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: 9307000
• 负责人: Elisa V Bandera
• 金额: $ 9.42万
• 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 2016-09-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9307000
• 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）：与美国其他种族和族裔群体相比，非洲裔美国人（AAs）中的晚期乳腺癌（BrCa）预后可能是多因素的，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增加BrCa和竞争性原因死亡率的妇女欧洲血统（EAs），其预后的作用AAs是不确定的，潜在的介导机制尚未阐明。我们建议评估（1）身体肥胖的影响（体重指数、体脂分布和身体组成）（包括化疗剂量减少和延迟）和结局（BrCa特异性死亡率、竞争性原因死亡率、全因死亡率、生活质量）;（2）在AA中更常见的肥胖相关合并症（包括高血压和糖尿病）对BrCa治疗和结局的影响，以及这些疾病的最佳管理是否会影响结果;以及（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，这些指标可能介导肥胖和肥胖相关合并症的影响。所有分析中将包括使用来自遗传信息标记（AIM）的基因型获得的基因组祖先估计值。我们提出了一项成本效益研究，该研究建立在正在进行的基于人群的病例对照研究中，在AA妇女（P01 CA 151135）的BrCa。新泽西州癌症登记处（NJSCR）的快速病例确认用于识别新泽西州10个县的新诊断BrCa病例。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1，700例，其中约1，100例在诊断后18至24个月采集血液样本，约860例在诊断后30至36个月采集血液样本。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）和生存率的差异，特别是与肥胖相关的差异。baeline在诊断后不久进行的家庭访谈收集了有关风险因素的信息，包括一生的体重史。进行人体测量和身体成分测量，并收集唾液样本。从多个供应商获得医疗记录并进行审查。我们建议在治疗完成后约12个月和约24个月采集血液样本，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访谈，以收集年度最新情况 关于人体测量、饮食和体力活动、病史，包括关于合并症及其管理的信息，以及生存因素（例如，生活质量、水肿、感知压力和疲劳）。被动跟踪将包括与国家司法委员会建立记录联系，以了解死亡者的生命状况、死亡时间和死亡原因。这项研究的结果具有很大的潜力，以改善肥胖AA BrCa患者的临床管理，提高生存率和生活质量的BrCa幸存者。