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Ben-Arye E, Lopez AM, Daoud N, Zoller L, Walker E, Davidescu M, Shulman K, Gressel O, Stein N, Brosh S, Schiff E, Samuels N. Identifying Factors Associated With Disparities in Access to Integrative Oncology Program. J Pain Symptom Manage 2024; 68:10-21. [PMID: 38552747 DOI: 10.1016/j.jpainsymman.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/28/2024] [Accepted: 03/14/2024] [Indexed: 04/09/2024]
Abstract
CONTEXT AND OBJECTIVES Cancer centers are increasingly providing complementary medicine as part of an emerging discipline termed 'integrative oncology' (IO). The present study explored factors associated with disparities in referral and adherence to a freely-provided IO program. METHODS The databases of three oncology centers in northern Israel were searched retrospectively for chemotherapy-treated oncology patients eligible for referral by their oncology healthcare professionals to an integrative physician (IP) consultation. Demographic and cancer-related variables associated with the referral, and attendance by patients at the consultation were identified, as was adherence to the 6-week IO treatment program (high adherence, attending ≥4 IO treatment sessions; low adherence, 0-3 sessions). RESULTS Of 4988 eligible patients, 1694 (34%) were referred to the IP consultation, with 1331 (78.6%) attending the consultation of which 766 (57.6%) were adherent to IO treatments. Multivariate analysis revealed lower referral rates among patients speaking primarily Arabic and Russian vs. Hebrew (OR = 3.0, 95% CI = 2.0-4.6, P < 0.0001); males vs. females (OR = 1.94, CI = 1.3-2.9, P = 0.001); those not reporting emotional distress (OR = 1.5, CI = 1.02-2.16, P = 0.037); and older age (OR = 1.04, CI = 1.03-1.06, P < 0.0001). Arabic and Russian-speaking patients were less likely to adhere to IO treatments (OR = 0.52, 95% CI = 0.32-0.83, P = 0.006). CONCLUSION Patients' ethno-national origin and immigration status (primary language, Arabic and Russian), male gender and older age were associated with lower rates of referral to and attendance of the IP consultation, with reduced adherence to weekly IO treatments. These findings require further study to identify barriers toward diversity, equity and inclusion in IO care, increasing awareness among healthcare professionals regarding the benefits of these services for improving patient wellbeing.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program (E.B.A., M.D.), The Oncology Service, Lin, Zebulun, and Carmel Medical Centers, Clalit Health Services, Haifa, Israel; Rappaport Faculty of Medicine (E.B.A., K.S., E.S.), Technion-Israel Institute of Technology, Haifa, Israel.
| | - Ana Maria Lopez
- Sidney Kimmel Medical College and Sidney Kimmel Cancer Center (A.M.L.), Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nihaya Daoud
- School of Public health, Faculty of Health Sciences (N.D.), Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Lilach Zoller
- Haifa and Western Galilee District (L.Z.), Clalit Health Services, Haifa, Israel
| | | | - Michal Davidescu
- Integrative Oncology Program (E.B.A., M.D.), The Oncology Service, Lin, Zebulun, and Carmel Medical Centers, Clalit Health Services, Haifa, Israel
| | - Katerina Shulman
- Rappaport Faculty of Medicine (E.B.A., K.S., E.S.), Technion-Israel Institute of Technology, Haifa, Israel; The Oncology Service (K.S.), Lin and Zebulun Medical Centers, Clalit Health Services, Haifa, Israel
| | - Orit Gressel
- Integrative Oncology Program (E.B.A., M.D.), The Oncology Service, Lin, Zebulun, and Carmel Medical Centers, Clalit Health Services, Haifa, Israel
| | - Nili Stein
- Department of Community Medicine and Epidemiology (N.S.), Carmel Medical Center, Haifa, Israel
| | | | - Elad Schiff
- Rappaport Faculty of Medicine (E.B.A., K.S., E.S.), Technion-Israel Institute of Technology, Haifa, Israel; Department of Internal Medicine & Integrative Medicine Service (E.S.), Bnai-Zion, hospital, Haifa, Israel
| | - Noah Samuels
- Center for Integrative Complementary Medicine (N.S.), Shaarei Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Pohl SA, Nelson BA, Patwary TR, Amanuel S, Benz EJ, Lathan CS. Evolution of community outreach and engagement at National Cancer Institute-Designated Cancer Centers, an evolving journey. CA Cancer J Clin 2024; 74:383-396. [PMID: 38703384 DOI: 10.3322/caac.21841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/26/2024] [Accepted: 04/09/2024] [Indexed: 05/06/2024] Open
Abstract
Cancer mortality rates have declined during the last 28 years, but that process is not equitably shared. Disparities in cancer outcomes by race, ethnicity, socioeconomic status, sexual orientation and gender identity, and geographic location persist across the cancer care continuum. Consequently, community outreach and engagement (COE) efforts within National Cancer Institute-Designated Cancer Center (NCI-DCC) catchment areas have intensified during the last 10 years as has the emphasis on COE and catchment areas in NCI's Cancer Center Support Grant applications. This review article attempts to provide a historic perspective of COE within NCI-DCCs. Improving COE has long been an important initiative for the NCI, but it was not until 2012 and 2016 that NCI-DCCs were required to define their catchment areas rigorously and to provide specific descriptions of COE interventions, respectively. NCI-DCCs had previously lacked adequate focus on the inclusion of historically marginalized patients in cancer innovation efforts. Integrating COE efforts throughout the research and operational aspects of the cancer centers, at both the patient and community levels, will expand the footprint of COE efforts within NCI-DCCs. Achieving this change requires sustained commitment by the centers to adjust their activities and improve access and outcomes for historically marginalized communities.
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Affiliation(s)
- Sarah A Pohl
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Barry A Nelson
- Dana-Farber/Harvard Cancer Center Faith Based Cancer Disparities Network, Boston, Massachusetts, USA
| | - Tanjeena R Patwary
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Salina Amanuel
- Columbia University Mailman School of Public Health, New York, New York, USA
| | - Edward J Benz
- Dana-Farber Cancer Center, Dana-Farber/Harvard Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher S Lathan
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Hines RB, Zhu X, Lee E, Eames B, Chmielewska K, Johnson AM. Health insurance and neighborhood poverty as mediators of racial disparities in advanced disease stage at diagnosis and nonreceipt of surgery for women with breast cancer. Cancer Med 2023; 12:15414-15423. [PMID: 37278365 PMCID: PMC10417299 DOI: 10.1002/cam4.6127] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/26/2023] [Accepted: 05/14/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND In our recent study, advanced disease stage and nonreceipt of surgery were the most important mediators of the racial disparity in breast cancer survival. The purpose of this study was to quantify the racial disparity in these two intermediate outcomes and investigate mediation by the more proximal mediators of insurance status and neighborhood poverty. METHODS This was a cross-sectional study of non-Hispanic Black and non-Hispanic White women diagnosed with first primary invasive breast cancer in Florida between 2004 and 2015. Log-binomial regression was used to obtain prevalence ratios (PR) with 95% confidence intervals (CIs). Multiple mediation analysis was used to assess the role of having Medicaid/being uninsured and living in high-poverty neighborhoods on the race effect. RESULTS There were 101,872 women in the study (87.0% White, 13.0% Black). Black women were 55% more likely to be diagnosed with advanced disease stage at diagnosis (PR, 1.55; 95% CI, 1.50-1.60) and nearly twofold more likely to not receive surgery (PR, 1.97; 95% CI, 1.90-2.04). Insurance status and neighborhood poverty explained 17.6% and 5.3% of the racial disparity in advanced disease stage at diagnosis, respectively; 64.3% remained unexplained. For nonreceipt of surgery, insurance status explained 6.8% while neighborhood poverty explained 3.2%; 52.1% was unexplained. CONCLUSIONS Insurance status and neighborhood poverty were significant mediators of the racial disparity in advanced disease stage at diagnosis with a smaller impact on nonreceipt of surgery. However, interventions designed to improve breast cancer screening and receipt of high-quality cancer treatment must address additional barriers for Black women with breast cancer.
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Affiliation(s)
- Robert B. Hines
- Department of Population Health SciencesUniversity of Central Florida College of MedicineOrlandoFloridaUSA
| | - Xiang Zhu
- Research Administration ‐ OperationsUniversity of Central Florida College of MedicineOrlandoFloridaUSA
| | - Eunkyung Lee
- Department of Health SciencesCollege of Health Professions and SciencesUniversity of Central FloridaOrlandoFloridaUSA
| | - Bradley Eames
- Department of Medical EducationUniversity of Central Florida College of MedicineOrlandoFloridaUSA
| | - Karolina Chmielewska
- Department of Medical EducationUniversity of Central Florida College of MedicineOrlandoFloridaUSA
| | - Asal M. Johnson
- Department of Environmental Sciences and StudiesPublic Health Program, Stetson UniversityDeLandFloridaUSA
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Purrington KS, Hastert TA, Madhav KC, Nair M, Snider N, Ruterbusch JJ, Schwartz AG, Stoffel EM, Peters ES, Rozek LS. The role of area-level socioeconomic disadvantage in racial disparities in cancer incidence in metropolitan Detroit. Cancer Med 2023. [PMID: 37184135 DOI: 10.1002/cam4.6065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/17/2023] [Accepted: 04/30/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Neighborhood deprivation is associated with both race and cancer incidence, but there is a need to better understand the effect of structural inequities on racial cancer disparities. The goal of this analysis was to evaluate the relationship between a comprehensive measure of neighborhood-level social disadvantage and cancer incidence within the racially diverse population of metropolitan Detroit. METHODS We estimated breast, colorectal, lung, and prostate cancer incidence rates using Metropolitan Detroit Cancer Surveillance System and US decennial census data. Neighborhood socioeconomic disadvantage was measured by the Area Deprivation Index (ADI) using Census Bureau's American Community Survey data at the Public Use Microdata Areas (PUMA) level. Associations between ADI at time of diagnosis and cancer incidence were estimated using Poisson mixed-effects models adjusting for age and sex. Attenuation of race-incidence associations by ADI was quantified using the "mediation" package in R. RESULTS ADI was inversely associated with incidence of breast cancer for both non-Hispanic White (NHW) and non-Hispanic Black (NHB) women (NHW: per-quartile RR = 0.92, 95% CI 0.88-0.96; NHB: per-quartile RR = 0.94, 95% CI 0.91-0.98) and with prostate cancer incidence only for NHW men (per-quartile RR = 0.94, 95% CI 0.90-0.97). ADI was positively associated with incidence of lung cancer for NHWs and NHBs (NHW: per-quartile RR = 1.12, 95% CI 1.04-1.21; NHB: per-quartile RR = 1.37, 95% CI 1.25-1.51) and incidence of colorectal cancer (CRC) only among NHBs (per-quartile RR = 1.11, 95% CI 1.02-1.21). ADI significantly attenuated the relationship between race and hormone receptor positive, HER2-negative breast cancer (proportion attenuated = 8.5%, 95% CI 4.1-16.6%) and CRC cancer (proportion attenuated = 7.3%, 95% CI 3.7 to 12.8%), and there was a significant interaction between race and ADI for lung (interaction RR = 1.22, p < 0.0001) and prostate cancer (interaction RR = 1.09, p = 0.00092). CONCLUSIONS Area-level socioeconomic disadvantage is associated with risk of common cancers in a racially diverse population and plays a role in racial differences in cancer incidence.
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Affiliation(s)
- Kristen S Purrington
- Department of Oncology, Wayne State University School of Medicine, Michigan, Detroit, USA
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Michigan, Detroit, USA
| | - Theresa A Hastert
- Department of Oncology, Wayne State University School of Medicine, Michigan, Detroit, USA
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Michigan, Detroit, USA
| | - K C Madhav
- Department of Internal Medicine, Yale School of Medicine, Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Connecticut, New Haven, USA
| | - Mrudula Nair
- Department of Oncology, Wayne State University School of Medicine, Michigan, Detroit, USA
| | - Natalie Snider
- Department of Oncology, Wayne State University School of Medicine, Michigan, Detroit, USA
| | - Julie J Ruterbusch
- Department of Oncology, Wayne State University School of Medicine, Michigan, Detroit, USA
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Michigan, Detroit, USA
| | - Ann G Schwartz
- Department of Oncology, Wayne State University School of Medicine, Michigan, Detroit, USA
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Michigan, Detroit, USA
| | - Elena M Stoffel
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Health System, Michigan, Ann Arbor, USA
| | - Edward S Peters
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Laura S Rozek
- Department of Oncology, Georgetown University School of Medicine, District of Columbia, Washington, USA
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5
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Perkins R, Mitchell E. Cervical cancer disparities. J Natl Med Assoc 2023; 115:S19-S25. [PMID: 37202000 DOI: 10.1016/j.jnma.2023.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/01/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Rebecca Perkins
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, United States
| | - Edith Mitchell
- Sidney Kimmel Cancer Center at Jefferson, Philadelphia, PA, United States.
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Leader AE, Melillo RJ, Greene Q, Blanding-Godbolt J, Shimada A, Eischen CM, Aplin AE. Engaging community members in cancer research: an assessment of an NCI-designated cancer center. Cancer Causes Control 2023; 34:307-319. [PMID: 36598655 DOI: 10.1007/s10552-022-01666-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 12/27/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Despite the importance of engaging community members in research, multiple barriers exist. We conducted a mixed-methods evaluation to understand the opportunities and challenges of engaging community members in basic, clinical, translational, and population science research. METHODS We designed a survey and an interview guide based on the constructs of the Consolidated Framework for Implementation Research. Surveys were distributed electronically to all cancer center investigators and interviews were conducted virtually with a select group of basic, clinical, and population science investigators. Survey data (n = 77) were analyzed across all respondents using frequency counts and mean scores; bivariate analyses examined differences in responses by research program affiliation, gender, race, and faculty rank. Interviews (n = 16) were audio recorded, transcribed verbatim, and analyzed using a reflective thematic approach. RESULTS There was strong agreement among investigators that "Community engagement in research will help the SKCC address cancer disparities in the catchment area" (M 4.2, SD 0.9) and less agreement with items such as "I know how to find and connect with community members who I can engage in my research" (M 2.5, SD 1.3). Investigators mentioned challenges in communicating complex science to a lay audience but were open to training and workshops to acquire skills needed to integrate community members into their research. CONCLUSION Cancer centers should develop and promote training and collaborative opportunities for investigators and community members. Overcoming challenges will lead to more patient- and community-centered cancer research in the future.
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Affiliation(s)
- Amy E Leader
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA. .,Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA. .,Thomas Jefferson University, 833 Chestnut Street, 11th Floor, Philadelphia, PA, 19107, USA.
| | - Rebecca J Melillo
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | - Ayako Shimada
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christine M Eischen
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Cancer Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrew E Aplin
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Cancer Biology, Thomas Jefferson University, Philadelphia, PA, USA
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Zhu L, Rahman A, Yeh MC, Ma GX. Racial/Ethnic Disparities of Cancer, Metabolic Syndrome, and Lifestyle Behaviors in People under 50: A Cross-Sectional Study of Data from the National Health and Nutrition Examination Survey. EPIDEMIOLOGIA 2022; 3:493-501. [PMID: 36416800 PMCID: PMC9680314 DOI: 10.3390/epidemiologia3040037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/23/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Recent epidemiological studies have suggested a trend of increasing prevalence of metabolic syndrome (MetS) and certain types of cancer among adults under age 50. How MetS is associated with cancer in adults under the age of 50, however, remains unclear. Furthermore, it remains unknown whether associations between MetS and cancer vary by racial/ethnic group and whether modifiable lifestyle factors influence MetS-cancer relationships. METHODS We used data from the 2011-2018 National Health and Nutrition Examination Survey (NHANES) to define a case-control sample to examine potential racial/ethnic disparities associated with MetS and cancer of any type. We used a chi-square test and binary logistic regression to examine the MetS and cancer association. RESULTS From a total sample of 10,220 cases, we identified 9960 no-cancer cases and 260 cancer cases. Binary logistic regression results showed that MetS was significantly associated with a cancer risk among non-Hispanic whites (odds ratio = 1.48, 95% confidence interval = 1.00-2.19); however, it was not associated with a risk among non-Hispanic Blacks, Hispanic/Latinos, or Asian Americans. We also found several significant predictors of cancer, including age, gender, tobacco use, and sleep duration, with their roles varying by racial/ethnic subgroup. CONCLUSION The findings of this study indicate that racial/ethnic differences are involved in the association between MetS and cancer, and highlight the potential mediating effects of lifestyle and behavioral factors. Future research should leverage the existing longitudinal data or data from cohort or case-control studies to better examine the causal link between MetS and cancer among racial/ethnic minorities.
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Affiliation(s)
- Lin Zhu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Areebah Rahman
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Ming-Chin Yeh
- Nutrition Program, Hunter College, City University of New York, New York, NY 10065, USA
| | - Grace X. Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
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Patierno BM, Foo WC, Allen T, Somarelli JA, Ware KE, Gupta S, Wise S, Wise JP, Qin X, Zhang D, Xu L, Li Y, Chen X, Inman BA, McCall SJ, Huang J, Kittles RA, Owzar K, Gregory S, Armstrong AJ, George DJ, Patierno SR, Hsu DS, Freedman JA. Characterization of a castrate-resistant prostate cancer xenograft derived from a patient of West African ancestry. Prostate Cancer Prostatic Dis 2022; 25:513-523. [PMID: 34645983 PMCID: PMC9005588 DOI: 10.1038/s41391-021-00460-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/31/2021] [Accepted: 09/15/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prostate cancer is a clinically and molecularly heterogeneous disease, with highest incidence and mortality among men of African ancestry. To date, prostate cancer patient-derived xenograft (PCPDX) models to study this disease have been difficult to establish because of limited specimen availability and poor uptake rates in immunodeficient mice. Ancestrally diverse PCPDXs are even more rare, and only six PCPDXs from self-identified African American patients from one institution were recently made available. METHODS In the present study, we established a PCPDX from prostate cancer tissue from a patient of estimated 90% West African ancestry with metastatic castration resistant disease, and characterized this model's pathology, karyotype, hotspot mutations, copy number, gene fusions, gene expression, growth rate in normal and castrated mice, therapeutic response, and experimental metastasis. RESULTS This PCPDX has a mutation in TP53 and loss of PTEN and RB1. We have documented a 100% take rate in mice after thawing the PCPDX tumor from frozen stock. The PCPDX is castrate- and docetaxel-resistant and cisplatin-sensitive, and has gene expression patterns associated with such drug responses. After tail vein injection, the PCPDX tumor cells can colonize the lungs of mice. CONCLUSION This PCPDX, along with others that are established and characterized, will be useful pre-clinically for studying the heterogeneity of prostate cancer biology and testing new therapeutics in models expected to be reflective of the clinical setting.
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Affiliation(s)
- Brendon M Patierno
- Department of Medicine, Division of Medical Oncology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Wen-Chi Foo
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA
- Department of Pathology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Tyler Allen
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Jason A Somarelli
- Department of Medicine, Division of Medical Oncology, Duke University School of Medicine, Durham, NC, 27710, USA
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Kathryn E Ware
- Department of Medicine, Division of Medical Oncology, Duke University School of Medicine, Durham, NC, 27710, USA
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Santosh Gupta
- Department of Medicine, Division of Medical Oncology, Duke University School of Medicine, Durham, NC, 27710, USA
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Sandra Wise
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| | - John P Wise
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| | - Xiaodi Qin
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Dadong Zhang
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Lingfan Xu
- Department of Pathology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Yanjing Li
- Department of Pathology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Xufeng Chen
- Department of Pathology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Brant A Inman
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA
- Department of Surgery, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Shannon J McCall
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA
- Department of Pathology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Jiaoti Huang
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA
- Department of Pathology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Rick A Kittles
- Division of Health Equities, Department of Population Sciences, City of Hope, Duarte, 91010, CA, USA
| | - Kouros Owzar
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Simon Gregory
- Department of Medicine, Division of Medical Oncology, Duke University School of Medicine, Durham, NC, 27710, USA
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA
- Center for Genomics and Computational Biology, Duke University, Durham, NC, 27710, USA
| | - Andrew J Armstrong
- Department of Medicine, Division of Medical Oncology, Duke University School of Medicine, Durham, NC, 27710, USA
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA
- Department of Surgery, Duke University School of Medicine, Durham, NC, 27710, USA
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC, USA
| | - Daniel J George
- Department of Medicine, Division of Medical Oncology, Duke University School of Medicine, Durham, NC, 27710, USA
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA
- Department of Surgery, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Steven R Patierno
- Department of Medicine, Division of Medical Oncology, Duke University School of Medicine, Durham, NC, 27710, USA
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA
| | - David S Hsu
- Department of Medicine, Division of Medical Oncology, Duke University School of Medicine, Durham, NC, 27710, USA
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA
- Center for Genomics and Computational Biology, Duke University, Durham, NC, 27710, USA
| | - Jennifer A Freedman
- Department of Medicine, Division of Medical Oncology, Duke University School of Medicine, Durham, NC, 27710, USA.
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA.
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Survival times of patients with glioblastoma in low- and middle-income countries: a systematic review and meta-analysis. Neurosurg Rev 2022; 45:3393-3403. [PMID: 36044130 DOI: 10.1007/s10143-022-01844-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/25/2022] [Accepted: 08/08/2022] [Indexed: 10/14/2022]
Abstract
Little is known about the survivorship of glioblastoma (GBM) patients in low- and middle-income countries (LMICs). We hypothesize that this would be lower than published figures for high-income countries due to cancer health disparities. We performed a systematic review and meta-analysis to estimate the median overall survival (OS) of GBM in LMICs and determine factors affecting OS. A systematic review of 12 electronic databases was conducted according to PRISMA guidelines to identify studies of newly diagnosed adult GBM patients done in countries classified as LMIC by the World Bank (WB) from inception to December 2020. Random effects meta-analysis of collected median overall survival data was done. Subgroup analysis and meta-regression were done to determine if WB income classification (WBIC), start year of recruitment (pre- or post-popularization of the standard Stupp protocol), and treatment modality affected OS. The 24 articles (n = 2,552) that met the inclusion criteria were from 8 low-middle income and upper-middle income countries, with 0 articles from low-income countries. Random effects analysis of 24 studies showed a pooled median OS of 14.17 months (95% CI 12.90-15.43, I2 = 79). Subgroup analysis showed a significant difference (p < 0.05) in the pooled median OS of studies predating Stupp protocol (12.54 mo, 95% CI 11.13-13.96, I2 = 80%; n = 1027) and studies postdating Stupp protocol (15.64 mo, 95% CI 13.58-17.69, I2 = 77; n = 1412). Subgroup analysis of WBIC and treatment modalities did not show significant differences. Published data on the survivorship of GBM patients in LMICs is sparse, highlighting the need for good quality pragmatic studies from LMICs. The limited evidence suggests improving survivorship after introduction of the Stupp protocol.
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Gilliam CA, Lindo EG, Cannon S, Kennedy L, Jewell TE, Tieder JS. Use of Race in Pediatric Clinical Practice Guidelines: A Systematic Review. JAMA Pediatr 2022; 176:804-810. [PMID: 35666494 DOI: 10.1001/jamapediatrics.2022.1641] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE National clinical practice guidelines (CPGs) guide medical practice. The use of race in CPGs has the potential to positively or negatively affect structural racism and health inequities. OBJECTIVE To review the use of race in published pediatric CPGs. EVIDENCE REVIEW A literature search of PubMed, Medscape, Emergency Care Research Institute Guidelines Trust, and MetaLib.gov was performed for English-language clinical guidelines addressing patients younger than 19 years of age from January 1, 2016, to April 30, 2021. The study team systematically identified and evaluated all articles that used race and ethnicity terms and then used a critical race theory framework to classify each use according to the potential to either positively or negatively affect structural racism and racial inequities in health care. FINDINGS Of 414 identified pediatric clinical practice guidelines, 126 (30%) met criteria for full review because of the use of race or ethnicity terms and 288 (70%) did not use race or ethnicity terms. The use of a race term occurred 175 times in either background, clinical recommendations, or future directions. A use of race with a potential negative effect occurred 87 times (49.7%) across 73 CPGs and a positive effect 50 times (28.6%) across 45 CPGs. CONCLUSIONS AND RELEVANCE In this systematic review of US-based pediatric CPGs, race was frequently used in ways that could negatively affect health care inequities. Many opportunities exist for national medical organizations to improve the use of race in CPGs to positively affect health care, particularly for racial and ethnic minoritized communities.
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Affiliation(s)
- Courtney A Gilliam
- Division of Hospital Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle
| | - Edwin G Lindo
- Department of Family Medicine, University of Washington School of Medicine, Seattle
| | - Shannon Cannon
- Division of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine & Public Health, Madison
| | | | | | - Joel S Tieder
- Division of Hospital Medicine, Department of Pediatrics, Seattle Children's and the University of Washington School of Medicine, Seattle
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11
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Ahmad S, Ashktorab H, Brim H, Housseau F. Inflammation, microbiome and colorectal cancer disparity in African-Americans: Are there bugs in the genetics? World J Gastroenterol 2022; 28:2782-2801. [PMID: 35978869 PMCID: PMC9280725 DOI: 10.3748/wjg.v28.i25.2782] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/27/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
Dysregulated interactions between host inflammation and gut microbiota over the course of life increase the risk of colorectal cancer (CRC). While environmental factors and socio-economic realities of race remain predominant contributors to CRC disparities in African-Americans (AAs), this review focuses on the biological mediators of CRC disparity, namely the under-appreciated influence of inherited ancestral genetic regulation on mucosal innate immunity and its interaction with the microbiome. There remains a poor understanding of mechanisms linking immune-related genetic polymorphisms and microbiome diversity that could influence chronic inflammation and exacerbate CRC disparities in AAs. A better understanding of the relationship between host genetics, bacteria, and CRC pathogenesis will improve the prediction of cancer risk across race/ethnicity groups overall.
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Affiliation(s)
- Sami Ahmad
- Department of Oncology, Johns Hopkins University, Baltimore, MD 21231, United States
| | - Hassan Ashktorab
- Department of Medicine, Howard University, Washington, DC 20060, United States
| | - Hassan Brim
- Department of Pathology, Howard University, Washington, DC 20060, United States
| | - Franck Housseau
- Department of Oncology, Johns Hopkins University, Baltimore, MD 21231, United States
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12
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Rose J, Dong W, Kim U, Hnath J, Statler A, Saroufim P, Song S, Ascha M, Menegay H, Tian Y, Beno M, Koroukian SM. An informatics infrastructure to catalyze cancer control research and practice. Cancer Causes Control 2022; 33:899-911. [PMID: 35380304 PMCID: PMC10865999 DOI: 10.1007/s10552-022-01571-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE A disconnect often exists between those with the expertise to manage and analyze complex, multi-source data sets, and the clinical, social services, advocacy, and public health professionals who can pose the most relevant questions and best apply the answers. We describe development and implementation of a cancer informatics infrastructure aimed at broadening the usability of community cancer data to inform cancer control research and practice; and we share lessons learned. METHODS We built a multi-level database known as The Ohio Cancer Assessment and Surveillance Engine (OH-CASE) to link data from Ohio's cancer registry with community data from the U.S. Census and other sources. Space-and place-based characteristics were assigned to individuals according to residential address. Stakeholder input informed development of an interface for generating queries based on geographic, demographic, and disease inputs and for outputting results aggregated at the state, county, municipality, or zip code levels. RESULTS OH-CASE contains data on 791,786 cancer cases diagnosed from 1/1/2006 to 12/31/2018 across 88 Ohio counties containing 1215 municipalities and 1197 zip codes. Stakeholder feedback from cancer center community outreach teams, advocacy organizations, public health, and researchers suggests a broad range of uses of such multi-level data resources accessible via a user interface. CONCLUSION OH-CASE represents a prototype of a transportable model for curating and synthesizing data to understand cancer burden across communities. Beyond supporting collaborative research, this infrastructure can serve the clinical, social services, public health, and advocacy communities by enabling targeting of outreach, funding, and interventions to narrow cancer disparities.
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Affiliation(s)
- Johnie Rose
- Case Western Reserve University Center for Community Health Integration, 11000 Cedar Ave., Ste. 402, Cleveland, OH, 44106-7136, USA.
- Case Comprehensive Cancer Center, Cleveland, OH, USA.
| | - Weichuan Dong
- Case Comprehensive Cancer Center, Cleveland, OH, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Uriel Kim
- Case Western Reserve University Center for Community Health Integration, 11000 Cedar Ave., Ste. 402, Cleveland, OH, 44106-7136, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Joseph Hnath
- Case Western Reserve University Center for Community Health Integration, 11000 Cedar Ave., Ste. 402, Cleveland, OH, 44106-7136, USA
| | - Abby Statler
- Case Comprehensive Cancer Center, Cleveland, OH, USA
- Taussig Cancer Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Paola Saroufim
- Cleveland Institute for Computational Biology, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sunah Song
- Cleveland Institute for Computational Biology, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Mustafa Ascha
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
- Cleveland Institute for Computational Biology, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Harry Menegay
- Cleveland Institute for Computational Biology, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Ye Tian
- Cleveland Institute for Computational Biology, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Mark Beno
- Cleveland Institute for Computational Biology, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Siran M Koroukian
- Case Comprehensive Cancer Center, Cleveland, OH, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
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13
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Rahmaddiansyah R, Hasani S, Zikrah AA, Arisanty D. The Effect of Gambier Catechin Isolate on Cervical Cancer Cell Death (HeLa Cell Lines). Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Cervical cancer is the second most common type of cancer in women worldwide. Human Papilloma Virus infection on the surface of the cervix is the most common cause which can cause abnormal growth of cervical cells.
AIM: This research was conducted in vitro which aims to determine whether catechin compounds can inhibit the growth and regulation of cervical cancer cells (HeLa cell line).
METHODS: This is experimental research using the colourimetric assay method and qualitative observation of cervical cancer cell morphology (HeLa cell line) under a fluorescence microscope. The administration of catechin compounds was tested at different concentrations to HeLa cells, namely 1000 g/ml, 500 g/ml, 250 g/ml, 125 g/ml, 62.5 g/ml, 31.25 g/ml.
RESULTS: The smallest cell viability was obtained from a concentration of 1000 g/ml which was 5.98% while the largest cell viability was found at a concentration of 31.25 g/ml, which was 40.01%. The resulting IC50 value was 22.91 g/ml. Gambier catechin compounds have very high antioxidants because they contain an IC50 value < 50 g/ml. The effect of gambier catechin compounds on HeLa cell death can be found by increasing the percentage of dead cells. The difference in the fluorescence images of HeLa cells in the experimental group was assessed based on the percentage of the number of cells that died or underwent apoptosis, which was marked by a red or orange fluorescent image. At the concentration of IC25, 31.87% of dead cells were found, the concentration of IC50 was 51.09% of dead cells, and the concentration of IC75 was 82.51% of dead cells. The test results showed that there was a significant difference in the average percentage of cells undergoing apoptosis in all study groups with p <0.05.
CONCLUSION: Based on research, it can be concluded that catechin compounds could inhibit the growth and regulation of cervical cancer cells (HeLa cell line). Later, it has the potential to be developed as an anticancer candidate for cervical cancer.
Keyword: Cervical cancer, Catechin, Apoptosis, HeLa cell line, Cell death.
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14
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Giri VN, Hartman R, Pritzlaff M, Horton C, Keith SW. Germline Variant Spectrum Among African American Men Undergoing Prostate Cancer Germline Testing: Need for Equity in Genetic Testing. JCO Precis Oncol 2022; 6:e2200234. [PMID: 35666082 PMCID: PMC9200399 DOI: 10.1200/po.22.00234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 04/28/2022] [Accepted: 05/03/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Guidelines for prostate cancer (PCA) germline testing (GT) have expanded, with impact on clinical management and hereditary cancer assessment. African American (AA) men have lower engagement in GT, with concern for widening disparities in genetically informed care. We evaluated the germline spectrum in a cohort of men with PCA enriched for AA men who underwent GT to inform tailored genetic evaluation strategies. METHODS Participants included AA and White men with PCA tested with a 14-gene PCA panel: ATM, BRCA1, BRCA2, CHEK2, EPCAM, HOXB13, MLH1, MSH2, MSH6, NBN, PALB2, PMS2, RAD51D, and TP53. Germline analysis was performed per standard clinical testing and variant classification protocols. Data were compared with Fisher's exact, chi-squared, or two sample t-tests, as appropriate. Multivariable analysis was conducted using Akaike's Information Criterion. The significance level was set a priori at .05. RESULTS The data set included 427 men all tested using the 14-gene PCA panel: AA (n = 237, 56%) and White (n = 190, 44%). Overall, the pathogenic/likely pathogenic (P/LP) variant rate was 8.2%, with AA men having lower rates of P/LP variants then White men (5.91% v 11.05%, respectively; P = .05). Borderline associations with P/LP variant status were observed by race (AA v White; odds ratio = 0.51; P = .07) and age (> 50 v ≤ 50 years; odds ratio = 0.48; P = .06). The P/LP spectrum was narrower in AA men (BRCA2, PALB2, ATM, and BRCA1) than White men (BRCA2, ATM, HOXB13, CHEK2, TP53, and NBN). A significant difference was noted in rates of variants of uncertain significance (VUSs) between AA men and White men overall (25.32% v 16.32%; P = .02) and for carrying multiple VUSs (5.1% v 0.53%, P = .008). CONCLUSION Germline evaluation in a cohort enriched for AA men highlights the narrower spectrum of germline contribution to PCA with significantly higher rates of multiple VUSs in DNA repair genes. These results underscore the imperative to engage AA men in GT, the need for larger panel testing in AA men, and the necessity to incorporate novel genomic technologies to clarify VUS to discern the germline contribution to PCA. Furthermore, tailored genetic counseling for AA men is important to ensure understanding of VUS and promote equitable genetics care delivery.
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Affiliation(s)
- Veda N. Giri
- Departments of Medical Oncology, Cancer Biology, and Urology, Cancer Risk Assessment and Clinical Cancer Genetics, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Rebecca Hartman
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
| | | | | | - Scott W. Keith
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
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15
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The Survival Relationship between Preoperative Inflammation Markers and Patients with Special Pathological Types of Gastric Cancer. Can J Gastroenterol Hepatol 2022; 2022:5715898. [PMID: 35340978 PMCID: PMC8956443 DOI: 10.1155/2022/5715898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/25/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The preoperative PLR is closely associated with prognosis of gastric cancer. This aims to research whether the PLR could predict overall survival (OS) of gastric cancer (GC) patients with SRC component. METHODS The data were collected from Harbin Medical University Cancer Hospital between January 2001 and December 2013 in China. The patients were diagnosed with GC by pathologic examination, which contained SRC component in pathological organization. PLR is obtained from peripheral blood markers (platelets/lymphocytes). RESULTS There is a difference in OS between high PLR group and low group, which is verified by Kaplan-Meier analysis and log-rank tests (P < 0.001). Moreover, multivariate analysis prove PLR was independent prognostic factor for GC (HR = 1.384, 95% (CI): 1.048-1.828; P = 0.022). The preoperative PLR in stage I + II (P = 0.033), stage III (P < 0.001), SRC component lower than 50% (P < 0.001), SRC component equal to or higher than 50% (P = 0.044), and R0 resection (P < 0.001) GC are still effective. CONCLUSION PLR is a simple, useful, and repeatable predictor of OS in gastric cancer of stages I-III with SRC component and may help clinicians identify patients with high risk and develop a more reasonable follow-up plan.
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Abstract
ABSTRACT Cancer health disparities have been well documented among different populations in the United States for decades. While the cause of these disparities is multifactorial, the COVID-19 pandemic has highlighted the structural barriers to health and health care and the gaps in public health infrastructure within the United States. The most long-standing inequities are rooted in discriminatory practices, current and historical, which have excluded and disenfranchised many of the most vulnerable populations in the nation. These systemic barriers are themselves a public health crisis, resulting in increased mortality rates in communities of color from both COVID-19 and cancer. While implementing programs to temporarily improve cancer equity locally or regionally is laudable, it is imperative to develop a public health strategy focused on alleviating the root causes of health inequities to improve the health and well-being of every citizen and ensure readiness for the next public health emergency.
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17
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Hong MAC, Omar AT, Khu KJO. Socioeconomic factors affecting survivorship of glioblastoma patients in the Philippines. J Clin Neurosci 2022; 98:89-95. [PMID: 35151062 DOI: 10.1016/j.jocn.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 10/19/2022]
Abstract
Glioblastoma (GBM) is the most common malignant primary brain tumor in adults worldwide. However, data on the survivorship of GBM patients in low- and middle-income countries is sparse. We determined whether socioeconomic factors such as marital status, place of residence, educational attainment, employment status, and income affected survival. A retrospective cohort study of surgically managed GBM patients (n = 48) in a single center over a five-year period was conducted using chart review and telephone interview. The mean age was 41 years, with a male predilection (62%). Most patients were married (73%), employed full time (79%), resided in a rural location (56%), completed secondary education (44%), and had a low income (83%). Most of the tumors were > 5 cm at the time of diagnosis (90%) and involved more than one lobe (40%). Majority underwent subtotal resection (56%). Only 15% (n = 7) had adjuvant chemoradiation while 23% (n = 11) had radiotherapy alone. Median overall survival was 7.6 months. Multivariate analysis showed that extent of resection (gross total resection, p = 0.0033; subtotal resection, p = 0.0069) and adjuvant treatment (p = 0.0254) were associated with improved survival, while low income (p = 0.0178) and educational (p = 0.0206) levels and part-time employment (p = 0.0063) were associated with decreased survival. Many GBM patients at our center presented at an advanced stage in their natural history, and majority (62%) did not receive adjuvant treatment after surgery. As such, the median overall survival was less than that reported in developed countries. Of the socioeconomic factors analyzed, low income and educational levels and part-time employment were negatively associated with survivorship.
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Affiliation(s)
- Manilyn Ann C Hong
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines
| | - Abdelsimar T Omar
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines.
| | - Kathleen Joy O Khu
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines.
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18
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Thomson MD, Williams AR, Sutton AL, Tossas KY, Garrett C, Sheppard VB. Engaging rural communities in cancer prevention and control research: Development and preliminary insights from a community-based research registry. Cancer Med 2021; 10:7726-7734. [PMID: 34647436 PMCID: PMC8559516 DOI: 10.1002/cam4.4199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/02/2021] [Accepted: 07/30/2021] [Indexed: 01/03/2023] Open
Abstract
Objective To report on the development and preliminary findings of a community‐based cancer registry, including the community‐engaged approach to recruitment, participant profile, and distribution of cancer risk factors by race/ethnicity and geography. Methods Community outreach and engagement best practices were used to recruit a diverse convenience sample of Virginia residents (≥18 years) that oversampled residents living in rural areas, defined as Rural‐Urban Continuum Codes (RUCC) 4–9 and African American (AA)/Black residents. Multiple survey administration methods included electronic (e‐survey) and in‐person survey by community‐based staff. Results At the time of this analysis, 595 participants are enrolled; 73% are rural, 46% are AA/Black. AA/Black participants reported similar education but lower income (p < 0.01) and health literacy (p < 0.01), lower alcohol use (p < 0.001), fewer sedentary behaviors (p = 0.01), but greater BMI (p < 0.05) compared to White participants. Rural residents reported significantly lower household income (p < 0.001) and greater use of Medicaid (p = 0.01) compared to urban participants. Biennial mammography was reported by 82% of women aged 45–74 years old and colonoscopy by 77% of participants ≥50 years old. Tobacco use was reported by 17%; no differences in cancer screening or tobacco use were identified by geography or by race. Conclusion and relevance Community engagement strategies successfully enrolled diverse residents within the cancer service area. AA/Black participants reported fewer cancer risk behaviors, similar educational attainment but lower income and health literacy compared to White respondents. Nuanced examinations of interactions among multilevel factors are needed to understand how individual, community, and institutional factors converge to maintain cancer disparities among AA/Black Virginians. Additional findings indicate a need for tobacco cessation, lung cancer screening, obesity treatment, and prevention initiatives.
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Affiliation(s)
- Maria D Thomson
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,Office of Community Outreach and Engagement, Massey Cancer Center, Richmond, Virginia, USA
| | | | | | - Katherine Y Tossas
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,Office of Community Outreach and Engagement, Massey Cancer Center, Richmond, Virginia, USA
| | - Charlotte Garrett
- Office of Community Outreach and Engagement, Massey Cancer Center, Richmond, Virginia, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,Office of Community Outreach and Engagement, Massey Cancer Center, Richmond, Virginia, USA
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19
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Leader AE, Aplin AE. From the Community to the Bench and Back Again: The Value of Patient and Community Engagement in Cancer Research. Cancer Discov 2021; 11:2135-2138. [PMID: 34479970 DOI: 10.1158/2159-8290.cd-21-0693] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Currently, patients and community members have more frequent interaction with clinical and population scientists than basic scientists, leading to gaps in their engagement across the cancer research continuum. Engaging patients and community members in all types of cancer research can bring personal experiences and societal factors to the forefront, informing scientists about these concerns and leading to research that is more responsive to patient and community needs. Engaging patients with cancer and community members as partners in research helps ensure that the scientific evidence generated is useful to patients and-more importantly-trusted by patients. This bidirectional engagement between patients/community members and research investigators fosters a collaborative and ethical foundation for scientific discovery. Although community-engaged research has been in existence for decades, more recent attention by national organizations to embed patients with cancer and community members into the research process has accelerated the importance of these efforts. Here, we describe the importance of patient and community engagement (PCE) in cancer research. We outline key principles in undertaking PCE in cancer research, provide a framework for PCE throughout the cancer research continuum, review metrics for evaluating the effectiveness of PCE in cancer research, and share opportunities for PCE in cancer research going forward.
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Affiliation(s)
- Amy E Leader
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania.
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Andrew E Aplin
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Cancer Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
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20
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Hines RB, Johnson AM, Lee E, Erickson S, Rahman SMM. Trends in Breast Cancer Survival by Race-Ethnicity in Florida, 1990-2015. Cancer Epidemiol Biomarkers Prev 2021; 30:1408-1415. [PMID: 34210675 DOI: 10.1158/1055-9965.epi-20-1746] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/16/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study was conducted to evaluate trends in survival, by race-ethnicity, for women diagnosed with breast cancer in Florida over a 26-year period. METHODS This was a retrospective cohort study of women diagnosed with invasive breast cancer in Florida between 1990 and 2015. Data were obtained from the Florida Cancer Data System. Women in the study were categorized according to race (white/black) and Hispanic ethnicity (yes/no). Cumulative incidence estimates of 5- and 10-year breast cancer-related death with 95% confidence intervals (CI) were obtained by race-ethnicity, according to diagnosis year. Subdistribution hazard models were used to obtain subdistribution HRs (sHR) for the relative rate of breast cancer death accounting for competing causes. RESULTS Breast cancer mortality decreased for all racial-ethnic groups, and racial-ethnic minorities had greater absolute and relative improvement for nearly all metrics compared with non-Hispanic white (NHW) women. However, for the most recent time period (2010-2015), black women still experienced significant survival disparities with non-Hispanic black (NHB) women, having twice the rate of 5-year [sHR = 2.04; 95% confidence interval (CI), 1.91-2.19] and 10-year (sHR = 2.02; 95% CI, 1.89-2.16) breast cancer-related death. Adjustment for covariates substantially reduced the excess rate of breast cancer-related death for black women. CONCLUSIONS Despite efforts to improve disparities in breast cancer outcomes for underserved women in Florida, black women continue to experience significant survival disparities. IMPACT These results highlight the need for targeted approaches to eliminate disparities in breast cancer survival for black women.
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Affiliation(s)
- Robert B Hines
- University of Central Florida College of Medicine, Orlando, Florida.
| | - Asal M Johnson
- Stetson University, Public Health Program, Deland, Florida
| | - Eunkyung Lee
- University of Central Florida College of Health Professions and Sciences, Orlando, Florida
| | | | - Saleh M M Rahman
- University of Central Florida College of Medicine, Orlando, Florida
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21
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Aristizabal P, Winestone LE, Umaretiya P, Bona K. Disparities in Pediatric Oncology: The 21st Century Opportunity to Improve Outcomes for Children and Adolescents With Cancer. Am Soc Clin Oncol Educ Book 2021; 41:e315-e326. [PMID: 34061564 PMCID: PMC9126642 DOI: 10.1200/edbk_320499] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Adult cancer disparities have been documented for decades and continue to persist despite clinical advancements in cancer prevention, detection, and treatment. Pediatric cancer survival has improved significantly in the United States for the past 5 decades to over 80%; however, disparate outcomes among children and adolescents with cancer still affect many populations in the United States and globally, including racial and ethnic minorities, populations with low socioeconomic status, and residents of underserved areas. To achieve equitable outcomes for all children and adolescents with cancer, it is imperative that concerted multilevel approaches be carried out to understand and address health disparities and to ensure access to high-quality cancer care. Addressing social determinants of health, such as removing barriers to health care access and ensuring access to social supports, can reduce pediatric cancer disparities. Nevertheless, public health policy, health system interventions, and innovative delivery of evidence-based services are critically needed. Partnerships among patients, caregivers, and health care providers, and among health care, academic, and governmental institutions, have a pivotal role in reducing cancer disparities and improving outcomes in the 21st century.
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Affiliation(s)
- Paula Aristizabal
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California San Diego/Peckham Center for Cancer and Blood Disorders, Rady Children’s Hospital San Diego, San Diego, CA
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla, CA
| | - Lena E. Winestone
- Department of Pediatrics, Division of Allergy, Immunology, and Blood & Marrow Transplantation, University of California San Francisco Benioff Children’s Hospitals, San Francisco, CA
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Puja Umaretiya
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kira Bona
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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22
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Somayaji D, Melendez M, Kwon M, Lathan C. Access to Cancer Care Resources in a Federally Qualified Health Center: a Mixed Methods Study to Increase the Understanding of Met and Unmet Needs of Cancer Survivors. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:591-602. [PMID: 31828550 DOI: 10.1007/s13187-019-01669-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Assessing the met and unmet needs of cancer survivors is critical in optimizing access to cancer services especially in underserved populations. The purpose of this study is to expand our understanding of the priority needs for cancer survivorship within racial/ethnic and underserved populations that speak either English or Spanish and seek health care in a federally qualified health center (FQHC). A convergent mixed methods design integrating survey and focus group data was utilized for this study. A total of 17 participants were enrolled in the study. The meta-inferences were drawn by looking across the top ten matched survey and focus group met and unmet needs including psychological, informational, and health system as well as patient care and support. The preferred languages of participants were Spanish 53% (n = 9) and English 47% (n = 8), and the survival breakdown was 65% (n = 11) within 0-5 years with 17.5% (n = 3), 6-10 years and 17.5% (n = 3), and 17.5% (n = 3) > 11 years. The most frequently met needs included health care providers and hospital staff being attentive to their physical and emotional needs and feeling they were treated with respect. Unmet needs were often related to physical and daily living needs such as pain, fatigue, sadness, depression, and not being able to work. Providing a needs-based approach of cancer health services in a FQHC or similar community-based health center is critical to meet the needs of cancer survivors to improve health outcomes and quality of life.
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Affiliation(s)
- Darryl Somayaji
- School of Nursing, University at Buffalo, 3435 Main St, Wende Hall 201C, Buffalo, NY, 14214, USA.
| | | | - Misol Kwon
- School of Nursing, University at Buffalo, 3435 Main St, Wende Hall 201C, Buffalo, NY, 14214, USA
| | - Christopher Lathan
- Dana Farber/Harvard Cancer Center Medicine Department, Harvard Medical School, 450 Brookline Ave, Boston, MA, 02215, USA
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Doykos PM, Chen MS, Watson K, Henderson V, Baskin ML, Downer S, Smith LA, Bhavaraju N, Dina S, Lathan CS. Special Convening and Listening Session on Health Equity and Community Outreach and Engagement at National Cancer Institute-Designated Comprehensive Cancer Centers. Health Equity 2021; 5:84-90. [PMID: 33681694 PMCID: PMC7929917 DOI: 10.1089/heq.2020.0155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 01/11/2023] Open
Abstract
In recent years, the cancer research and care community has been more attuned to health equity, increasingly pursuing coordinated and comprehensive action to achieve equitable health outcomes. In addition to its support of a joint research agenda for health disparities in 2017, the National Cancer Institute (NCI) has demonstrated its commitment to addressing health inequities with its 2012 requirement for cancer centers to define and address the needs of a local "catchment area" and the 2016 mandate for Community Outreach and Engagement (COE). With several years of experience with the COE requirements, there is an opportunity to reflect on the experience to-date and identify opportunities to bolster the impact of COE on equitable cancer outcomes for the future. To do so, the Bristol Myers Squibb Foundation (BMSF) hosted a special convening and listening session in April 2019. The session agenda was cocreated by BMSF and NCI leaders and staff. It brought together 41 individuals, including representatives from the NCI Cancer Centers Program, Division of Cancer Control and Population Health and Center to Reduce Cancer Health Disparities, 22 NCI-designated, emerging or affiliated comprehensive cancer centers, and the broader cancer community. This article captures key themes from that meeting, including an overview of current COE efforts, with a deeper look at how four cancer centers are embedding health equity and COE efforts into their institutions and work, and the successes and challenges they have encountered.
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Affiliation(s)
| | - Moon S Chen
- UC Davis Comprehensive Cancer Center, Sacramento, California, USA
| | - Karriem Watson
- University of Illinois Cancer Center, Chicago, Illinois, USA
| | - Vida Henderson
- University of Illinois Cancer Center, Chicago, Illinois, USA
| | - Monica L Baskin
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sarah Downer
- The Center for Health Law and Policy Innovation, Harvard Law School, Cambridge, Massachusetts, USA
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Doykos PM, Chen MS, Watson K, Henderson V, Baskin ML, Downer S, Smith LA, Bhavaraju N, Dina S, Lathan CS. Recommendations from a Dialogue on Evolving National Cancer Institute-Designated Comprehensive Cancer Center Community Outreach and Engagement Requirements: A Path Forward. Health Equity 2021; 5:76-83. [PMID: 33681693 PMCID: PMC7929918 DOI: 10.1089/heq.2020.0156] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 12/30/2022] Open
Abstract
While cancer mortality is declining in the United States, significant racial, ethnic, economic and geographic inequities persist. To help address inequities in cancer treatment, care, support and research, the National Cancer Institute (NCI) instituted the community outreach and engagement (COE) mandate for NCI-designated comprehensive cancer centers (CCCs). The Bristol Myers Squibb Foundation designed a convening and listening session on COE with NCI leaders and staff gathering representatives from CCCs and the broader cancer community. This paper captures recommendations from the listening session for the NCI and CCCs to further evolve the implementation and impact of the COE mandate on cancer control and outcomes.
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Affiliation(s)
| | - Moon S Chen
- UC Davis Comprehensive Cancer Center, Sacramento, California, USA
| | - Karriem Watson
- University of Illinois Cancer Center, Chicago, Illinois, USA
| | - Vida Henderson
- University of Illinois Cancer Center, Chicago, Illinois, USA
| | - Monica L Baskin
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sarah Downer
- The Center for Health Law and Policy Innovation, Harvard Law School, Cambridge, Massachusetts, USA
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25
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Al Abo M, Hyslop T, Qin X, Owzar K, George DJ, Patierno SR, Freedman JA. Differential alternative RNA splicing and transcription events between tumors from African American and White patients in The Cancer Genome Atlas. Genomics 2021; 113:1234-1246. [PMID: 33705884 DOI: 10.1016/j.ygeno.2021.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/15/2021] [Accepted: 02/01/2021] [Indexed: 11/26/2022]
Abstract
Individuals of African ancestry suffer disproportionally from higher incidence, aggressiveness, and mortality for particular cancers. This disparity likely results from an interplay among differences in multiple determinants of health, including differences in tumor biology. We used The Cancer Genome Atlas (TCGA) SpliceSeq and TCGA aggregate expression datasets and identified differential alternative RNA splicing and transcription events (ARS/T) in cancers between self-identified African American (AA) and White (W) patients. We found that retained intron events were enriched among race-related ARS/T. In addition, on average, 12% of the most highly ranked race-related ARS/T overlapped between any two analyzed cancers. Moreover, the genes undergoing race-related ARS/T functioned in cancer-promoting pathways, and a number of race-related ARS/T were associated with patient survival. We built a web-application, CanSplice, to mine genomic datasets by self-identified race. The race-related targets have the potential to aid in the development of new biomarkers and therapeutics to mitigate cancer disparity.
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Affiliation(s)
- Muthana Al Abo
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Terry Hyslop
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Xiaodi Qin
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Kouros Owzar
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Daniel J George
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA; Department of Medicine, Division of Medical Oncology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Steven R Patierno
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA; Department of Medicine, Division of Medical Oncology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Jennifer A Freedman
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA; Department of Medicine, Division of Medical Oncology, Duke University School of Medicine, Durham, NC, 27710, USA.
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26
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Zavala VA, Bracci PM, Carethers JM, Carvajal-Carmona L, Coggins NB, Cruz-Correa MR, Davis M, de Smith AJ, Dutil J, Figueiredo JC, Fox R, Graves KD, Gomez SL, Llera A, Neuhausen SL, Newman L, Nguyen T, Palmer JR, Palmer NR, Pérez-Stable EJ, Piawah S, Rodriquez EJ, Sanabria-Salas MC, Schmit SL, Serrano-Gomez SJ, Stern MC, Weitzel J, Yang JJ, Zabaleta J, Ziv E, Fejerman L. Cancer health disparities in racial/ethnic minorities in the United States. Br J Cancer 2021; 124:315-332. [PMID: 32901135 PMCID: PMC7852513 DOI: 10.1038/s41416-020-01038-6] [Citation(s) in RCA: 482] [Impact Index Per Article: 160.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 07/16/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023] Open
Abstract
There are well-established disparities in cancer incidence and outcomes by race/ethnicity that result from the interplay between structural, socioeconomic, socio-environmental, behavioural and biological factors. However, large research studies designed to investigate factors contributing to cancer aetiology and progression have mainly focused on populations of European origin. The limitations in clinicopathological and genetic data, as well as the reduced availability of biospecimens from diverse populations, contribute to the knowledge gap and have the potential to widen cancer health disparities. In this review, we summarise reported disparities and associated factors in the United States of America (USA) for the most common cancers (breast, prostate, lung and colon), and for a subset of other cancers that highlight the complexity of disparities (gastric, liver, pancreas and leukaemia). We focus on populations commonly identified and referred to as racial/ethnic minorities in the USA-African Americans/Blacks, American Indians and Alaska Natives, Asians, Native Hawaiians/other Pacific Islanders and Hispanics/Latinos. We conclude that even though substantial progress has been made in understanding the factors underlying cancer health disparities, marked inequities persist. Additional efforts are needed to include participants from diverse populations in the research of cancer aetiology, biology and treatment. Furthermore, to eliminate cancer health disparities, it will be necessary to facilitate access to, and utilisation of, health services to all individuals, and to address structural inequities, including racism, that disproportionally affect racial/ethnic minorities in the USA.
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Affiliation(s)
- Valentina A Zavala
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Paige M Bracci
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - John M Carethers
- Departments of Internal Medicine and Human Genetics, and Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Luis Carvajal-Carmona
- University of California Davis Comprehensive Cancer Center and Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Sacramento, CA, USA
- Genome Center, University of California Davis, Davis, CA, USA
| | | | - Marcia R Cruz-Correa
- Department of Cancer Biology, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Melissa Davis
- Division of Breast Surgery, Department of Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - Adam J de Smith
- Center for Genetic Epidemiology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Julie Dutil
- Cancer Biology Division, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Jane C Figueiredo
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Rena Fox
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kristi D Graves
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Andrea Llera
- Laboratorio de Terapia Molecular y Celular, IIBBA, Fundación Instituto Leloir, CONICET, Buenos Aires, Argentina
| | - Susan L Neuhausen
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Lisa Newman
- Division of Breast Surgery, Department of Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
- Interdisciplinary Breast Program, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - Tung Nguyen
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Nynikka R Palmer
- Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Sorbarikor Piawah
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Erik J Rodriquez
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Stephanie L Schmit
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Silvia J Serrano-Gomez
- Grupo de investigación en biología del cáncer, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Mariana C Stern
- Departments of Preventive Medicine and Urology, Keck School of Medicine of USC, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey Weitzel
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Jun J Yang
- Department of Pharmaceutical Sciences, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jovanny Zabaleta
- Department of Pediatrics and Stanley S. Scott Cancer Center LSUHSC, New Orleans, LA, USA
| | - Elad Ziv
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Laura Fejerman
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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27
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Valera P, Acuna N, Alzate-Duque L, Liang LE, Cupertino P, Merulla J. The Development and Prototype Feedback of Digital Cancer 101 Videos to Enhance Cancer Education for Marginalized Communities With Limited Health Literacy. Cancer Control 2021; 28:10732748211006055. [PMID: 33784858 PMCID: PMC8209315 DOI: 10.1177/10732748211006055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/07/2021] [Accepted: 03/09/2021] [Indexed: 11/15/2022] Open
Abstract
Social media, in the form of digital videos targeted to people with limited health literacy, as well as disadvantaged or marginalized groups, may help reduce cancer health disparities and improve health outcomes in these populations. In this article, we document the process of adapting the content from the Cancer 101 curriculum to create animated scripts about the cancer care continuum that is clear, straightforward, and in plain language. The development of the Cancer 101 digital videos required a multidisciplinary collaboration from-public health, medicine, technology, and expertise in correctional health, smoking cessation, web development, video producers, and individuals directly impacted by cancer disparities. The Cancer 101 videos were showcased at a community health fair where the videos were viewed by attendants waiting to be seen by a medical provider. While waiting for their cancer screening, 13 individuals were selected and invited to watch all 11 videos totaling less than 60-minutes of viewing time. They included 3 Latina women, 2 Latino men, and 8 Haitian women. All participants were between the ages of 40-65 years old. Overall, participants agreed that they would recommend the videos to friends/family (M = 4.77, SD = 0.44) and that they plan to watch other video modules to learn more information about cancer (M = 4.72, SD = 0.47). Additionally, participants enjoyed the graphics and audio of the videos presented (M = 4.85, SD = 0.38). Furthermore, participants noted that Cancer 101 digital videos described cancer in plain language, leading to a better understanding of the disease. Future research is needed to implement Cancer 101 digital videos in healthcare clinics to increase cancer information and improve cancer screening rates in marginalized communities.
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Affiliation(s)
- Pamela Valera
- Rutgers School of Public Health, Department of Urban-Global Public Health, Newark, NJ, USA
- Cancer Health Justice Lab (www.chjl.org), Newark, NJ, USA
| | - Nicholas Acuna
- Cancer Health Justice Lab (www.chjl.org), Newark, NJ, USA
- Rutgers School of Public Health, Piscataway, NJ, USA
| | - Luis Alzate-Duque
- Cancer Health Justice Lab (www.chjl.org), Newark, NJ, USA
- Rutgers New Jersey Medical School, Department of Medicine, Newark, NJ, USA
| | | | - Paula Cupertino
- University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY, USA
| | - Jessica Merulla
- HypnoViD Media Productions, Inc. (http://www.hypnovid.com), NY, USA
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28
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Mama SK, Bhuiyan N, Foo W, Segel JE, Bluethmann SM, Winkels RM, Wiskemann J, Calo WA, Lengerich EJ, Schmitz KH. Rural-urban differences in meeting physical activity recommendations and health status in cancer survivors in central Pennsylvania. Support Care Cancer 2020; 28:5013-5022. [PMID: 32036469 PMCID: PMC7415488 DOI: 10.1007/s00520-020-05342-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/02/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE This study explored rural-urban differences in meeting physical activity (PA) recommendations and health status in cancer survivors in central Pennsylvania and associations between PA and health status. METHODS Cancer survivors (N = 2463) were identified through a state cancer registry and mailed questionnaires assessing PA and health status. Rural-urban residence was based on county of residence at diagnosis. Participants self-reported frequency and duration of leisure-time PA and were classified as meeting: (1) aerobic recommendations (≥ 150 min/week), (2) muscle-strengthening recommendations (≥ 2 times/week), (3) both aerobic and muscle-strengthening recommendations, or (4) neither recommendation. Logistic regression models examined associations between rural-urban residence and meeting PA recommendations and associations between PA and health status, adjusting for age, cancer type, gender, and income. RESULTS Nearly 600 (N = 591, 24.0%) cancer survivors returned completed questionnaires (rural 9.5%, urban 90.5%). Half (50.0%) of rural cancer survivors reported no leisure-time PA compared to 35.2% of urban cancer survivors (p = 0.020), and urban cancer survivors were 2.6 times more likely to meet aerobic PA recommendations (95% CI 1.1-6.4). Odds of reporting good physical and mental health were 2.3 times higher among survivors who reported meeting aerobic recommendations compared to those who did not meet PA recommendations (95% CI 1.1-4.5), adjusting for rurality and covariates. CONCLUSIONS Results demonstrate persistent rural-urban differences in meeting PA recommendations in cancer survivors and its association with self-reported health. IMPLICATIONS FOR CANCER SURVIVORS Findings underscore the need for interventions to increase PA in rural cancer survivors in an effort to improve health status and reduce cancer health disparities.
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Affiliation(s)
- Scherezade K Mama
- Department of Kinesiology, The Pennsylvania State University, 268J Recreation Building, University Park, PA, 16802, USA.
- Penn State Cancer Institute, Hershey, PA, USA.
| | - Nishat Bhuiyan
- Department of Kinesiology, The Pennsylvania State University, 268J Recreation Building, University Park, PA, 16802, USA
| | - Wayne Foo
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Joel E Segel
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, USA
| | - Shirley M Bluethmann
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Renate M Winkels
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
- Human Nutrition & Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Joachim Wiskemann
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
| | - William A Calo
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Eugene J Lengerich
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Kathryn H Schmitz
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
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29
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Schenk A, López S, Kschischo M, McGranahan N. Germline ancestry influences the evolutionary disease course in lung adenocarcinomas. Evol Appl 2020; 13:1550-1557. [PMID: 32952607 PMCID: PMC7484830 DOI: 10.1111/eva.12964] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/15/2020] [Accepted: 03/05/2020] [Indexed: 12/18/2022] Open
Abstract
Precision medicine relies on targeting specific somatic alterations present in a patient's tumor. However, the extent to which germline ancestry may influence the somatic burden of disease has received little attention. We estimated the genetic ancestry of non-small-cell lung cancer (NSCLC) patients and performed an in-depth analysis of the influence of genetic ancestry on the evolutionary disease course. Compared with European Americans (EA), African Americans (AA) with lung adenocarcinoma (LUAD) were found to be significantly younger and smoke significantly less. However, LUADs from AAs exhibited a significantly higher somatic mutation burden, with a more pronounced tobacco carcinogen footprint and increased frequencies of alterations affecting cancer genes. Conversely, no significant differences were observed between lung squamous cell carcinomas (LUSC) from EAs and AAs. Our results suggest germline ancestry influences the somatic evolution of LUAD but not LUSC.
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Affiliation(s)
- Alina Schenk
- Department of Mathematics and TechnologyUniversity of Applied Sciences KoblenzRemagenGermany
| | - Saioa López
- Cancer Genome Evolution Research GroupUniversity College London Cancer InstituteLondonUK
- Cancer Research UK Lung Cancer Centre of ExcellenceUniversity College London Cancer InstituteLondonUK
| | - Maik Kschischo
- Department of Mathematics and TechnologyUniversity of Applied Sciences KoblenzRemagenGermany
| | - Nicholas McGranahan
- Cancer Genome Evolution Research GroupUniversity College London Cancer InstituteLondonUK
- Cancer Research UK Lung Cancer Centre of ExcellenceUniversity College London Cancer InstituteLondonUK
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30
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The changing landscape of cancer in the USA — opportunities for advancing prevention and treatment. Nat Rev Clin Oncol 2020; 17:631-649. [DOI: 10.1038/s41571-020-0378-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2020] [Indexed: 12/28/2022]
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31
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Francis-Lyon PA, Malik F, Cheng X, Ghezavati A, Xin F, Cai R. TRPV6 as a Putative Genomic Susceptibility Locus Influencing Racial Disparities in Cancer. Cancer Prev Res (Phila) 2020; 13:423-428. [PMID: 31996368 DOI: 10.1158/1940-6207.capr-19-0351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/15/2019] [Accepted: 01/22/2020] [Indexed: 11/16/2022]
Abstract
It is well established that African Americans exhibit higher incidence, higher mortality, and more aggressive forms of some cancers, including those of breast, prostate, colon, stomach, and cervix. Here we examine the ancestral haplotype of the TRPV6 calcium channel as a putative genomic factor in this racial divide. The minor (ancestral) allele frequency is 60% in people of African ancestry, but between 1% and 11% in all other populations. Research on TRPV6 structure/function, its association with specific cancers, and the evolutionary-ecological conditions that impacted selection of its haplotypes are synthesized to provide evidence for TRPV6 as a germline susceptibility locus in cancer. Recently elucidated mechanisms of TRPV6 channel deactivation are discussed in relation to the location of the allele favored in selection, suggesting a reduced capacity to inactivate the channel in those who have the ancestral haplotype. This could result in an excessively high cellular Ca2+, which has been implicated in cancer, for those in settings where calcium intake is far higher than in their ancestral environment. A recent report associating increasing calcium intake with a pattern of increase in aggressive prostate cancer in African-American but not European-American men may be related. If TRPV6 is found to be associated with cancer, further research would be warranted to improve risk assessment and examine interventions with the aim of improving cancer outcomes for people of African ancestry.
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Affiliation(s)
| | - Fahreen Malik
- University of San Francisco, Health Informatics Program, San Francisco, California
| | - Xiaoyun Cheng
- University of San Francisco, Health Informatics Program, San Francisco, California
| | - Alireza Ghezavati
- University of San Francisco, Health Informatics Program, San Francisco, California
| | - Feihan Xin
- University of San Francisco, Health Informatics Program, San Francisco, California
| | - Rafiki Cai
- Friends of the Congo, Chief Technology Officer, Washington, District of Columbia
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Islami F, Miller KD, Siegel RL, Zheng Z, Zhao J, Han X, Ma J, Jemal A, Yabroff KR. National and State Estimates of Lost Earnings From Cancer Deaths in the United States. JAMA Oncol 2019; 5:e191460. [PMID: 31268465 DOI: 10.1001/jamaoncol.2019.1460] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Information on the economic burden of cancer mortality can serve as a tool in setting policies and prioritizing resources for cancer prevention and control. However, contemporary data are lacking for the United States nationally and by state. Objective To estimate lost earnings due to death from cancer overall and for the major cancers in the United States nationally and by state. Design, Setting, and Participants Person-years of life lost (PYLL) were calculated using numbers of cancer deaths and life expectancy data in individuals aged 16 to 84 years who died from cancer in the United States in 2015. The annual median earnings in the United States were used to assign a monetary value for each PYLL by age and sex. Cancer mortality and life expectancy data were obtained from the National Center for Health Statistics and annual median earnings from the US Census Bureau's 2016 Current Population Survey's March Annual Social and Economic Supplement. Data analysis was performed from October 22, 2018, to February 25, 2019. Main Outcomes and Measures Lost earnings due to cancer death, represented as estimated future wages in the absence of premature death. Results A total of 8 739 939 person-years of life were lost to cancer death in persons aged 16 to 84 years in the United States in 2015, translating to lost earnings of $94.4 billion (95% CI, $91.7 billion-$97.3 billion). For individual cancer sites, lost earnings were highest for lung cancer ($21.3 billion), followed by colorectal ($9.4 billion), female breast ($6.2 billion), and pancreatic ($6.1 billion) cancer. Age-standardized lost earning rates per 100 000 were lowest in the West and highest in the South, ranging from $19.6 million (95% CI, $19.1 million-$20.2 million) in Utah to $35.3 million ($34.4 million-$36.3 million) in Kentucky. Approximately 2.4 million PYLL and $27.7 billion (95% CI, $26.9 billion-$28.5 billion) in lost earnings (29.3% of total that occurred in 2015) would have been avoided in 2015 if all states had the same age-specific PYLL or lost earning rates as Utah. Conclusions and Relevance Our findings indicate large state variation in the economic burden of cancer and suggest the potential for substantial financial benefit through delivery of effective cancer prevention, screening, and treatment to minimize premature cancer mortality in all states.
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Affiliation(s)
- Farhad Islami
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Kimberly D Miller
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Zhiyuan Zheng
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Jingxuan Zhao
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Xuesong Han
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Jiemin Ma
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - K Robin Yabroff
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
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Looking at cancer health disparities without the colored lenses. CANCER HEALTH DISPARITIES 2019; 3:e1-e9. [PMID: 31440743 DOI: 10.9777/chd.2019.1004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Cancer health disparities (CHDs), defined as the adverse differences in cancer incidence and mortality, are prevalent in certain racial and ethnic groups. Underlying causes of CHDs are multi-factorial and debatable. While low socioeconomic status, geographical location, lifestyle and behavioral factors are mostly believed to contribute to CHDs, regardless of ethnic and racial background, significant data now also exist to support a genetic basis of such disparities as well. Clearly, CHDs could best be understood by studying the interplay of multiple (genetic and non-genetic) factors and then translating the resulting knowledge into effective approaches for reducing the existing disparity gaps. This review article highlights these aspects in brief and calls the people of different expertise to work together to make an impact and tackle the challenges associated with CHDs.
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Terebelo HR, Abonour R, Gasparetto CJ, Toomey K, Durie BGM, Hardin JW, Jagannath S, Wagner L, Narang M, Flick ED, Srinivasan S, Yue L, Kitali A, Agarwal A, Rifkin RM. Development of a prognostic model for overall survival in multiple myeloma using the Connect ® MM Patient Registry. Br J Haematol 2019; 187:602-614. [PMID: 31382320 PMCID: PMC6899784 DOI: 10.1111/bjh.16139] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 06/10/2019] [Indexed: 02/02/2023]
Abstract
Median overall survival (OS) has improved for patients with newly diagnosed multiple myeloma (NDMM), but prognosis varies depending on baseline patient characteristics. Current models use data from selected clinical trial populations, which prevent application to patients in an unselected community setting that reflects routine clinical practice. Using data from the Connect® MM Registry, a large, US, multicentre, prospective observational cohort study (Cohort 1: 2009-2011; Cohort 2: 2012-2016) of 3011 patients with NDMM, we identified prognostic variables for OS via the multivariable analysis of baseline patient characteristics in Cohort 1 (n = 1493) and developed a tool to examine individual outcomes. Factors associated with OS (n = 1450 treated patients; P < 0·05) were age, del(17p), triplet therapy use, EQ-5D mobility, International Staging System stage, solitary plasmacytoma, history of diabetes, platelet count, Eastern Cooperative Oncology Group performance status and serum creatinine, which were used to create survival matrices for 3- and 5-year OS. The model was internally and externally validated using Connect MM Cohort 2 (Harrell's concordance index, 0·698), MM-015 (0·649), and the phase 3 FIRST (0·647) clinical trials. This novel prognostic tool may help inform outcomes for NDMM in the era of triplet therapy use with novel agents.
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Affiliation(s)
| | | | | | | | | | | | | | - Lynne Wagner
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | | | - Lihua Yue
- Celgene Corporation, Summit, NJ, USA
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Beyer KMM, Laud PW, Zhou Y, Nattinger AB. Housing discrimination and racial cancer disparities among the 100 largest US metropolitan areas. Cancer 2019; 125:3818-3827. [PMID: 31287559 DOI: 10.1002/cncr.32358] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/01/2019] [Accepted: 05/21/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cancer contributes substantially to the life expectancy gap between US blacks and whites, and racial cancer disparities remain stubborn to eradicate. Disparities vary geographically, suggesting that they are not inevitable. METHODS The authors examined the relationship between housing discrimination and the size of cancer disparities across large US metropolitan statistical areas (MSAs). MSA-level cancer disparities were measured using data from the US Centers for Disease Control and Prevention. Mortgage discrimination for each MSA was estimated using the Home Mortgage Disclosure Act database, and MSA racial segregation was determined using US Census data. Patterns of housing discrimination and cancer disparities were mapped, and the associations between these place-based factors and cancer disparities across MSAs were measured. RESULTS Black-to-white cancer mortality disparities (rate ratios) varied geographically, ranging from 1.50 to 0.86; 88% of mortality ratios were >1, indicating higher mortality for blacks. In areas with greater mortgage discrimination, the gap between black and white cancer mortality rates was larger (correlation coefficient [r] = 0.32; P = .001). This relationship persisted in sex-specific analyses (males, r = 0.37; P < .001; females, r = 0.23; P = .02) and in models controlling for confounders. In contrast, segregation was inconsistently associated with disparities. Adjusting for incidence disparities attenuated, but did not eliminate, the correlation between mortgage discrimination and mortality disparities (r = 0.22-0.24), suggesting that cancer incidence and survival each account for part of the mortality disparity. CONCLUSIONS Mortgage discrimination is associated with larger black-to-white cancer mortality disparities. Some areas are exceptions to this trend. Examination of these exceptions and of policies related to housing discrimination may offer novel strategies for explaining and eliminating cancer disparities.
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Affiliation(s)
- Kirsten M M Beyer
- Division of Epidemiology, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Purushottam W Laud
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Yuhong Zhou
- Division of Epidemiology, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ann B Nattinger
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Odedina FT, Reams RR, Kaninjing E, Nguyen J, Mochona B, Lyon DE, Askins N, Behar-Horenstein LS. Increasing the Representation of Minority Students in the Biomedical Workforce: the ReTOOL Program. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:577-583. [PMID: 29542061 PMCID: PMC7247618 DOI: 10.1007/s13187-018-1344-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
With the growing burden of cancer in minority populations and limited progress in eliminating cancer disparities, it has become important to develop a diverse oncology workforce in basic, clinical, and behavioral research who will address cancer disparities and increase the participation of minority populations in clinical trials. To address the lack of well-trained underrepresented minority cancer scientists in Florida, the University of Florida collaborated with Florida A&M University in 2012 to establish the Florida Prostate Cancer Research Training Opportunities for Outstanding Leaders (ReTOOL) Program. Since 2012, the ReTOOL program has expanded to (1) cover all areas of cancer disparities; (2) offer training opportunities to minority students from all historically Black colleges and universities (HBCUs) in Florida; and (3) successfully secure both intramural and extramural federal funding to continuously provide research training opportunities for minority students in Florida. Focusing primarily on training Black students, the ReTOOL model includes culturally sensitive recruitment, mentorship, didactic curriculum, networking, and hands on experience in cancer research. This paper discusses the lessons learned from administering the ReTOOL program for 5 years, which includes having the right inputs (such as majority-minority institutions partnership, funding, faculty advisors, committed mentors, culturally competent staff, and standardized program requirements) and processes (such as pipeline approach, structured applications system, didactic curriculum, research experience, and continuous mentoring) for an effective research training program. The program impact is an increase in the pool of underrepresented minority candidates with scientific and academic career progression paths focused on reducing cancer health disparities.
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Affiliation(s)
- Folakemi T Odedina
- College of Pharmacy, University of Florida, Orlando, FL, USA.
- College of Medicine, University of Florida, Gainesville, FL, USA.
| | - R R Reams
- Florida A&M University, Tallahassee, FL, USA
| | - E Kaninjing
- College of Pharmacy, University of Florida, Orlando, FL, USA
| | - J Nguyen
- College of Pharmacy, University of Florida, Orlando, FL, USA
| | - B Mochona
- Florida A&M University, Tallahassee, FL, USA
| | - D E Lyon
- College of Nursing, University of Florida, Gainesville, FL, USA
| | - N Askins
- College of Pharmacy, University of Florida, Orlando, FL, USA
| | - L S Behar-Horenstein
- Colleges of Dentistry, University of Florida, Gainesville, FL, USA
- College of Education, University of Florida, Gainesville, FL, USA
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Kessler MD, Bateman NW, Conrads TP, Maxwell GL, Dunning Hotopp JC, O’Connor TD. Ancestral characterization of 1018 cancer cell lines highlights disparities and reveals gene expression and mutational differences. Cancer 2019; 125:2076-2088. [PMID: 30865299 PMCID: PMC6541501 DOI: 10.1002/cncr.32020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/15/2019] [Indexed: 12/11/2022]
Abstract
Background Although cell lines are an essential resource for studying cancer biology, many are of unknown ancestral origin, and their use may not be optimal for evaluating the biology of all patient populations. Methods An admixture analysis was performed using genome‐wide chip data from the Catalogue of Somatic Mutations in Cancer (COSMIC) Cell Lines Project to calculate genetic ancestry estimates for 1018 cancer cell lines. After stratifying the analyses by tissue and histology types, linear models were used to evaluate the influence of ancestry on gene expression and somatic mutation frequency. Results For the 701 cell lines with unreported ancestry, 215 were of East Asian origin, 30 were of African or African American origin, and 453 were of European origin. Notable imbalances were observed in ancestral representation across tissue type, with the majority of analyzed tissue types having few cell lines of African American ancestral origin, and with Hispanic and South Asian ancestry being almost entirely absent across all cell lines. In evaluating gene expression across these cell lines, expression levels of the genes neurobeachin line 1 (NBEAL1), solute carrier family 6 member 19 (SLC6A19), HEAT repeat containing 6 (HEATR6), and epithelial cell transforming 2 like (ECT2L) were associated with ancestry. Significant differences were also observed in the proportions of somatic mutation types across cell lines with varying ancestral proportions. Conclusions By estimating genetic ancestry for 1018 cancer cell lines, the authors have produced a resource that cancer researchers can use to ensure that their cell lines are ancestrally representative of the populations they intend to affect. Furthermore, the novel ancestry‐specific signal identified underscores the importance of ancestral awareness when studying cancer. Preclinical cancer cell line research is often conducted without an awareness of ancestral background, which results in incongruities between the genetic backgrounds of used cell lines and the patient populations they are intended to represent. By calculating genetic ancestry for 1018 common cancer cell lines and identifying ancestry‐specific expression and somatic mutation patterns, the importance of ancestral awareness is emphasized, and a resource is provided that can be used by cancer researchers to ensure that their cell lines are ancestrally representative of the populations they aim to impact.
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Affiliation(s)
- Michael D. Kessler
- Institute for Genome SciencesUniversity of Maryland School of MedicineBaltimoreMaryland
- Department of MedicineUniversity of Maryland School of MedicineBaltimoreMaryland
- Program in Personalized and Genomic MedicineUniversity of Maryland School of MedicineBaltimoreMaryland
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer CenterBaltimoreMaryland
| | - Nicholas W. Bateman
- Gynecologic Cancer Center of Excellence, Department of Obstetrics and Gynecology and the John P. Murtha Cancer CenterUniformed Services University of the Health Sciences and Walter Reed National Military Medical CenterBethesdaMaryland
- Inova Schar Cancer Institute, Inova Center for Personalized HealthFairfaxVirginia
| | - Thomas P. Conrads
- Gynecologic Cancer Center of Excellence, Department of Obstetrics and Gynecology and the John P. Murtha Cancer CenterUniformed Services University of the Health Sciences and Walter Reed National Military Medical CenterBethesdaMaryland
- Inova Schar Cancer Institute, Inova Center for Personalized HealthFairfaxVirginia
- Department of Obstetrics and GynecologyInova Fairfax Medical CampusFalls ChurchVirginia
| | - George L. Maxwell
- Gynecologic Cancer Center of Excellence, Department of Obstetrics and Gynecology and the John P. Murtha Cancer CenterUniformed Services University of the Health Sciences and Walter Reed National Military Medical CenterBethesdaMaryland
- Inova Schar Cancer Institute, Inova Center for Personalized HealthFairfaxVirginia
- Department of Obstetrics and GynecologyInova Fairfax Medical CampusFalls ChurchVirginia
| | - Julie C. Dunning Hotopp
- Institute for Genome SciencesUniversity of Maryland School of MedicineBaltimoreMaryland
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer CenterBaltimoreMaryland
- Department of Microbiology and ImmunologyUniversity of Maryland School of MedicineBaltimoreMaryland
| | - Timothy D. O’Connor
- Institute for Genome SciencesUniversity of Maryland School of MedicineBaltimoreMaryland
- Department of MedicineUniversity of Maryland School of MedicineBaltimoreMaryland
- Program in Personalized and Genomic MedicineUniversity of Maryland School of MedicineBaltimoreMaryland
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer CenterBaltimoreMaryland
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Hemming J, Eide K, Harwood E, Ali R, Zhu Z, Cutler J. Exploring Professional Development for New Investigators Underrepresented in the Federally Funded Biomedical Research Workforce. Ethn Dis 2019; 29:123-128. [PMID: 30906160 PMCID: PMC6428175 DOI: 10.18865/ed.29.s1.123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective The National Research Mentoring Network (NRMN) is a strategic partnership whose goals include remedying documented disparities by race and ethnicity in the awarding of National Institutes of Health research grants. Our objectives were to offer a profile of early-career investigators who applied to NRMN's Grantsmanship Coaching Programs (GCP) and test for differences in the research productivity, professional obligations, research resources, and motivations of applicants from underrepresented groups (URGs) compared with applicants from well-represented groups (WRGs). We also evaluated how employment at a minority serving institution (MSI) influenced access to research resources and professional obligations. Participants 880 investigators who submitted online applications to join an NRMN GCP between August 1, 2015 and February 1, 2018. Methods We used two-sample tests of proportions and logistic regression to explore differences in applicants' characteristics and local research environment by group (URG vs WRG) and institution type (MSI vs Other). Results URG and WRG applicants did not differ in grant application submission history. However, URG applicants had published fewer articles than WRG peers (9.8 vs 15.3, P<.001) and fewer articles as first/last author (4.4 vs 6.9, P<.001). URG applicants reported less access to core facilities to conduct research (74% vs 81%, P<.05). Investigators at MSIs reported less access to collaborators (P<.01) and departmental colleagues with federal funding (P<.001) and spent less time on conducting research (P<.001). URGs were more motivated to seek professional development support to expand their peer networks (P<.05) and advance their careers (P<.001). Conclusions Our findings identified several points of intervention to help applicants from URGs to improve their future chances of obtaining competitive funding.
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Affiliation(s)
- Japera Hemming
- Clinical Research Center, Morehouse School of Medicine, Atlanta, GA
| | - Kristin Eide
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
| | - Eileen Harwood
- School of Public Health, University of Minnesota, Minneapolis, MN
| | - Ratib Ali
- Department of Economics, Boston College, Boston, MA
| | - Zhu Zhu
- Department of Economics, Boston College, Boston, MA
| | - Jason Cutler
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
| | - National Research Mentoring Network Coaching Group Directors
- Clinical Research Center, Morehouse School of Medicine, Atlanta, GA
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
- School of Public Health, University of Minnesota, Minneapolis, MN
- Department of Economics, Boston College, Boston, MA
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Swords DS, Mulvihill SJ, Brooke BS, Skarda DE, Firpo MA, Scaife CL. Disparities in utilization of treatment for clinical stage I-II pancreatic adenocarcinoma by area socioeconomic status and race/ethnicity. Surgery 2018; 165:751-759. [PMID: 30551868 DOI: 10.1016/j.surg.2018.10.035] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/15/2018] [Accepted: 10/30/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Utilization of multimodality therapy for clinical stage I-II pancreatic ductal adenocarcinoma is associated with meaningful prolongation of survival. Although the qualitative existence of disparities in treatment utilization by socioeconomic status and race/ethnicity is well documented, the absolute magnitudes of these disparities have not been previously quantified. METHODS The exposures in this retrospective cohort study of the 2010-2015 National Cancer Database were a 7-value area-level socioeconomic status index and race/ethnicity. Main outcomes were surgery, chemotherapy, and multimodality therapy (surgery and chemotherapy). Adjusted rate differences were calculated after logistic regression. Models excluded intermediate variables. Overall survival was evaluated in unadjusted and adjusted analyses. RESULTS Of 43,760 patients, 63.4% underwent surgery. Of 39,808 patients without chemotherapy contraindications, refusal, or missing data, 75.1% received chemotherapy and 51.4% received multimodality therapy. Adjusted rate differences for utilization of surgery, chemotherapy, and multimodality therapy in the lowest socioeconomic status patients were -10.0 (95% confidence interval [CI] -12.4 to -7.5), -12.7 (95% CI -16.3 to -9.1), and -15.4 (95% CI -18.8 to -12.0), respectively, versus the highest socioeconomic status patients. Adjusted rate differences for multimodality therapy utilization in non-Hispanic Black and Hispanic patients were -10.1 (95% CI -13.6 to -6.7) and -11.8 (95% CI -14.3 to -9.2), respectively, versus non-Hispanic White patients. Median overall survival increased in a graded fashion from 14.1 (95% CI 13.4-14.8) months in the lowest socioeconomic status patients to 20.2 months (95% CI 19.6-20.8) in the highest socioeconomic status patients. Survival differences were attenuated but not eliminated in multivariable Cox models. CONCLUSION Socioeconomic status and race/ethnicity are more powerful determinants of whether patients receive treatment for clinical stage I-II pancreatic ductal adenocarcinoma than previously appreciated. Nationwide quality improvement efforts aimed at addressing these inequities are warranted.
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Affiliation(s)
- Douglas S Swords
- Department of Surgery, University of Utah, Salt Lake City; Surgical Services Clinical Program, Intermountain Healthcare, Salt Lake City, UT.
| | | | | | - David E Skarda
- Department of Surgery, University of Utah, Salt Lake City; Surgical Services Clinical Program, Intermountain Healthcare, Salt Lake City, UT
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Segrin C, Badger TA, Sikorskii A. A dyadic analysis of loneliness and health-related quality of life in Latinas with breast cancer and their informal caregivers. J Psychosoc Oncol 2018; 37:213-227. [DOI: 10.1080/07347332.2018.1520778] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Chris Segrin
- Department of Communication, University of Arizona, Tucson, Arizona, USA
| | - Terry A. Badger
- College of Nursing, University of Arizona, Tucson, Arizona, USA
| | - Alla Sikorskii
- Department of Psychiatry, Michigan State University, East Lansing, Michigan, USA
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Abstract
In this issue of Cancer Cell, Yuan et al. compared the somatic alterations harbored by tumors from European and African ancestry individuals. They determined that the latter group has a propensity for aberrations that are consistent with genomic instability, potentially lending insight to the genomic basis of cancer health disparities.
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Affiliation(s)
- Jason J Pitt
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore
| | - Yonglan Zheng
- Center for Clinical Cancer Genetics and Global Health, Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Olufunmilayo I Olopade
- Center for Clinical Cancer Genetics and Global Health, Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
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Rice D, Schabath MB. The Future of LGBT Cancer Care: Practice and Research Implications. Semin Oncol Nurs 2018; 34:99-115. [DOI: 10.1016/j.soncn.2017.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Krieger N, Jahn JL. Tumor Specimen Biobanks: Data Gaps for Analyzing Health Inequities-the Case of Breast Cancer. JNCI Cancer Spectr 2018; 2:pky011. [PMID: 31360842 PMCID: PMC6649821 DOI: 10.1093/jncics/pky011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/05/2018] [Accepted: 03/15/2018] [Indexed: 11/13/2022] Open
Abstract
Biobanks are increasingly recognized to be vital for analyzing tumor properties, treatment options, and clinical prognosis, yet few data exist on whether they are equipped to enable research on cancer inequities, that is, unfair and unnecessary social group differences in health. We conducted a systematic search of global biobanks, identified 46 that have breast tumor tissue and share data externally with academic researchers, and e-mailed and called to obtain data on the sociodemographic, socioeconomic, and geospatial data included, plus time span encompassed. Among the 32 biobank respondents, 91% housed specimens solely from the Global North, only 31% obtained socioeconomic data, 63% included racial/ethnic data (of which 55% lacked socioeconomic data), 44% included limited geographic data, and 55% had specimens dating back at most to 2000. To enable research to address cancer inequities, including trends over time, biobanks will need to address the data gaps documented by our study.
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Affiliation(s)
- Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jaquelyn L Jahn
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
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