Search

The Hispanic/Latino(x) population (H/L) in the United States of America is heterogeneous and fast growing. Cancer is the number one cause of death among H/Ls, accounting for 21% of deaths. Whereas for the most common cancers, incidence rates are lower in H/Ls compared with non-H/L White (NHW) individuals, H/Ls have a higher incidence of liver, stomach, cervical, penile, and gallbladder cancers. H/L patients tend to be diagnosed at more advanced stages for breast, colorectal, prostate, and lung cancers, and melanoma compared with NHW individuals. Etiologic and cancer outcomes research among H/Ls lags other populations. In this review, we provide a summary of challenges, opportunities, and research priorities related to cancer etiology, cancer outcomes, and survivorship to make progress in addressing scientific gaps. Briefly, we prioritize the need for more research on determinants of obesity, nonalcoholic fatty liver disease and its progression to liver cancer, stomach and gallbladder cancers, and pediatric acute lymphoblastic leukemia. We emphasize the need to improve cancer screening, early detection of cancer, and survivorship care. We highlight critical resources needed to make progress in cancer epidemiologic studies among H/L populations, including the importance of training the next generation of cancer epidemiologists conducting research in H/Ls.

Background: Latinos are underrepresented in biomedical research, particularly biomarker research, yet they constitute the nation's largest ethnic/racial minority. Optimal methods for obtaining biospecimens for biomarker research among Latinos need to be identified. To minimize barriers and enhance participation, this study developed and tested tailored strategies for collecting biomarkers of chronic stress and premature aging among Spanish-speaking Latina breast cancer survivors. Methods: This study used a community-based participatory approach and selected hair and saliva as noninvasive biospecimens to assess telomere length, the cortisol awakening response (CAR), and hair cortisol concentration. We developed bilingual multimedia instructional materials, and community health workers assisted in collections. Telephone surveys assessed willingness to participate in future studies, barriers to sample collection, and recommendations for improving the strategies. Results: A total of 103 participants were recruited over 18 months from two rural sites in California, and 88 were retained at 6-month follow-up. At baseline, rates of donating salivary DNA for telomere length measurement, saliva for CAR analysis, and hair for cortisol concentration were 98%, 89%, and 52%, respectively. At follow-up, rates were 83%, 76%, and 55%, respectively. The majority of participants reported being very willing to provide hair (72%) or saliva (74%) for future studies. Conclusions: Our results support the feasibility of including minorities in biomedical research. We report excellent rates of saliva collection when community partners are engaged in the process, and when patient-centered and culturally tailored recruitment methods are implemented. Impact: The development of methods to facilitate the inclusion of minorities in biomedical research is critical to eliminate racial/ethnic health disparities.

PURPOSE: Latina breast cancer survivors, especially those who primarily speak Spanish, experience worse symptoms and quality of life than non-Latina survivors. This presentation will describe a new framework, the Transcreation Framework for Community-Engaged Behavioral Interventions to Reduce Health Disparities, and how it was applied to develop a translational research program to address psychosocial health disparities among Spanish-speaking Latina breast cancer survivors (SSBCS). METHODS: Applying the Transcreation Framework (TF), the research program uses community-engaged interventions to equip SSBCS with information and skills to manage their disease. We focus on community-based self-care approaches because many underserved communities have limited access to cancer support services and oncology specialists. Applying the framework, we used rigorous scientific methods in community settings to develop, implement and evaluate the effectiveness of behavioral interventions in reducing psychosocial distress and symptoms among urban and rural SSBCS. RESULTS: We define transcreation as the process of planning, delivering, and evaluating interventions so that they resonate with the community experiencing health disparities, while achieving intended health outcomes. Following the TF’s seven iterative steps, we: 1) engaged community partners; 2) selected a theory to guide intervention development; 3) identified candidate evidence-based interventions and community best practices; 4) designed a new transcreated program prototype; 5) designed studies to test the intervention in community settings; 6) built community capacity to deliver the interventions; and 7) delivered and evaluated intervention implementation processes and outcomes. Formative research identified four general areas of need among SSBCS: fear; loss of control over cancer and life; lack of social support; lack of culturally appropriate care; and lack of cancer information in Spanish that they could understand. Population-based research identified cancer self-efficacy and social support as promising mechanisms to improve quality of life of SSBCS, thus we selected social-cognitive theory as the basis for the intervention prototype. With extensive community involvement, we identified an evidence-based stress management program and a community-based program and incorporated them with our prior research to develop Nuevo Amanecer, a new transcreated 8-week cognitive-behavioral stress management program for delivery by peers (trained SSBCS). Two sequential randomized controlled trials were conducted with urban SSBCS first, then rural SSBCS. The program improved several quality of life domains and decreased breast cancer concerns and depressive and bodily symptoms in the first RCT, and reduced anxiety and improved self-efficacy in performing several stress management skills in the 2nd RCT. Subsequently, we used the TF to develop a survivorship care planning and physical activity intervention (health coach plus mobile app and activity tracker) and tested it in a 2-month pilot study among SSBCS that resulted in reduced fatigue and health distress, improved emotional well-being, increased knowledge of needed follow-up care and resources, and an average increase of 1,313 daily steps. CONCLUSIONS: Engaging underserved communities in the design and implementation of behavioral interventions for cancer survivors leads to programs that are more likely to be effective and sustained because they are embedded and delivered in the communities experiencing cancer health disparities. Peer- and community health worker-delivered cancer support programs could be a low-cost, effective method for meeting the psychosocial needs of and increasing inclusion of underrepresented groups in cancer research. Research Implications: The TF can guide development and testing of behavioral interventions for communities experiencing cancer health disparities. The TF results in interventions that balance fidelity to evidence with fit to the setting because they are designed with community. Citation Format: Anna Maria Nápoles. Applying the Transcreation Framework to Address Psychosocial Health Disparities among Latina Breast Cancer Survivors [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr IA29.

Introduction: Effective interventions tailored for rural Spanish-speaking Latina breast cancer survivors are needed to address their psychosocial health disparities. Purpose: Describe development of a rural community-based cognitive-behavioral stress management program, Nuevo Amanecer-R (NA-R) (New Dawn-R) and baseline characteristics of rural Latina breast cancer survivors enrolled in the RCT testing the program. Methods: Using community-based participatory research (CBPR) strategies, we applied a translational model appropriate for underserved populations that integrated an evidence-based intervention, a community best-practices program, and formative research to develop a program that could be delivered by trained breast cancer survivors (peers) in rural settings. We trained community recruiters to enroll, and collect hair and saliva biospecimens from, Spanish-speaking Latinas with nonmetastatic breast cancer in 3 rural California communities. Women were randomized to receive the program immediately or in 6 months. Primary outcomes include the Functional Assessment of Cancer Therapy-Breast Quality of Life (FACT-B) Total Score and its Physical, Social, Emotional, Functional Well-being, and Additional Concerns about Breast Cancer subscale scores (higher scores=better quality of life), with assessments at baseline, 3 months, and 6 months. Results: Based on input from survivors, advocates, and clinicians, modifications to the initial program for rural Latina survivors included further simplification of language, more visuals, developing stress management videos in Spanish and English, and expansion from 8 to 10 sessions to increase skills practice and healthy lifestyles information. Trained peers are delivering the 10-week NA-R program through weekly in-person 90-minute sessions in participants' homes. Components include managing the initial impact of cancer, finding cancer information and support, thoughts and mood management skills, behavioral stress management skills, and goal-setting. Of 231 women approached, 54 (24%) refused, 24 (10%) were ineligible, and 153 (66%) were randomized (76 to intervention, 77 to control group). To date, all baseline, 90% of 3-month, and 92% of 6-month assessments are completed. Participant characteristics are: mean age of 54.8 years (range, 28 to 88); 69% have < high school education; 66% are married; 80% have public/no health insurance; and 48% experienced financial hardship in the past year. Baseline FACT-B mean scores are: Total Score, 96.7 (possible range 0-144); Emotional Well-being, 17.3 (possible range 0-24); Functional Well-being, 18.2 (possible range 0-28); Social/Family Well-being, 18.2 (possible range 0-28); Physical Well-being, 20.4 (possible range 0-28); and Breast Cancer Concerns, 22.7 (possible range 0-36). Conclusions: Using CBPR principles in the design and implementation of community-based RCTs enhances cultural appropriateness, congruence with community contexts, and recruitment and retention. Citation Format: Jasmine Santoyo-Olsson, Anita L. Stewart, Carmen Ortiz, Steven Gregorich, Anna Maria Napoles. Baseline characteristics of rural Spanish-speaking Latina breast cancer survivors enrolled in a community-based RCT of a peer-delivered cognitive-behavioral stress management intervention: The Nuevo Amanecer rural trial [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A043.

Purpose: Women of African ancestry in the United States are more likely to die from breast cancer than their European counterparts. While prior studies suggest differences in the frequency of hormone receptor-negative disease as an underlying cause, recent studies report higher race-based mortality rates in patients with hormone receptor-positive, luminal breast cancer. Here we explore biologic factors that may underly this disparity by comparing racial differences in the level, functional activity, and prognostic significance of 3 master transcriptional regulators of mammary luminal differentiation. Patients and Methods: Medical records and tissues from 555 patients (293 European and 262 African ancestry) diagnosed with Stage 0 to IV breast cancer, from 2001 to 2010 at a major medical center in East North Carolina, were analyzed for the expression of functional biomarkers of luminal differentiation including estrogen receptor (ESR1), and pioneer transcription factors FOXA1 and GATA3. Differential comparison of protein expression was integrated with network-level gene expression analysis (22% of cohort) to define predictive correlations with race and survival. Results: Univariate and multivariate odds ratios combined with area under the curve receiver operator characteristics show significant differences in predictive activity of these functional biomarkers based on race and survival—ESR1 (EA OR= 0.47, p = 5e-04; AA OR= 0.77, p = 0.22), FOXA1 (EA OR= 0.38, p= 1.4e-04; AA OR = 0.53, p = 1.3e-02), and GATA3 (EA OR= 0.36, p= 3.7e-06, AA OR= 0.57, p= 0.51)—and uncover genes in the downstream regulons of these biomarkers that strongly correlate either with genetic ancestry or overall survival. Conclusion: Transcriptional regulatory networks linked to mammary luminal differentiation reveal race-specific differences in master regulatory activity that may underlie tumor characteristics contributing to racial disparities in outcome. These biomarkers and their downstream regulons represent important targets to explore intrinsic mechanisms that drive breast cancer survival disparities. Citation Format: Jung S. Byun, Sandeep K. Singhal, Sam Park, Dae Ik Yi, Tingfen Yan, Ambar Caban, Alana Jones, Partha Mukhopadhyay, Sara Gil Hernandez, Stephen Hewitt, Lisa A. Newman, Melissa Davis, Jorge Sepulveda, Adrianna De Siervi, Anna Napoles, Nasreen Vohra, Kevin Gardner. Racial differences in the associations between luminal master regulator transcription factor expression and breast cancer survival [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C033.

Introduction: Compared to their white counterparts, Latina breast cancer survivors suffer from greater distress and poorer health-related quality of life. Yet little is known about the determinants of such distress. Purpose: Examine the independent associations of coping self-efficacy, social support, neighborhood cohesion, engagement with physicians, and financial hardship with depressive symptoms and perceived stress using baseline data from a randomized controlled trial of a stress management intervention among Spanish-speaking rural Latina breast cancer survivors. Methods: All data were self-reported and collected via in-person interviews in Spanish, except for medical information, which was obtained from medical records review. Bivariate linear models regressed either depressive symptoms (Patient Health Questionnaire-8) or stress (Perceived Stress Scale) on coping self-efficacy, social support, neighborhood cohesion, difficulty engaging with physicians, and financial hardship, controlling for demographic, medical factors, and study site. Hypothesized predictors that were statistically significant at p Results: In bivariate analyses, coping confidence (b = -2.50; p Conclusions: Interventions that focus on increasing women's coping confidence and sense of neighborhood cohesion, and services to reduce their financial hardship, could help alleviate psychosocial health disparities among rural Latina cancer survivors. Citation Format: Anna M. Napoles, Jasmine Santoyo-Olsson, Anita L. Stewart, Carmen Ortiz, Steven Gregorich. How do coping resources and financial hardship affect rural Latina breast cancer survivors' stress and depressive symptoms: The Nuevo Amanecer Rural Trial [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A103.

Among Latinas, breast cancer is the primary cause of cancer-associated mortality. Latinas experience breast cancer health disparities in disease-free survival, health-related quality of life, pain, fatigue, and anxiety, which may be a result of experiences of chronic stress. Chronic stress can impact the hypothalamic pituitary adrenal (HPA) axis, leading to changes in the tumor microenvironment and subsequently facilitate cancer progression. Little is known about the role of stress in cancer health disparities among Latinas. Our aim was to assess the feasibility of biospecimen collection and describe biologic and self-reported levels of stress using baseline data from a randomized controlled trial of a stress-management intervention among Spanish-speaking rural Latina breast cancer survivors (LBCS). We used community-based participatory research (CBPR) methods to recruit women, conduct interviews, and obtain saliva and hair samples. Recruiters were bilingual-bicultural women from local communities working in the community organizations that were research partners. Videos and print materials with graphics were developed in low-literacy Spanish to demonstrate biospecimen collection procedures. Recruiters provided instruction and demonstrations on sample collection and collected self-reported stress and depressive symptoms via in-person interviews in Spanish. Self-reported measures of stress and depressive symptoms consisted of the Perceived Stress Scale (PSS-10) and Personal Health Questionnaire (PHQ-8). Biologic stress was measured using hair (1 sample) and salivary cortisol (3 samples/day for 3 days). Mean hair cortisol concentration (HCC) in pc/mg units was used to assess chronic stress. The cortisol awakening response (CAR) measure assessed the activity of the HPA axis; curves that demonstrate a cortisol peak 30 minutes after awakening and a cortisol dip bedtime were considered normal. We recruited 103 participants from the Central Valley and Imperial County, California. Eighty-six percent provided saliva samples for CAR analysis, and 53% provided hair samples for HCC. Participants' mean age was 56 years (SD=10.6) and mean time since breast cancer diagnosis was 3.2 years (SD=3.2). Participants reported moderate (PSS mean score = 14.5; SD 7.5) stress levels and mild depression (PHQ-8 mean score = 6.3; SD 5.5). Biologic stress measurements demonstrated that 37% of participants had an abnormal CAR at baseline, and elevated HCC (mean HCC = 362.9 pg/mg). Bivariate models showed no relationship between self-reported and biologic markers of stress. Using CBPR methods leads to successful recruitment of Latinas to clinical research involving biospecimen collection. Although self-reported stress and depression were moderate or mild, biologic stress levels were high and abnormal in over 1/3 of participants, suggesting that chronic stress, and its subsequent integration into the biologic stress pathways, may help explain ethnic disparities in cancer outcomes of LBCS. Citation Format: Cathy Samayoa, Jasmine Santoyo-Olsson, Leticia Márquez-Magaña, Anna M. Nápoles. Biologic and self-reported stress levels among Latina breast cancer survivors: The Nuevo Amanecer Rural Trial [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C111.

We highlight two critical challenges that must be addressed to accelerate the advancement of the science of recruitment and retention of ethnically diverse populations into clinical research. First, we present evidence of the relative lack of attention by researchers to recruitment and retention of ethnically diverse populations. Then, we present data on the inadequacy of dedicated funding to advance systematically this field. To begin to address these challenges, we describe strategies used by the National Institute on Aging (NIA)-funded Resource Centers on Minority Aging Research and other NIA-funded programs to advance the science of recruitment and retention. Finally, we propose broad recommendations for generating a body of evidence on successful methods of recruitment and retention of ethnically diverse populations in clinical research. To eliminate cancer health disparities in ethnically diverse populations, much more research is needed on effective strategies for increasing minority enrollment in cancer research. Experimental studies in the recruitment literature that rigorously test recruitment or retention methods are an exception despite the valuable evidence they contribute. Comparative effectiveness research on recruitment and retention methods designed to address mechanisms of underrepresentation in clinical research will require dedicated funding and concerted efforts by investigators. Citation Format: Anna M. Nápoles. Advancing the science of recruitment and retention of ethnically diverse populations. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr ED01-04.

Purpose of study: The study aim was to assess associations between various acculturation measures and self-rated health (SRH), as well as potential mediation by spiritual well-being and cancer self-efficacy of any associations. Experimental procedure: Secondary analysis of data from a cross-sectional telephone survey of a population-based registry sample of 330 self-identified Latina breast cancer survivors was conducted. Multivariate logistic regression models assessed relationships between acculturation measures (i.e., the Short Acculturation Scale for Hispanics (SASH), country of birth (foreign or U.S. born), and English proficiency (main predictor)) and SRH (outcome). The role of cancer self-efficacy (measured with a version of the Cancer Behavior Inventory CBI-B) and spiritual well-being subscales (Sense of Peace/Meaning and Faith) of the Functional Assessment of Chronic Illness Therapy as mediators was also assessed in multivariate logistic regression models. New Data: The sample mean age was 58.3 years (range 30-90 years; SD 11.9), about 60% were foreign-born and approximately half were English proficient (EP, speaks English well/very well) vs. limited English proficient (LEP, speaks English not at all/poorly/fairly well). Approximately 70% were of Mexican origin, about 70% had a high school education or less, and two-thirds were privately insured. Almost all were 2-3 years post-diagnosis (283; 85.8%). The mean cancer self-efficacy score was 3.43 (SD 0.59; range 1-4). The mean sense of peace/meaning score was 26.6 (SD 5.31; range 0-32) and the mean faith score was 14.20 (SD 2.99; range 0-16). About one-quarter of the women reported poor or fair SRH. In unadjusted analyses of the acculturation measures, English proficiency demonstrated the strongest association with SRH; women who were EP were more likely than LEP women to rate their health as good/very good/excellent (OR= 2.26 CI= 1.15, 4.45, p In multivariate models English proficiency was associated significantly with SRH independent of other sociodemographic characteristics (OR=2.26; 95% CI 1.15, 4.45). Adding cancer self-efficacy to the model attenuated the effect of English proficiency on SRH (OR=1.76, 95% CI 0.87, 3.55), and self-efficacy was positively associated with SRH (OR=2.24, 95% CI 1.22, 4.10). In the final model, adding sense of peace/meaning was associated independently with SRH (OR= 2.44, 95% CI 1.30, 4.56) and attenuated the association of self-efficacy and SRH (OR=1.67, 95% CI 0.88, 3.18). Conclusion: The association of English proficiency with SRH was partially mediated by cancer self-efficacy and sense of peace/meaning, with the latter explaining much of the effect. Findings support development of interventions for Latina breast cancer survivors that target modifiable resiliency factors, like sense of peace/meaning or self-efficacy, to address racial disparities in quality of life (QOL) and SRH for Latina breast cancer survivors; particularly for those at risk of poorer QOL and SRH given English proficiency limitations. This abstract is also presented as Poster B25. Citation Format: Maria DeLourdes Garcia-Jimenez, Jasmine Santoyo-Olsson, Carmen Ortiz, Anna M. Napoles. The effect of language on the self-rated health of Latina breast cancer survivors: Cancer self-efficacy and spiritual well-being as potential mediators of this association. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr PR05.