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

项目摘要 癌症是美国西班牙裔/拉丁裔（H/L）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，预计在未来四十年内将翻一番。H/L具有可变的SES， 出生地、地理分布、遗传混合以及健康的社会、心理和行为决定因素。 在特定癌症的患病率、侵袭性和死亡率方面存在显著差异（例如，子宫颈、肝脏、胃） 以及多个患者报告的结局（PRO），无论疾病部位如何。H/L更有可能出现 晚期疾病、更严重的合并症和更严重的症状负担以及更差的健康相关生活质量 （HRQoL）。H/L的生存率进一步受到社会经济地位低、教育和保险覆盖率、语言 障碍和获得护理的机会有限。H/L的生存率研究受到限制，原因是：（a）样本量小， 随访;（B）关注常见癌症（例如，乳腺或前列腺），限制了对高患病率/死亡率部位的关注; 限制H/L来源和SES代表性;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、社会心理、生活方式、生物学）。阿万赞多·卡米尼奥斯 （主要途径）：西班牙裔/拉丁裔癌症生存队列研究将涉及招募、评估和 随访约3，000例在过去2年内完成原发性癌症治疗的H/L，H/L各不相同 背景，城市与农村居住和癌症网站在两个主要的美国大都市地区-迈阿密和旧金山 安东尼奥这两个地区都有大多数H/L人群（迈阿密约65%;圣安东尼奥约64%），H/L方面存在差异 起源和SES，并由NCI指定的癌症中心提供服务。我们将招募一个样本， 美国H/L人群的多样性（约50%墨西哥人和约50%其他H/L来源）。佛罗里达癌症数据系统 德克萨斯州癌症登记处将补充招募（约30%的队列）， 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）、HRQoL 和疾病活动（例如，进展、复发、癌症和全因死亡率）。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合作的强大和成功的记录，将是 评估为我们结果的决定因素：（1）社会文化（例如，社会经济地位、文化适应、文化价值观）;（2）压力和 逆境（例如，慢性和创伤性应激，种族应激）;（3）心理社会（例如，社会支持，应对，家庭 凝聚力/冲突）;（4）生活方式和行为（例如，身体活动、营养、健康信息寻求）;以及（5） 生物的（例如，炎症/促转移基因表达信号传导、心脏代谢标志物、遗传混合物）。 将在基线、6个月、12个月和此后每年对受试者进行评估。方法在多级潜在 纵向模型，癌症基因组学和计算生物学将被用来测试我们的假设。期间 在UG 3阶段，我们将雇用和培训工作人员，建立并最终确定研究方案，招募约18%的样本并进行 初步分析。在UH 3阶段，我们将完成招募，进行所有剩余的评估， 分析数据并传播调查结果，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.