Oncology Nurses' Experiences With Patients Who Choose to Discontinue Cancer Chemotherapy

PURPOSE/OBJECTIVES

To describe the experiences of oncology nurses whose patients prematurely discontinue cancer chemotherapy.
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RESEARCH APPROACH

Qualitative, in-depth interviews.
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SETTING

Large oncology practice in South Carolina.
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PARTICIPANTS

Seven oncology nurses.
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METHODOLOGIC APPROACH

A general interview guide was used to obtain descriptions about nurses' experiences with patients who chose to discontinue chemotherapy. Interviews were analyzed using van Manen's approach to hermeneutic phenomenology.
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FINDINGS

Nurses experienced mixed emotions and struggled to balance their feelings with their respect for patient autonomy. Participants perceived that treatment side effects and inconvenience, advanced age, pessimistic attitude, and lack of social support influenced patients' decisions to discontinue treatment. 
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CONCLUSIONS

Findings indicate that nurses experience distress when patients prematurely discontinue treatment, and participants identified opportunities to support patients in continuing treatment.
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INTERPRETATION

Oncology nurses respect patients' rationales for discontinuing therapy and support their right to independent decision making. Nurses also struggle to cope with their reactions to patients' decisions. This tug of war somewhat parallels patients' struggles to balance quality of life with longevity.

The association between an inflammatory diet and global cognitive function and incident dementia in older women: The Women's Health Initiative Memory Study

INTRODUCTION

The Mediterranean and Dietary Approaches to Stop Hypertension diets have been associated with lower dementia risk. We evaluated dietary inflammatory potential in relation to mild cognitive impairment (MCI)/dementia risk.

METHODS

Baseline food frequency questionnaires from n = 7085 women (aged 65-79 years) were used to calculate Dietary Inflammatory Index (DII) scores that were categorized into four groups. Cognitive function was evaluated annually, and MCI and all-cause dementia cases were adjudicated centrally. Mixed effect models evaluated cognitive decline on over time; Cox models evaluated the risk of MCI or dementia across DII groups.

RESULTS

Over an average of 9.7 years, there were 1081 incident cases of cognitive impairment. Higher DII scores were associated with greater cognitive decline and earlier onset of cognitive impairment. Adjusted hazard ratios (HRs) comparing lower (anti-inflammatory; group 1 referent) DII scores to the higher scores were group 2-HR: 1.01 (0.86-1.20); group 3-HR: 0.99 (0.82-1.18); and group 4-HR: 1.27 (1.06-1.52).

CONCLUSIONS

Diets with the highest pro-inflammatory potential were associated with higher risk of MCI or dementia.

Changes in the Inflammatory Potential of Diet Over Time and Risk of Colorectal Cancer in Postmenopausal Women

We examined the associations between changes in dietary inflammatory potential and risk of colorectal cancer (CRC) in 87,042 postmenopausal women recruited from 1993-1998 by the Women's Health Initiative, conducted in the United States. Food frequency questionnaire data were used to compute patterns of change in dietary inflammatory index (DII) scores and cumulative average DII scores over 3 years. Cox regression models were used to estimate hazard ratios for CRC risk. After a median of 16.2 years of follow-up, 1,038 CRC cases were diagnosed. DII changes were not substantially associated with overall CRC, but proximal colon cancer risk was higher in the proinflammatory-change DII group than in the antiinflammatory-stable DII group (hazard ratio = 1.32, 95% confidence interval: 1.01, 1.74). Among nonusers of nonsteroidal antiinflammatory drugs (NSAIDs) (Pinteraction = 0.055), the proinflammatory-stable DII group was at increased risk of overall CRC and proximal colon cancer. Also among nonusers of NSAIDs, risks of overall CRC, colon cancer, and proximal colon cancer were higher in the highest quintile compared with the lowest cumulative average DII quintile (65%, 61%, and 91% higher risk, respectively). Dietary changes toward, or a history of, proinflammatory diets are associated with an elevated risk of colon cancer, particularly for proximal colon cancer and among nonusers of NSAIDs.

The relationship of plasma Trans fatty acids with dietary inflammatory index among US adults

Background

It has been suggested that trans fatty acids (TFAs) play an important role in cardiovascular diseases. We investigated the association between plasma TFAs and the dietary inflammatory index (DII) ™ in US adults.

Methods

National Health and Nutrition Examination Survey (NHANES) participants with data on plasma TFAs measured from 1999 to 2010 were included. Energy-adjusted-DII ™ (E-DII ™) expressed per 1000 kcal was calculated from 24-h dietary recalls. All statistical analyses accounted for the survey design and sample weights.

Results

Of the 5446 eligible participants, 46.8% (n = 2550) were men. The mean age of the population was 47.1 years overall, 47.8 years for men and 46.5 years for women (p = 0.09). After adjustment for C-reactive protein, body-mass-index, smoking, race, age, education, and marital status in linear regressions, trans 9-hexadecenoic acid [β coefficient 0.068 (95% CI: 0.032 to 0.188)], trans 11-octadecenoic acid [β coefficient 0.143 (95% CI: 0.155 to 0.310)], trans 9-octadecenoic acid [β coefficient 0.122 (95% CI: 0.120 to 0.277)], trans 9, and trans 12-octadienoic acid [β coefficient 0.103 (95% CI: 0.090 to 0.247)] were positively associated with the DII (all p < 0.001).

Conclusion

The association of plasma TFAs with a marker of dietary inflammation suggests an underlying mechanism in the initiation and progression of cardiovascular diseases.

Dietary Inflammatory Index and liver status in subjects with different adiposity levels within the PREDIMED trial

BACKGROUND & AIMS

To assess the possible association between a validated Dietary Inflammatory Index (DII) and specific dietary components with suitable non-invasive markers of liver status in overweight and obese subjects within the PREDIMED study.

METHODS

A cross-sectional study encompassing 794 randomized overweight and obese participants (mean ± SD age: 67.0 ± 5.0 y, 55% females) from the PREDIMED (PREvención con DIeta MEDiterránea) trial was conducted. DII is a validated tool evaluating the effect of diet on six inflammatory biomarkers (IL-1b, IL-4, IL-6, IL-10, TNF-α and C-reactive protein). Furthermore, a validated 137-item food-frequency-questionnaire was used to obtain the information about the food intake. In addition, anthropometric measurements and several non-invasive markers of liver status were assessed and the Fatty Liver Index (FLI) score was calculated.

RESULTS

A higher DII and lower adherence to Mediterranean diet (MeDiet) were associated with a higher degree of liver damage (FLI > 60) in obese as compared to overweight participants. Furthermore, the DII score was positively associated with relevant non-invasive liver markers (ALT, AST, GGT and FLI) and directly affected FLI values. Interestingly, a positive correlation was observed between liver damage (>50th percentile FLI) and nutrients and foods linked to a pro-inflammatory dietary pattern.

CONCLUSIONS

This study reinforced the concept that obesity is associated with liver damage and revealed that the consumption of a pro-inflammatory dietary pattern might contribute to obesity and fatty liver disease features. These data suggest that a well-designed precision diet including putative anti-inflammatory components could specifically prevent and ameliorate non-alcoholic fatty liver manifestations in addition to obesity.

Biomarker-calibrated nutrient intake and healthy diet index associations with mortality risks among older and frail women from the Women's Health Initiative

Background: Although studies to date have confirmed the association between nutrition and frailty, the impact of dietary intake and dietary patterns on survivorship in those with frailty is yet to be examined in a well-powered cohort with validated frailty status. Moreover, previous studies were limited by measurement error from dietary self-reports.Objective: We derived biomarker-calibrated dietary energy and protein intakes to address dietary self-report error. Using these data, we then evaluated the association of mortality in older women with frailty and dietary intake and healthy diet indexes, such as the alternate Mediterranean Diet (aMED), the Dietary Approaches to Stop Hypertension (DASH) score, and the Dietary Inflammatory Index (DII).Design: The analytic sample included 10,034 women aged 65-84 y with frailty and complete dietary data from the Women's Health Initiative Observational Study. Frailty was assessed with modified Fried's criteria. Dietary data were collected by food-frequency questionnaire.Results: Over a mean follow-up period of 12.4 y, 3259 (31%) deaths occurred. The HRs showed progressively decreased rates of mortality in women with higher calibrated dietary energy intakes (P-trend = 0.003), higher calibrated dietary protein intakes (P-trend = 0.03), higher aMED scores (P-trend = 0.006), and higher DASH scores (P-trend = 0.02). Although the adjusted point estimates of HRs (95% CIs) for frail women scoring in the second, third, and fourth quartiles on DII measures were 1.15 (1.03, 1.27), 1.28 (1.15, 1.42), and 1.24 (1.12, 1.38), respectively, compared with women in the first quartile, no overall effect was observed across quartiles (P-trend = 0.35). Subgroup analyses by chronic morbidity or smoking status or by excluding women with early death did not substantially change these findings.Conclusions: The current study highlights the importance of nutrition in older, frail women. Diet quality and quantity should be considered in managing persons with frailty.

Association between dietary inflammatory index and inflammatory markers in the HELENA study

BACKGROUND

Previous research has shown that diet is associated with low-grade systemic inflammation among adults. However, no study has yet been conducted to explore the association between inflammatory potential of diet and low-grade systemic inflammation among adolescents whose dietary behavior may be different from adults.

METHODS AND RESULTS

We examine the predictive ability of 24-h recall-derived dietary inflammatory index (DII) scores on inflammation among 532 European adolescents in the HELENA cross-sectional study. The DII is a literature-derived dietary index developed to predict inflammation. The DII was calculated per 1000 calories and was tested against C-reactive protein, ILs-1,2,4,10, TNF-α, ICAM, vascular cell adhesion molecule (VCAM), and IFN-γ. All inflammatory markers had nonnormal distributions and therefore were log transformed. Analyses were performed using multivariable linear regression, adjusting for age, sex, city, BMI, smoking, and physical activity. Pro-inflammatory diet (higher DII scores) was associated with increased levels of various inflammatory markers: TNF-α, IL-1, 2, IFN-γ,  and vascular cell adhesion molecule (bDIIt3vs1 = 0.13, 95% CI: 0.001, 0.25; 0.13, 95% CI 0.001, 0.25; 0.40, 95% CI: 0.03, 0.77; 0.53, 95% CI: 0.05, 1.01; 0.07, 95% CI: 0.01, 0.13, respectively).

CONCLUSION

These results reinforce the fact that diet, as a whole, plays an important role in modifying inflammation in adolescents.

Inflammatory diet and risk for colorectal cancer: A population-based case-control study in Newfoundland, Canada

OBJECTIVE

Chronic inflammation is implicated in causing cancer. Diet plays an important role in regulating chronic inflammation by altering circulating levels of inflammatory biomarkers. Effect of single food or nutrient on cancer often is inconclusive; perhaps due to dietary interactions and multicolinearity. The aim of this study was to determine prediagnostic inflammatory potential of overall diet in relation to risk for colorectal cancer (CRC).

METHODS

In all, 547 patients with CRC from Newfoundland Familial Colorectal Cancer Registry and 685 controls from the general population were identified. Data on sociodemographic, medical history, lifestyle, and a 169-item food frequency questionnaire were collected retrospectively from both groups. Energy-adjusted Dietary Inflammatory Index (DII) score was calculated and used as both categorical and continuous variables for analysis. Odds ratio was estimated using multivariable logistic regression after adjusting potential confounders. A linear test for trend was performed using the median value in each quartile.

RESULTS

Overall energy-adjusted mean DII score was -0.81 (range -5.19 to 6.93). Cases (-0.73 ± 1.5) had slightly higher DII scores than controls (-0.89 ± 1.6; P = 0.04). After adjusting the potential confounders, a statistically significant association was found between DII score and CRC risk. Using DII as a continuous variable (odds ratio [OR]_continuous 1.10, 95% confidence interval [CI] 1.01-1.20) and categorical variable (OR_{quartile 1 versus 4} 1.65, 95% CI 1.13-2.42; P_trend = 0.02).

CONCLUSION

Our findings indicate that proinflammatory diets are associated with an increased risk for CRC in the Newfoundland population.

Role of inflammation in the association between the western dietary pattern and metabolic syndrome among Lebanese adults

The aim of this study was to investigate whether inflammation mediates the previously observed direct association between the western dietary pattern (WDP) and metabolic syndrome (MetS) among Lebanese adults. Sociodemographic, lifestyle, dietary pattern scores, anthropometric and biochemical data of 331 adults were used in this study. Inflammation indicators considered were: serum C-reactive protein (CRP) and the dietary inflammatory index (DII). The scores of the WDP were significantly associated with DII (r = .64) but not with serum CRP. Higher CRP levels increased the odds of MetS and four out of five of its components, while no association was found between the DII and MetS.

CONCLUSION

The findings of this study confirmed the association of serum CRP with MetS but did not support mediation effect of inflammation on the association between the WDP and MetS. These findings are important to direct future investigations on diet, inflammation and association with diseases risk.

Association Between Diet Inflammatory Index and Osteoporotic Hip Fracture in Elderly Chinese Population

BACKGROUND

Chronic inflammation provides the substrate for various mechanisms involved in osteoporotic fracture. The Dietary Inflammatory Index (DII) could shed light on the effect of the inflammatory potential of the diet on osteoporotic hip fracture.

OBJECTIVE

This study tested the hypothesis that higher DII scores are associated with greater hip fracture risk in an elderly Chinese population.

METHODS

A 1:1 age- (±3 years), sex- and region-matched case-control study of 1050 pairs (female/male: 781/269) of elderly (age range = 52-83 years) Chinese was conducted in Guangdong, China (2009-2015). Cases were newly diagnosed (within 2 weeks) hip fracture patients and controls were recruited from either communities (n = 835 controls) or the hospital (n = 215). DII scores were calculated from self-reports using a validated 79-item food frequency questionnaire. Odds ratios (ORs) and their 95% confidence intervals (CIs) of the risk of hip fracture for DII scores were estimated from conditional logistic regression.

RESULTS

The multivariable-adjusted ORs (95% CIs) for hip fracture across quartiles of DII scores were 1 (reference), 1.42 (1.01, 1.99), 1.63 (1.16, 2.28), and 2.44 (1.73, 3.45) (P trend <.001). Comparing extreme quartiles, the adjusted ORs (95% CIs) for hip fractures were 2.08 (1.38, 3.12) for female and 4.30 (1.89, 9.80) for male participants, respectively (P interaction = .26). When stratified by the source of controls, a dose-response positive relationship was observed between DII scores and hip fracture risk among community-based controls but not those from the hospital (P interaction = .16).

CONCLUSIONS

A proinflammatory diet appears to be positively associated with hip fracture risk.

Dietary inflammatory index and risk of first myocardial infarction; a prospective population-based study

BACKGROUND

Chronic, low-grade inflammation is an established risk factor for cardiovascular disease. The inflammatory impact of diet can be reflected by concentrations of inflammatory markers in the bloodstream and the inflammatory potential of diet can be estimated by the dietary inflammatory index (DII^TM), which has been associated with cardiovascular disease risk in some previous studies. We aimed to examine the association between the DII and the risk of first myocardial infarction (MI) in a population-based study with long follow-up.

METHOD

We conducted a prospective case-control study of 1389 verified cases of first MI and 5555 matched controls nested within the population-based cohorts of the Northern Sweden Health and Disease Study (NSHDS), of which the largest is the ongoing Västerbotten Intervention Programme (VIP) with nearly 100 000 participants during the study period. Median follow-up from recruitment to MI diagnosis was 6.4 years (6.2 for men and 7.2 for women). DII scores were derived from a validated food frequency questionnaire (FFQ) administered in 1986-2006. Multivariable conditional logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI), using quartile 1 (most anti-inflammatory diet) as the reference category. For validation, general linear models were used to estimate the association between the DII scores and two inflammatory markers, high-sensitivity C-reactive protein (hsCRP) and interleukin 6 (IL-6) in a subset (n = 605) of the study population.

RESULTS

Male participants with the most pro-inflammatory DII scores had an increased risk of MI [OR_Q4vsQ1 = 1.57 (95% CI 1.21-2.02) P _trend = 0.02], which was essentially unchanged after adjustment for potential confounders, including cardiovascular risk factors [OR_Q4vsQ1 = 1.50 (95% CI 1.14-1.99), P _trend = 0.10]. No association was found between DII and MI in women. An increase of one DII score unit was associated with 9% higher hsCRP (95% CI 0.03-0.14) and 6% higher IL-6 (95% CI 0.02-0.11) in 605 controls with biomarker data available.

CONCLUSION

A pro-inflammatory diet was associated with an elevated risk of first myocardial infarction in men; whereas for women the relationship was null. Consideration of the inflammatory impact of diet could improve prevention of cardiovascular disease.

Association between Inflammatory Potential of Diet and Stress Levels in Adolescent Women in Iran

BACKGROUND

The relation between diet and stress has not been widely explored. In this study, we examined the association between the inflammatory potential of diet and levels of stress among adolescent girls in Iran.

METHODS

A total of 299 adolescent girls aged 15-18 years were recruited during 2014-2015. Stress was assessed using the Depression, Anxiety and Stress Scale (DASS)-21 scale. Data were analyzed as continuous DASS scores and as a dichotomous outcome with a cut-off value of 9. The dietary inflammatory index (DII) is a literature-derived population-based dietary. DII scores were index computed from dietary intake assessed using a validated food frequency questionnaire. Multivariable linear and logistic regressions were used to calculate beta estimates and odds ratios adjusting for potential confounding factors.

RESULTS

In total, 84 girls (28% of the entire study sample) had at least a moderate level of stress symptoms (DASS > 9). Girls with the most pro-inflammatory diet (tertile 3) had higher DASS stress scores (β = 2.75; 95% CI = 1.05, 4.46) and were at 3.48 times (95% CI = 1.33, 9.09) risk of having at least moderate level of stress compared to girls with the most anti-inflammatory diets (tertile 1).

CONCLUSION

These data suggest that Iranian adolescent girls with a pro-inflammatory diet, as shown by higher DII scores, had higher levels of stress and greater odds of having at least a moderate level of stress symptoms.

Abstract C66: Screening via multiple PSA measures to detect virulent prostate cancer could provide a way to address fundamental issues in African-American men's health

The dilemma facing individuals wishing to make decisions regarding prostate cancer (PrCA) screening pivots on two opposing outcomes: over-diagnosing indolent cancer and under-diagnosing virulent cancer. In conjunction with limited data on which to draw conclusions, this dilemma formed the basis on which the US Preventive Services Task Force made its decision to not recommend PSA screening. Data driving that decision-making process was derived nearly entirely from European and European-American men, even though African Americans are much more likely to be diagnosed with later-stage, more aggressive disease at younger ages. The discrepancy that we see between the US' highest-world-quintile incidence rates and second-lowest-world-quintile mortality rates may be explained entirely by the presence of high-virulence disease among African Americans.

Clearly, detecting aggressive disease represents a significant public health issue and unmet clinical need. Development and discovery of biomarkers to predict PrCA that is likely to kill if left untreated is the major challenge in PrCA prevention and control. With this background in mind we sought to interrogate a large data set with multiple PSAs measured at regular (i.e., annual) intervals to see if we could predict high-virulence PrCA. Using the PLCO data we showed that with ≥three measures we were able to improve sensitivity and specificity of the PSA test to &gt;97% overall and &gt;99% among African-American men for detecting virulent, clinically relevant high-risk prostate cancer (PSA level ≥ 20ng/ml, cancer that invades prostate capsule, PrCA that involves more than one lobe, or Gleason score &gt;7).

At this juncture, we have begun to address the question of what can be done to distinguish aggressive PrCA in African-American men. We propose creating a cohort of 48,000 individuals who are willing to undergo annual PSA screening with the intention of validating/refining the algorithm that the University of South Carolina team developed using PLCO trial data that combines three or more PSA measures to detect virulent, high-risk PrCA. This cohort also would serve another important purpose. There currently exists no other cohort with a sufficient number of African-American men to address other important cancer-related health issues. So, if designed correctly, this cohort could serve numerous other purposes.

This would be a simple follow-up study design with extensive baseline data collection and follow-up data collected at regular (i.e., annual) intervals. This would require strong community buy-in, commitment to providing information needed for informed decision-making, formulating rules for referring men out for diagnostic workup, and putting procedures in place for data linkage (e.g., to the cancer registries). Twelve institutions in 10 states across the US have expressed interest in being involved.

Currently, there are two, non-mutually exclusive, options for recruitment.

The Veterans Administration (VA) system could be ideal setting for this because: 1. They already have the screening infrastructure in place; 2. There isn't the financial incentive to over-diagnose and over-treat; 3. There is an excellent system of medical records; 4. There are many African-American veterans in the VA system; and 5. The medical home (for subsequent care) already is in place.

The NCI's community oncology research program (NCORP) appears to understand the CBPR imperative. As such, they have good access to local, interested communities and in some regions of the country this includes large AA populations. They have excellent community relations and local “connectivity” that could help to ensure a competent, caring ‘medical home' that would be essential for program viability (i.e., recruitment and follow-up). Depending on geographical particulars, there could be good overlap with the VA. NCORPS could add an important element of academic medicine/ NCI imprimatur to the mix.

Citation Format: James R. Hebert, Abraham Turner, Johnny Payne, Azza Shoaibi. Screening via multiple PSA measures to detect virulent prostate cancer could provide a way to address fundamental issues in African-American men's health. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C66.

Abstract B50: A church-based diet, physical activity, and stress intervention results in lower waist to hip ratios and reduced chronic inflammation in African-American males

Introduction: Acute inflammation, the body's response to infection or physical insult, helps to control infection, heal wounds, and promote tissue regeneration. When normal systems of negative feedback fail to turn off inhibitory signaling, persistent chronic inflammation results. Such chronic inflammation has been shown to be associated with cancers of many anatomic sites and other chronic diseases that are both more prevalent and more virulent among African Americans in the Southeastern United States. Also, chronic inflammation has been associated with poor diet, low levels of physical activity, and high levels of psychosocial stress. Using principles of community-based participatory research (CBPR), this randomized controlled trial (RCT) was designed and administered jointly by members of African-American churches and academic researchers. Its goal was to test the effectiveness of a community-based diet, physical activity and stress reduction intervention in reducing inflammation in overweight and obese African-American adults.

Methods: The RCT was conducted in greater Columbia, SC from 2010 to 2014. Churches were randomized to receive the intervention either immediately or with a 12-month delay. The latter served as the study's control arm. Church members were the unit of measurement for all health-related outcomes. Three lay health leaders, who constituted the Church Education Team (CET) and facilitated the study, were selected by the pastor of each church. The first intervention phase consisted of 12 weekly group classes led by a trained community health educator and involving hands-on cooking of mainly vegetable-based meals, sharing of healthy recipes, increasing physical activity, and mindfulness-based stress reduction. The second phase included monthly boosters conducted over an additional 9 months, and was meant to reinforce and expand on topics introduced in the more intensive, 12-week phase. Anthropometric measures were taken along with C-reactive protein (CRP), interleukin (IL)-6 and Monocyte Chemoattractant Protein (MCP)-1. A composite inflammatory score was computed by summing the z-scores for CRP, IL-6 and MCP-1. Linear regression models were fit to test intervention effectiveness and to identify predictors of success.

Results: Males in the intervention arm had lower mean adjusted CRP values compared to controls (2.6 vs. 3.7mg/L, p=0.05) at 12-week follow-up (immediately after weekly intervention classes). After 1-year follow-up, a difference of similar magnitude, but not statistically significant, was observed (2.6 vs. 3.9, p=0.17). A nearly statistically significant difference in the composite inflammatory biomarker score also was observed between intervention and control arms among males (-0.38 vs. 0.17, p=0.07). Adjustment for ratings of intervention attendance and sustainability revealed a statistically significant difference in waist-to-hip ratio (WHR) between intervention and control group subjects (0.84 vs. 0.86, p=0.03) at 12-week follow-up among all participants.

Conclusion: This RCT showed a significant reduction in CRP among males, but not females; and WHR reductions among all participants at 12-week follow-up. Results also included a large dropout and relatively large differences in factors related to retention and participants' investment in the process. Therefore, alternatives to randomization as a method of treatment allocation may be more appropriate from a public health perspective, especially in communities with large cancer-related health disparities.

Citation Format: James R. Hebert, Michael D. Wirth, Brook E. Harmon, Nitin Shivappa, Thomas G. Hurley, Lisa C. Davis, Cheryl A. Armstead, Angela E. Murphy. A church-based diet, physical activity, and stress intervention results in lower waist to hip ratios and reduced chronic inflammation in African-American males. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B50.

Abstract B27: A synergistic regional network's infrastructure to reduce cancer related health disparities

Cancer Health Disparities is defined by the National Cancer Institute (NCI) as “adverse differences in cancer incidence, prevalence, morbidity, mortality, survivorship, and burden of cancer or related health conditions that exist among specific population groups in the United States.” NCI recognizes the substantial progress in cancer treatment, screening, diagnosis, and prevention over the past several decades. However, addressing cancer-related health disparities in certain populations is an area in which progress has not kept pace. Therefore, NCI's Center to Reduce Center Health Disparities (CRCHD) created region-based “hubs” under the Geographic Management of Cancer Health Disparities Program (GMaP) to advance the science of cancer health disparities in the regions, contribute to the next generation of cancer health disparities researchers, and achieve measureable reductions in cancer health disparities in the United States.

GMaP Region 1 North (R1N) hub is based at the University of Kentucky Markey Cancer Center, with Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, University of South Carolina Cancer Prevention and Control Program, and the University of Virginia Cancer Center as lead institutions. The overall goal of GMaP R1N is to enhance the capacity of regional cancer centers, associated academic partners, community partners, and early-stage investigators to contribute to the reduction of cancer health disparities in the region covering Kentucky, West Virginia, Virginia, Delaware, Maryland, New Hampshire, Vermont, Maine, and Washington DC.

GMaP R1N is utilizing an infrastructure of investigators and partners throughout the region that serve on the Advisory Committee, Education and Outreach Subcommittee, Diversity Training Subcommittee, and/or Evaluation Subcommittee to: create opportunities for scientific exchange, cooperation, and collaboration among cancer and cancer-related health disparities researchers throughout the region; attract underrepresented students, trainees/scholars, and investigators to the biomedical cancer research enterprise; enhance access of underrepresented students, trainees, and scholars to career development and mentoring opportunities; and increase cancer information dissemination and sharing of best practices among researchers and trainees/ scholars.

Using this infrastructure, R1N anticipates enhanced collaboration between regional cancer centers and other academic partners, including regional minority serving institutions; increases in the number of competitive collaborative grant applications to NCI from regional cancer and academic centers; increases in the number of successful K- and R- award applications to NCI by underrepresented students, trainees/scholars, and investigators in the region; increased mentoring relationships developed, both within and across regional cancer and academic centers; and increased dissemination of research and career development opportunities across regional institutions.

Citation Format: Neha Jaggi, Julia Faith Houston, James R. Hebert, Mark Dignan, Nathan L. Vanderford, Mark Cromo, Mark Evers, Janice Bowie, Adrian Dobs, Olive Mbah, Ashleigh DeFries Gallagher, Roger Anderson. A synergistic regional network's infrastructure to reduce cancer related health disparities. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B27.

Abstract A81: Utilizing the Geographic Management of Cancer Health Disparities Program (GMaP) Region 1 North partnership survey as a tool to promote mentoring and collaborative grant applications

Introduction:

Region 1 North of the National Cancer Institute's Geographic Management of Cancer Health Disparities Program (GMaP) is based at the University of Kentucky Markey Cancer Center (UK MCC). GMaP was funded for a three-year period as a supplement to the UK MCC Cancer Center Support Grant with an overall goal to reduce cancer health disparities. Efforts to achieve this goal include enhancing the capacity of regional cancer centers, associated academic partners, community partners, and early-stage investigators to increase research on disparities by fostering collaborative research applications and facilitating the career development of the next generation of underrepresented cancer and cancer health disparities investigators.

Methods:

UK MCC GMaP investigators are partnering with researchers at Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, the University of Virginia Cancer Center, the University of South Carolina Cancer Prevention and Control Program, and other regional cancer center and academic partners to implement multi-faceted programming to increase and strengthen collaborative research and training efforts across the Region 1 North coverage area, which includes DC, DE, KY, ME, MD, NH, VA, VT, and WV. GMaP Region 1 North has implemented an online survey of investigators and partners throughout the region to assess their career level, research focus and interests, and readiness to submit grant applications within the next 12 months.

Results:

A total of 161 responses to the survey have been received. The respondents include undergraduate and graduate students, faculty members, research and administrative staff and community members. Over 70% of respondents described themselves as researchers (32% cancer center researchers) and almost 50% as mentors. The most common response categories for types of research conducted include basic science (52%), translational (44%), cancer health disparities (39%) and behavioral/population focused research (36%). Of those currently funded by extramural sources, 26% reported R01 funding and nearly all of the remaining respondents reported funding by a wide variety of other NIH mechanisms. Most (88%) respondents indicated that they are planning R01 and/or R21 applications within the next 12 months.

Conclusion:

The survey has provided Region 1 North investigators with a working foundation for matching mentors with underrepresented early-stage investigators for K- and R-series grant applications. Additionally, the survey results provide a tool to promote collaborative applications across regional institutions through targeted communication and media efforts.

Citation Format: Mark B. Dignan, Nathan L. Vanderford, B Mark Evers, Mark Cromo, Janice Bowie, Adrian Dobs, Ashleigh Gallagher, Olive Mbah, Julia F. Houston, Neha Jaggi, Roger Anderson, James R. Hebert. Utilizing the Geographic Management of Cancer Health Disparities Program (GMaP) Region 1 North partnership survey as a tool to promote mentoring and collaborative grant applications. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A81.

Dietary inflammatory index and risk of epithelial ovarian cancer in African American women

Chronic inflammation has been implicated in the development of epithelial ovarian cancer (EOC); yet the contribution of inflammatory foods and nutrients to EOC risk has been understudied. We investigated the association between the dietary inflammatory index (DII), a novel literature-derived tool to assess the inflammatory potential of one's diet, and EOC risk in African American (AA) women in the African American Cancer Epidemiology Study, the largest population-based case-control study of EOC in AA women to date. The energy-adjusted DII (E-DII) was computed per 1,000 kilocalories from dietary intake data collected through a food frequency questionnaire, which measured usual dietary intake in the year prior to diagnosis for cases or interview for controls. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated using multivariable logistic regression for the association between the E-DII and EOC risk. 493 cases and 662 controls were included in the analyses. We observed a 10% increase in EOC risk per a one-unit change in the E-DII (OR = 1.10, 95% CI = 1.03-1.17). Similarly, women consuming the most pro-inflammatory diet had a statistically significant increased EOC risk in comparison to the most anti-inflammatory diet (ORQuartile4/Quartile1  = 1.72; 95% CI = 1.18-2.51). We also observed effect modification by age (p < 0.05), where a strong, significant association between the E-DII and EOC risk was observed among women older than 60 years, but no association was observed in women aged 60 years or younger. Our findings suggest that a more pro-inflammatory diet was associated with an increased EOC risk, especially among women older than 60 years.

The impact of meal timing on cardiometabolic syndrome indicators in shift workers

The aims of this study were to 1) compare the inflammatory potential of night- and day-shift nurses' diets with regard to time of day and work status and 2) explore how the timing of food intake during work and off-work is associated with cardiometabolic syndrome (CMS) risk factors between these two groups. Female nurses (N = 17; 8 day-shift and 9 night-shift) reported food intake over 9 days. On a middle day off of work, metabolic parameters were measured after an overnight fast. Energy/macronutrient intake and inflammatory potential of dietary intake (as assessed via the Dietary Inflammatory Index^TM) were calculated for nurses' workdays, work nights, off-work days, and off-work nights. Work-night total food intake (grams) accounted for a significant amount of variance in CMS risk factors for night-shift nurses only. Increased total gram consumption during night-shift nurses' work nights was associated with increased lipid levels - independent of the macronutrient composition of the food consumed. Alternatively, for night-shift nurses, work-day intake of several food parameters accounted for a significant proportion of variance in HDL cholesterol levels, with higher intake associated with higher HDL levels. For both day- and night-shift nurses, food intake during the day was more pro-inflammatory regardless of shift type or work status. Our novel approach of combining time-of-day-specific and work-day-specific analyses of dietary inflammatory factors and macronutrient composition with measurement of CMS risk factors suggests a link between meal timing and cardiometabolic health for shift-working nurses.

Association between Maternal Dietary Inflammatory Index (DII) and abortion in Iranian women and validation of DII with serum concentration of inflammatory factors: case-control study

Previous studies have shown that some dietary components may be implicated in the etiology of spontaneous abortion. However, the possible relationship between diet-related inflammation and the risk of abortion has not yet been investigated. We examined the ability of the literature-derived Dietary Inflammatory Index (DII) to predict the abortion incidence in women suffering from recurrent abortion in a case-control study conducted from April 2010 to March 2011. This included 67 incident cases and 68 controls (frequency matched to cases by age) who attended infertility and miscarriage specialized centers in Tehran, Iran. The DII was computed based on dietary intake assessed using a validated and reproducible 168 item food-frequency questionnaire. Logistic regression models were used to estimate multivariable ORs adjusted for age, education, occupation, and body mass index. Subjects with higher DII scores (i.e., a more pro-inflammatory diet) had higher odds of abortion, with the DII being used as a continuous variable (OR_continuous = 2.12, 95% CI: 1.02-4.43). When analysis was carried out with DII expressed as a dichotomous variable, women in the pro-inflammatory diet group (DII > 1.24) were at 2.12 times higher odds of having abortion compared with women in the referent group (DII ≤ 1.24) (ORDII_{>1.24/≤1.24} = 2.12; 95% CI: 1.02-4.43). In the same study, for every 1-unit increase in DII, there was a corresponding increase in interleukin-6 by 0.15 pg/mL, 95% CI (<0.01, 0.28). In conclusion, subjects who consumed a more pro-inflammatory diet were at increased odds of abortion compared with those who consumed a more anti-inflammatory diet.

Association between Dietary Inflammatory Index (DII) and risk of prediabetes: a case-control study

The possible relationship between diet-related inflammation and the risk of prediabetes requires further investigation, especially in non-Western populations. We examined the ability of the dietary inflammatory index (DII) to predict the risk of prediabetes in a case-control study conducted at specialized centers in Esfahan, Iran. A total of 214 incident cases of prediabetes were selected with the nonrandom sampling procedure, and the 200 controls randomly selected from the same clinics were frequency-matched on age (±5 years) and sex. DII scores were computed based on dietary intake assessed using a validated and reproducible 168-item food-frequency questionnaire. Linear and logistic regression models were used to estimate multivariable beta estimates and odds ratios (ORs). Subjects in tertile 3 versus tertile 1 (T3VS1) of DII had significantly higher fasting plasma glucose (DII_T3VS1: b = 4.49; 95% CI 1.89, 7.09), oral glucose tolerance (DII_T3VS1: b = 8.76; 95% CI 1.78, 15.73), HbA1c (DII_T3VS1: b = 0.30; 95% CI 0.17, 0.42), low-density lipoprotein (DII_T3VS1: b = 16.37; 95% CI 11.04, 21.69), triglyceride (DII_T3VS1: b = 21.01; 95% CI 8.61, 33.42) and body fat (DII_T3VS1: b = 2.41; 95% CI 0.56, 4.26) and lower high-density lipoprotein (DII_T3VS1: b = -3.39; 95% CI -5.94, -0.84) and lean body mass (DII_T3VS1: b = -3.11; 95% CI -4.83, -1.39). After multivariate adjustment, subjects in the most pro-inflammatory DII group had 19 times higher odds of developing prediabetes compared with subjects in tertile 1 (DII_T3VS1: OR = 18.88; 95% CI 7.02, 50.82). Similar results were observed when DII was used as a continuous variable, (DII_continuous: OR = 3.62; 95% CI 2.50, 5.22). Subjects who consumed a more pro-inflammatory diet were at increased risk of prediabetes compared with those who consumed a more anti-inflammatory diet.

Longitudinal changes in the dietary inflammatory index: an assessment of the inflammatory potential of diet over time in postmenopausal women

BACKGROUND/OBJECTIVES

The dietary inflammatory index (DII) measured at one time point is associated with risk of several chronic diseases, but disease risk may change with longitudinal changes in DII scores. Data are lacking regarding changes in DII scores over time; therefore, we assessed changes in the DII in the Women's Health Initiative (WHI).

SUBJECTS/METHODS

DII scores were calculated using data from repeated food frequency questionnaires in the WHI Observational Study (OS; n=76 671) at baseline and year 3, and the WHI Dietary Modification trial (DM; n=48482) at three time points. Lower DII scores represent more anti-inflammatory diets. We used generalized estimating equations to compare mean changes in DII over time, adjusting for multiple comparisons, and multivariable-adjusted linear regression analyses to determine predictors of DII change.

RESULTS

In the OS, mean DII decreased modestly from -1.14 at baseline to -1.50 at year 3. In the DM, DII was -1.32 in year 1, -1.60 in year 3 and -1.48 in year 6 in the intervention arm and was -0.65 in year 1, -0.94 in year 3 and -0.96 in year 6 in the control arm. These changes were modified by body mass index, education and race/ethnicity. A prediction model explained 22% of the variance in the change in DII scores in the OS.

CONCLUSIONS

In this prospective investigation of postmenopausal women, reported dietary inflammatory potential decreased modestly over time. Largest reductions were observed in normal-weight, highly educated women. Future research is warranted to examine whether reductions in DII are associated with decreased chronic disease risk.

Cardiovascular disease incidence among females in South Carolina by type of oral contraceptives, 2000-2013: a retrospective cohort study

INTRODUCTION

Certain types of oral contraceptives can produce favorable effects on lipid metabolism and vascular tone, while others have potentially detrimental effects. Endogenous and exogenous hormones exert different effects on high-density lipoprotein (HDL) and low-density lipoprotein (LDL) depending on the type, combination, and dose of the hormone. The estrogenic and progestogenic effects of exogenous hormones on HDL and LDL are inconsistent. Studying surrogate end points (LDL, HDL levels) may provide a misleading picture of OCs.

METHODS

Medicaid data from 2000 to 2013 were used to assess the relationship between the type of OCs and CVD incidence. Multivariable logistic regression was used to model relationships between cardiovascular disease and OC use adjusting for potential confounders.

RESULTS

Compared to combined oral contraceptives (COC), progestin-only oral contraceptives (POC) were associated with decreased heart disease and stroke incidence after adjusting for important covariates (OR 0.74; 95 % CI 0.57, 0.97 and OR 0.39; 95 % CI 0.16, 0.95, respectively). However, there was a positive association between POC + COC and both heart disease and stroke incidence (OR 2.28; 95 % CI 1.92, 2.70 and OR 2.12; 95 % CI 1.34, 3.35, respectively).

CONCLUSION

In light of an association between POC use and decreased heart disease and stroke, women's CVD risk factors should be carefully considered when choosing which OC to use. Baseline CVD risk should be a part of the discussion between women and their primary care providers when making choices regarding OCs.

Carotenoid intake and adipose tissue carotenoid levels in relation to prostate cancer aggressiveness among African-American and European-American men in the North Carolina-Louisiana prostate cancer project (PCaP)

BACKGROUND

Associations between carotenoid intake and prostate cancer (CaP) incidence have varied across studies. This may result from combining indolent with aggressive disease in most studies. This study examined whether carotenoid intake and adipose tissue carotenoid levels were inversely associated with CaP aggressiveness.

METHODS

Data on African-American (AA, n = 1,023) and European-American (EA, n = 1,079) men with incident CaP from North Carolina and Louisiana were analyzed. Dietary carotenoid intake was assessed using a detailed-food frequency questionnaire (FFQ), and abdominal adipose tissue samples were analyzed for carotenoid concentrations using high-performance liquid chromatography. Multivariable logistic regression was used in race-stratified analyses to calculate odds ratios (ORs) and 95% confidence intervals (95%CI) comparing high aggressive CaP with low/intermediate aggressive CaP.

RESULTS

Carotenoid intake differed significantly between AAs and EAs, which included higher intake of lycopene among EAs and higher β-cryptoxanthin intake among AAs. Comparing the highest and lowest tertiles, dietary lycopene was associated inversely with high aggressive CaP among EAs (OR = 0.55, 95%CI: 0.34-0.89, Ptrend  = 0.02), while an inverse association was observed between dietary β-cryptoxanthin intake and high aggressive CaP among AAs (OR = 0.56, 95%CI: 0.36-0.87, Ptrend  = 0.01). Adipose tissue α-carotene and lycopene (cis + trans) concentrations were higher among EAs than AAs, and marginally significant inverse linear trends were observed for adipose α-carotene (Ptrend  = 0.07) and lycopene (Ptrend  = 0.11), and CaP aggressiveness among EAs only.

CONCLUSIONS

These results suggest that diets high in lycopene and β-cryptoxanthin may protect against aggressive CaP among EAs and AAs, respectively. Differences in dietary behaviors may explain the observed racial differences in associations. Prostate 76:1053-1066, 2016. © 2016 Wiley Periodicals, Inc.

Patterns of change over time and history of the inflammatory potential of diet and risk of breast cancer among postmenopausal women

We utilized the dietary inflammatory index (DII) to investigate associations between patterns of change in, and history of the inflammatory potential of diet and risk of breast cancer in the Women's Health Initiative (WHI). We included 70,998 postmenopausal women aged 50-79 years recruited from 1993 to 1998 into the WHI Observational Study and Dietary Modification trial control group and followed through August 29, 2014. We utilized data from food frequency questionnaires administered at baseline and Year 3, to calculate average DII scores, patterns of change in DII, and used these measures in multivariable-adjusted Cox regression models to estimate hazards ratios (HR) and 95 % confidence intervals (CI) for incident invasive breast cancer and its subtypes. After 1,093,947 person-years of follow-up, 3471 cases of invasive breast cancer were identified. There was no substantial association between average DII scores or patterns of change in DII and risk of overall invasive breast cancer (HR, 1.03; 95 % CI, 0.90, 1.17; P-trend = 0.79; comparing extreme average DII quintiles). However, there was a significant nonlinear association between average DII scores and the ER-, PR-, HER2+, subtype (HR, 2.37; 95 % CI, 1.08, 5.20; P-trend = 0.18; comparing extreme quintiles). For patterns of change in DII, the age-adjusted association with ER-, PR-, HER2+ subtype comparing women in the proinflammatory stable to those in the anti-inflammatory stable categories (HR, 1.82; 95 % CI, 1.06, 3.13) persisted in the multivariable-adjusted model but was less precise (HR, 1.85; 95 % CI, 0.96, 3.55; P = 0.06). Dietary inflammatory potential may differentially influence the development of specific breast cancer phenotypes.