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: 9124839
• 负责人: Elisa V Bandera
• 金额: $ 131.76万
• 依托单位: RBHS -CANCER INSTITUTE OF NEW JERSEY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-11 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9124839
• 关键词: Affect; African American; Angiotensin-Converting Enzyme Inhibitors; Asthma; Bioavailable; Biological; Biological Markers; Blood specimen; Blood typing procedure; Body Composition; Body fat; Body mass index; Breast Cancer Patient; Breast Cancer Treatment; Breast Cancer survivor; Cancer Prognosis; Cardiovascular Diseases; Case-Control Studies; Cause of Death; Characteristics; Clinical Management; Clinical Trials; Comorbidity; County; Data; Diabetes Mellitus; Diagnosis; Diet; Dose; Economic Factors; Ethnic group; European; Fatigue; Fatty acid glycerol esters; Genomics; Genotype; Guidelines; Health; Health Services Accessibility; High Prevalence; Home environment; Hypertension; Immune; Immunity; Inflammation; Inflammatory; Insulin; Insulin Resistance; Intervention; Interview; Lymphedema; Measurement; Mediating; Medical History; Medical Records; Metformin; Newly Diagnosed; Non-Insulin-Dependent Diabetes Mellitus; Non-Steroidal Anti-Inflammatory Agents; Obesity; Outcome; Overweight; Pathway interactions; Patients; Pharmaceutical Preparations; Pharmacotherapy; Physical activity; Provider; Quality of life; Race; Recording of previous events; Risk Factors; Role; Saliva; Sampling; Serum; Signal Transduction; Somatomedins; Staging; Stress; Surveys; Therapeutic; Time; Treatment outcome; United States; Update; Vital Status; Vitamin D; Waist-Hip Ratio; Weight; Woman; adaptive immunity; adipokines; cancer care; chemotherapy; circulating biomarkers; cohort; cost effective; cytokine; design; follow-up; health care disparity; improved; insulin-related factor; low socioeconomic status; malignant breast neoplasm; medication compliance; mortality; neoplasm registry; obesity management; outcome forecast; population based; prognostic; racial difference; racial disparity; receptor; socioeconomics; survivorship; tumor; waist circumference

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）：与美国其他种族和民族相比，非洲裔美国人（AAs）乳腺癌（BrCa）预后较差可能是多因素的，包括肿瘤特征、社会经济因素和难以获得护理。虽然有强有力的证据表明，肥胖和肥胖相关的合并症会增加欧洲血统女性（EAs）的BrCa和竞争原因死亡率，但其在AAs中的预后作用尚不确定，潜在的介导机制尚未阐明。我们建议评估(1)体脂（体重指数、体脂分布和体成分）对接受BrCa治疗（包括化疗剂量减少和延迟）和结局（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)肥胖相关的合并症（包括高血压和糖尿病）在AAs中更常见，与BrCa治疗和结果的关系，以及这些疾病的最佳管理是否影响结果；(3)潜在的机制途径，包括免疫因子、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。使用来自祖先信息标记（AIMs）的基因型获得的基因组祖先估计将包括在所有分析中。我们在正在进行的AA女性BrCa人群病例对照研究（P01 CA151135）的基础上提出了一项具有成本效益的研究。新泽西州癌症登记处（NJSCR）的快速病例确定用于确定新泽西州十个县新诊断的BrCa病例。在此，我们建议将AA病例的招募时间延长至2018年3月，将总数增加至约1700例，其中约1100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，以评估在护理、生活质量（QoL）和生存方面的差异，特别是与肥胖有关的差异。诊断后不久进行的直线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。我们建议在治疗结束后~12个月和~24个月采集血液样本，评估肥胖相关的生物标志物，并每年进行主动和被动随访，获取详细的病历。积极的跟进将包括访谈，以收集年度最新情况