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

项目摘要 癌症是美国拉美裔/拉丁裔(H/L)人的主要死亡原因。H/L占5750万 美国人(18%)，现在是最大的少数民族，预计在未来40年内将翻一番。H/L具有可变的SE， 出生地、地理分布、基因混合以及社会、心理社会和行为健康的决定因素。 在特定癌症(如宫颈癌、肝癌、胃癌)的患病率、侵袭性和死亡率方面存在显著差异 以及跨多个患者报告的结果(PRO)，而不考虑疾病位置。H/L更有可能出现在 晚期疾病、更大的合并症和更大的症状负担以及与健康相关的生活质量较差 (HRQOL)。低社会保障、教育和保险覆盖范围、语言等因素进一步损害了H/L的生存能力 障碍和有限的获得护理的机会。H/L的生存研究一直受到限制，原因是：(A)小样本和短样本 后续行动；(B)重点关注常见癌症(如乳腺癌或前列腺癌)，限制对高发/死亡地点的关注； 受限的H/L起源和SES表示；以及(D)缺乏考虑多个决定因素的指导模型(例如， 社会文化、医疗、压力、心理社会、生活方式、生物学)对幸存者结果的影响。阿凡赞多·卡米诺斯 (领先路径)：拉美裔/拉丁裔癌症生存队列研究将涉及招募、评估和 近2年内完成原发肿瘤治疗且H/L类型多样的~3,000名H/L的随访 背景：迈阿密和旧金山这两个美国主要大都会地区的城市和农村居住地和癌症地点 安东尼奥。这两个地区都有大多数H/L人口(~65%的迈阿密人；~%的圣安东尼奥人)，关于H/L是不同的 Origin和SES，由NCI指定的癌症中心提供服务。我们将招募一个接近于 美国H/L群体的多样性(~50%墨西哥人和~50%其他H/L血统)。佛罗里达州癌症数据系统 德克萨斯州癌症登记处将补充招募(约占队列的30%)，并帮助建立 代表性。我们的主要结果是症状负担(例如，疼痛、疲劳、抑郁、认知)、HRQL 和疾病活动(例如，进展、复发、癌症和全因死亡)。我们的跨学科团队有一个 在五个目标领域的学术生产力和协作方面取得了强劲和成功的记录， 被评估为我们结果的决定因素：(1)社会文化(例如，社会文化、文化适应、文化价值观)；(2)压力和 逆境(如慢性和创伤性压力、民族压力)；(3)心理社会(如社会支持、应对、家庭 凝聚力/冲突)；(4)生活方式和行为(例如，体育活动、营养、寻求健康信息)；以及(5) 生物学(例如，炎症/转移基因表达信号、心脏代谢标记物、遗传混合物)。 参与者将在基线、6个月、12个月和此后每年进行评估。多层潜伏期的方法 纵向建模、癌症基因组学和计算生物学将被用来检验我们的假设。在.期间 UG3阶段，我们将招聘和培训员工，制定和最终确定研究方案，招募~18%的样本并进行 初步分析。在UH3阶段，我们将完成招募，进行所有剩余的评估， 分析数据和传播研究结果，以指导和实施H/L幸存者的二级和三级预防。

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