||5UG3CA260317-02 Interpret this number
||University Of Miami Coral Gables
||Avanzando Caminos (Leading Pathways): the Hispanic/Latino Cancer Survivorship Cohort Study.”
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.
Cancer Epidemiology in Hispanic Populations: What Have We Learned and Where Do We Need to Make Progress?
, Ramirez A.G.
, Nápoles A.M.
, Gomez S.L.
, Stern M.C.
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2022-05-04; 31(5), p. 932-941.