Avanzando Caminos (Leading Pathways): The Hispanic/Latino Cancer Survivorship Cohort Study.”

Avanzando Caminos（领先途径）：西班牙裔/拉丁裔癌症幸存者队列研究。

• 批准号: 10212734
• 负责人: Frank J Penedo
• 金额: $ 99.96万
• 依托单位: UNIVERSITY OF MIAMI CORAL GABLES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10212734
• 关键词: Acculturation; Address; Admixture; American; Area; Attention; Behavioral; Biological; Biological Assay; Biological Factors; Biological Process; Breast; Cancer Center; Cancer Survivor; Cancer Survivorship; Catchment Area; Cause of Death; Cervix Uteri; Characteristics; Chronic stress; Clinics and Hospitals; Cognition; Cohort Studies; Collaborations; Community Outreach; Comprehensive Cancer Center; Computational Biology; Conflict (Psychology); Country; Cuban; Data; Discrimination; Disease; Education; Emotions; Family; Fatigue; Florida; Gene Expression; Genetic; Geographic Distribution; Geographic Locations; Geography; Health; Health Services Accessibility; High Prevalence; Hispanics; Individual; Inflammation; Inflammatory; Information Systems; Insurance Coverage; Knowledge; Language; Latino; Life Style; Literature; Liver; Malignant Neoplasms; Malignant neoplasm of prostate; Measures; Mediating; Mediator of activation protein; Medical; Mental Depression; Methods; Mexican; Mexican Americans; Minority; Minority Groups; Modeling; NCI-Designated Cancer Center; National origin; Not Hispanic or Latino; Outcome; Outcome Study; Pain; Participant; Pathway interactions; Patient Outcomes Assessments; Phase; Physical Function; Physical activity; Population; Prevalence; Procedures; Productivity; Prostate; Protocols documentation; Puerto Rican; Quality of life; Recurrence; Reporting; Research; Risk; Rural; Sampling; Second Primary Cancers; Secondary Prevention; Signal Transduction; Site; Sleep; Social Functioning; Social support; Socioeconomic Status; South American; South Texas; Stomach; Stress; Survivors; Symptoms; Testing; Texas; Training; Urban Community; Work; advanced disease; cancer genomics; cancer site; cancer therapy; cancer type; cardiometabolism; cohesion; cohort; comorbidity; coping; cultural values; data management; emotional functioning; ethnic minority population; experience; follow-up; health related quality of life; low socioeconomic status; malignant breast neoplasm; metropolitan; mortality; neoplasm registry; nutrition; optimism; primary outcome; psychosocial; recruit; resilience; rural residence; satisfaction; sex; social; social culture; survivorship; tertiary prevention; traumatic stress; treatment adherence

Project Summary Cancer is the leading cause of death among Hispanics/Latinos (H/Ls) in the US. H/Ls account for 57.5 million Americans (18%), now the largest minority expected to double over the next four decades. H/Ls have variable SES, nativity, geographic distribution, genetic admixture, and social, psychosocial and behavioral determinants of health. Significant disparities exist in prevalence, invasiveness and mortality in specific cancers (e.g., cervix, liver, stomach) and across multiple patient reported outcomes (PROs) regardless of disease site. H/Ls are more likely to present with advanced disease, greater comorbidities and report greater symptom burden and poorer health-related quality of life (HRQoL). Survivorship in H/Ls is further compromised by low SES, education and insurance coverage, language barriers and limited access to care. Survivorship studies in H/Ls have been limited due to: (a) small samples with short follow-ups; (b) focus on common cancer (e.g., breast or prostate), limiting attention to high-prevalence/mortality sites; restricted H/L origin and SES representation; and (d) lack of guiding models considering multiple determinants (e.g., sociocultural, medical, stress, psychosocial, lifestyle, biological) of survivors’ outcomes. Avanzando Caminos (Leading Pathways): the Hispanic/Latino Cancer Survivorship Cohort Study will involve recruitment, assessment and follow-up of ~3,000 H/Ls who completed primary cancer treatment within the past 2 years and are diverse in H/L background, urban vs. rural residence and cancer site across two major US metropolitan areas—Miami and San Antonio. Both areas have majority H/L populations (~65% of Miami; ~64% of San Antonio), are diverse regarding H/L origin and SES and are served by NCI-designated cancer centers. We will recruit a sample that approximates the diversity of the H/L population in the US (~ 50% Mexican & ~50% other H/L origin). The Florida Cancer Data System and the Texas Cancer Registry will supplement recruitment (~30% of cohort) and serve to establish representativeness. Our primary outcomes are symptom burden (e.g., pain, fatigue, depression, cognition), HRQoL and disease activity (e.g., progression, recurrence, cancer & all-cause mortality). Our transdisciplinary team has a strong and successful record of academic productivity and collaboration across the five targeted domains that will be evaluated as determinants of our outcomes: (1) sociocultural (e.g., SES, acculturation, cultural values); (2) stress and adversity (e.g., chronic and traumatic stress, ethnic-stress); (3) psychosocial (e.g., social support, coping, family cohesion/conflict); (4) lifestyle and behavioral (e.g., physical activity, nutrition, health information seeking); and (5) biological (e.g., inflammatory/pro-metastatic gene expression signaling, cardiometabolic markers, genetic admixture). Participants will be assessed at baseline, 6-months, 12-months and annually thereafter. Methods in multilevel latent longitudinal modeling, cancer genomics and computational biology will be used to test our hypotheses. During the UG3 phase, we will hire and train staff, establish and finalize study protocols, recruit ~18% of the sample and conduct preliminary analyses. During the UH3 phase we will complete recruitment, conduct all remaining assessments, analyze data and disseminate findings to guide and implement secondary and tertiary prevention in H/L survivors.

项目概要 癌症是美国西班牙裔/拉美裔 (H/L) 死亡的主要原因。H/L 人数达 5,750 万人。 美国人 (18%) 是目前预计 H/L 在未来 40 年翻一番的最大少数群体，其 SES 会发生变化。 出生地、地理分布、遗传混合以及健康的社会、心理和行为决定因素。 特定癌症（例如宫颈癌、肝癌、胃癌）的患病率、侵袭性和死亡率存在显着差异 并且在多个患者报告的结果 (PRO) 中，无论疾病部位如何，H/L 都更有可能出现。 疾病晚期、合并症增多，症状负担加重，健康相关生活质量较差 (HRQoL)。低社会经济地位、教育和保险覆盖率、语言进一步损害了 H/L 的生存率。 由于以下原因，H/L 中的生存研究受到障碍和限制：(a) 样本量小、时间短。 后续行动；(b) 关注常见癌症（例如乳腺癌或前列腺癌），限制对高患病率/死亡率部位的关注； 受限的 H/L 起源和 SES 表示；以及 (d) 缺乏考虑多个决定因素的指导模型（例如， 阿万赞多·卡米诺斯（Avanzando Caminos）的结果的社会文化、医疗、压力、心理、生活方式、生物学。 （主要途径）：西班牙裔/拉丁裔癌症幸存者队列研究将涉及招募、评估和 对过去 2 年内完成原发性癌症治疗且 H/L 不同的约 3,000 名 H/L 进行随访 美国两个主要大都市区——迈阿密和圣保罗的背景、城市与农村居住地以及癌症发生地点 安东尼奥。这两个地区的 H/L 人口占大多数（迈阿密约 65%；圣安东尼奥约 64%），且 H/L 人口多样化。 起源和 SES，并由 NCI 指定的癌症中心提供服务，我们将招募近似的样本。 美国 H/L 人群的多样性（约 50% 是墨西哥人，约 50% 是其他 H/L 来源）佛罗里达癌症数据系统。 德克萨斯州癌症登记处将补充招募（约 30% 的队列）并致力于建立 我们的主要结果是症状负担（例如疼痛、疲劳、抑郁、认知）、HRQoL。 和疾病活动（例如进展、复发、癌症和全因死亡率）。 五个目标领域的学术生产力和协作的强大而成功的记录 评估结果的决定因素：(1) 社会文化（例如社会经济地位、文化适应、文化价值观）；(2) 压力和 逆境（例如，慢性和创伤性压力、种族压力）；（3）社会心理（例如，社会支持、应对、家庭） 凝聚力/冲突）；（4）生活方式和行为（例如身体活动、营养、健康信息寻求）； 生物学（例如，炎症/促转移基因表达信号、心脏代谢标志物、遗传混合物）。 参与者将在基线、6 个月、12 个月以及此后每年进行多级潜在方法评估。 纵向模型、癌症基因组学和计算生物学将用于检验我们的假设。 UG3 阶段，我们将雇用和培训员工，建立并最终确定研究方案，招募约 18% 的样本并进行 在 UH3 阶段，我们将完成招募，进行所有剩余的评估， 分析数据并传播研究结果，以指导和实施 H/L 幸存者的二级和三级预防。