Survivorship and Access to care for Latinos to Understand and address Disparities (SALUD)

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ABSTRACT Pediatric cancer survivors (PCS) experience an excess risk of adverse outcomes related to their cancer diagnosis and the treatment they receive. The accumulation and severity of these acute and chronic health conditions broadly impact PCS functioning, quality of life, and health care resource utilization. Consequently, PCS are more likely to live in financial hardship, have lower educational attainment, be unemployed due to poor health, and be under- or uninsured compared with their age-based peers. Latino PCS are at particularly high risk for having a lower socioeconomic status (SES compared with non-Latino PCS. These factors contribute to reduced access to routine medical care, and lower overall survival of Latino children diagnosed with cancer. Existing and well-established patient cohorts of PCS largely include long-term (at least 5 years) survivors and a relatively small proportion of Latino PCS, so that the outcome data that inform our understanding of risk for cancer treatment late effects, and therefore our clinical practice guidelines, are largely derived from the experiences of NHW PCS. The over-arching objective of this proposal is to identify and comprehensively assess adverse outcomes among Latino PCS that will inform clinical guidelines and lay the foundation for early, targeted interventions to mitigate such outcomes in this vulnerable and growing population of PCS. Key to the success of our proposal is the prospective establishment of a Latino PCS cohort in Texas that is linked with genomic and geographic data (UG3 planning phase), which will permit analyses of the interaction between ancestry and SES on risk for adverse cancer treatment outcomes during the UH3 implementation phase. There is a significant unmet need to comprehensively characterize the socioeconomic, psychosocial, genomic, and metabolomic risk determinants of treatment-related toxicities and relapse in Latino PCS in the context of known clinical risk factors. In addition, among under-represented minorities there is a critical need to identify facilitators and barriers to obtaining survivorship care. Therefore, utilizing existing and prospectively collected longitudinal data, we will: (1) Identify demographic, clinical, and genetic/molecular determinants of treatment-related toxicities and their association with chronic health conditions, patient-reported symptoms, and neurocognitive/ psychological and functional outcomes in Latino PCS; (2) Identify demographic, clinical, and genetic/molecular determinants of the excess risk of cancer relapse/recurrence in a cohort of Latino PCS; and (3) Determine Latino PCS understanding of risk for late effects and rationale for survivorship care, and identify perceived facilitators and barriers to obtaining survivorship care. This proposal synergizes multidisciplinary expertise and data collected from clinical and epidemiological resources to establish a prospective, comprehensive biobank and database inclusive of a large population of Latino PCS. Our aims represent the largest assessment to date of genetic and SES contributors to outcomes in Latino PCS, an effort that is imperative to inform risk assessments for adverse outcomes in an ethno-diverse population, as well as potential barriers to obtaining optimal survivorship care.