力肥胖的AA BRCA患者的临床管理，以改善BRCA幸存者的生存和QOL。