Grant Number:	5UH3CA260317-05 Interpret this number
Primary Investigator:	Penedo, Frank
Organization:	University Of Miami Coral Gables
Project Title:	Avanzando Caminos (Leading Pathways): the Hispanic/Latino Cancer Survivorship Cohort Study.”
Fiscal Year:	2026

Cancer is the 2nd leading cause of death among Hispanics (Hs) in the US, who account for 57.5 million Americans (18%). Hs represent a high-risk group regarding prevalence, invasiveness, symptom burden, mortality in specific cancers (e.g., cervix, liver, stomach), and multiple patient-reported outcomes (PROs) regardless of disease site. Furthermore, they present with greater comorbidities and report poorer health-related quality of life (HRQoL). Survivorship in Hs is further compromised by limited insurance coverage and limited access to care. Despite this higher risk, risk and protective factors that may explain adverse outcomes remain poorly understood as studies in Hs have been limited due to: (a) small samples with short follow-ups; (b) focus on common cancers (e.g., breast or prostate), limiting attention to high-prevalence/mortality sites; (c) restricted Hs origin and SES representation; and (d) lack of guiding models considering multiple drivers (e.g., medical, stress, psychological, lifestyle, and biological factors) of survivors’ outcomes. Leading Pathways: the Hispanic/Latino Cancer Survivorship Cohort Study will involve recruitment, assessment and follow-up of ~3,000 Hs who completed primary cancer treatment within the past 2 years and represent multiple H backgrounds, urban and rural communities and cancer site across two US metropolitan areas—Miami and San Antonio. Both areas have large H populations (~65% of Miami; ~64% of San Antonio), with varied H origin, urban vs. rural residence and SES, and are served by NCI-designated cancer centers. The Florida Cancer Data System and the Texas Cancer Registry will supplement recruitment (~30% of the 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 evaluated as determinants of our outcomes: (1) demographic (e.g., SES, access to care); (2) stress and adversity (e.g., chronic and traumatic stress, medical stress); (3) psychological (e.g., family 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 Hs and other high-risk communities. Information gained regarding risk and protective factors, will contribute to primary and secondary prevention targets to ameliorate risk in multiple cancer high-risk populations.