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

非裔美国人的肥胖、相关合并症和乳腺癌结果

• 批准号: 9006779
• 负责人: Elisa V Bandera
• 金额: $ 4.73万
• 依托单位: RBHS -CANCER INSTITUTE OF NEW JERSEY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-06-01 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9006779
• 关键词: Address; Adherence; Affect; African American; Area; Award; Behavior; Biological; Biological Markers; Blood specimen; Body Composition; Body fat; Body mass index; Breast Cancer Patient; Breast Cancer Treatment; Breast Cancer survivor; Cancer Control; Cancer Institute of New Jersey; Cancer Patient; Cancer Prognosis; Cancer Survivorship; Caring; Case-Control Studies; Cause of Death; Characteristics; Chronically Ill; Clinical Management; Collection; Committee Members; Communities; Comorbidity; Complement; Continuance of life; County; Data; Diabetes Mellitus; Diagnosis; Diagnostic; Diet; Dose; Economic Factors; Epidemiologic Studies; Ethnic group; European; Faculty; Fatigue; Funding; Genomics; Genotype; Health; Health Services Accessibility; High Prevalence; Home environment; Hormonal; Hypertension; Immune; Insulin Resistance; Interdisciplinary Study; Intervention; Interview; Learning; Lymphedema; Malignant Neoplasms; Measurement; Mediating; Medical History; Medical Records; Medicine; Mental Depression; Mentors; Newly Diagnosed; Obesity; Oral; Outcome; Parents; Participant; Pathway interactions; Pharmaceutical Preparations; Physical activity; Population; Provider; Psychology; Quality of life; Race; Recording of previous events; Recruitment Activity; Reporting; Research; Research Methodology; Research Personnel; Risk Factors; Role; Saliva; Sampling; Scholarship; Sleep; Sleep disturbances; Stress; Symptoms; Time; Treatment outcome; United States; Update; Vasomotor; Vital Status; Vitamin D; Weight; Woman; adipokines; breast cancer diagnosis; cancer health disparity; cancer prevention; career; career development; chemotherapy; clinically significant; cohort; cost effective; design; epidemiology study; follow-up; hormone therapy; improved; malignant breast neoplasm; mortality; neoplasm registry; population based; professor; prognostic; programs; psychosocial; sedentary; skills; socioeconomics; survivorship; treatment adherence; tumor

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

描述（由申请人提供）：与美国其他种族和族裔群体相比，非洲裔美国人 (AA) 的乳腺癌 (BrCa) 预后较差可能是由多种因素造成的，包括肿瘤特征、社会经济因素和获得护理的机会较差。虽然有强有力的证据表明，肥胖和肥胖相关合并症会增加欧洲血统女性 (EA) 的 BrCa 和竞争性原因死亡率，但其在 AA 中的预后作用尚不确定，且潜在的中介机制尚未阐明。我们建议评估（1）体脂（体重指数、体脂分布和身体成分）对接受的 BrCa 治疗（包括化疗剂量减少和延迟）和结果（BrCa 特异性死亡率、竞争原因死亡率、全因死亡率、生活质量）的影响； (2) AA 中更常见的肥胖相关合并症（包括高血压和糖尿病）对 BrCa 治疗和结果的影响，以及这些病症的最佳管理是否会影响结果； (3) 潜在的机制途径，包括免疫因素、维生素 D、脂肪因子和胰岛素抵抗指标，它们可能介导肥胖和肥胖相关合并症的影响。使用祖先信息标记 (AIM) 的基因型获得的基因组祖先估计将包含在所有分析中。我们提出一项具有成本效益的研究，该研究建立在正在进行的 AA 女性 BrCa 人群病例对照研究 (P01 CA151135) 的基础上。新泽西州癌症登记处 (NJSCR) 的快速病例查明用于识别新泽西州 10 个县新诊断的 BrCa 病例。在此，我们建议将 AA 病例的招募期限延长至 2018 年 3 月，将总数增加至约 1,700 例，其中约 1,100 例在诊断后 18 至 24 个月采集血样，约 860 例在诊断后 30 至 36 个月采集血样。我们建议建立一个 AA BrCa 幸存者队列，以评估护理、生活质量 (QoL) 和生存方面的差异，特别是与肥胖相关的差异。诊断后不久进行的贝林家庭访谈收集了风险因素的信息，包括终生体重史。进行人体测量和身体成分测量并收集唾液样本。获取并审查来自多个提供者的医疗记录。我们建议在治疗完成后约12个月和约24个月收集血液样本以评估肥胖相关生物标志物，并进行年度主动和被动随访并获得详细的医疗记录。积极的后续行动将包括采访以收集年度更新 有关人体测量、饮食和身体活动、病史（包括合并症及其管理的信息）以及生存因素（例如生活质量、淋巴水肿、感知压力和疲劳）的信息。被动随访将包括与 NJSCR 进行记录联系，以获得死者的生命状况、死亡时间和原因。这项研究的结果对于改善肥胖 AA BrCa 患者的临床管理、提高 BrCa 幸存者的生存率和生活质量具有巨大潜力。