Researchers Unravel Hispanic Cancer Survivors’ Experience
Article Summary
- Avanzando Caminos is a study that looks to identify factors that drive poor health outcomes among Hispanics following cancer treatments.
- Principal investigator Dr. Frank Penedo is investigating why Hispanics are less likely to achieve quality-of-life levels comparable to what they had before cancer.
- The study is focusing on the impact of contextual, cultural and psychosocial factors on health after cancer treatment.
The National Cancer Institute’s (NCI) six-year, $9.8 million Avanzando Caminos (Leading Pathways) Hispanic/Latino Cancer Survivorship Study has entered its second phase. Avanzando Caminos seeks to identify multiple factors that drive poor quality and health outcomes among Hispanics following primary cancer treatments.
Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine, leads the observational study in collaboration with Mays Cancer Center at the University of Texas Health Science Center at San Antonio. Researchers are examining how social, cultural, behavioral, psychosocial, biological and medical factors impact Latinos after cancer treatment.
A Heavy and Puzzling Cancer Burden
The landmark study of 3,000 Hispanic cancer survivors of diverse Hispanic origin is the largest survivorship study to date and includes survivors of common as well as rare cancers.
Cancer is the leading cause of death for Hispanics/Latinos in the United States. Hispanics are less likely to achieve quality-of-life levels comparable to what they had before they were treated for cancer. In some cases, they report greater symptom burden and experience less favorable treatment outcomes, according to Frank Penedo, Ph.D., the Avanzando Caminos’ lead principal investigator.
“We don’t fully understand why that is the case,” said Dr. Penedo, who is also associate director for population sciences and director of cancer survivorship and supportive care at Sylvester.
Leading Pathways will use data to understand the “why.” Unlike prior, smaller studies of Hispanics that have focused on groups from specific geographic locations, a single Hispanic heritage background or less acculturated communities, this study will include Hispanics of Mexican, Cuban, Caribbean, Central American and South American descent.
Initial Phase a Success
Funding for this phase of Leading Pathways depended on meeting NCI benchmarks in the study’s first three years.
“We met the benchmarks of recruiting at least 18% of the sample and collecting at least 85% of the assessments we proposed to collect, which included comprehensive psychosocial assessments and blood samples,” Dr. Penedo said. “To date, we have recruited 700 of the 3,000 participants, so we’re on track.”
Dr. Penedo, a professor of psychology and medicine at the Miller School, is working with his colleagues to continue conducting the study’s large-scale assessments and follow-ups.
“These are comprehensive assessments that tap into multiple determinants of quality of life, symptom burden and disease activity and outcomes,” Dr. Penedo said. “We’re looking at contextual factors, like socioeconomic status and neighborhood composition, as well as cultural values like family interdependence that are prevalent in the Hispanic community. We’re also looking at typical psychosocial and behavioral factors like coping, social support, emotional distress, diet, physical activity and sleep. Biological markers being collected, such as pro-inflammatory and pro-angiogenic signaling, may show how social determinants of health and psychosocial factors get under the skin and affect symptom burden such as pain, fatigue, cognitive function and disease activity, including multiple health outcomes.”
Study Progress, Challenges
Dr. Penedo and colleagues have found, that recruiting Hispanics with less common cancers, like liver, lung and kidney cancers, has proven challenging.
“Despite enormous efforts to get participants with these cancers, we’re finding that, by the time those patients present to our clinics, they have metastatic disease, which is the most advanced stage of the disease and is harder to treat and were initially excluded from the study,” he said. “We worked with the NCI to revise our criteria to include participants with advanced disease to make sure we capture these challenging cancers.”
For many study participants, cancer is one of multiple health concerns.
“We’re also finding higher rates than we expected of comorbid conditions, like diabetes, hypertension and kidney disease,” Dr. Penedo said. “That means that many of our participants are not only dealing with cancer but also these other chronic conditions, which add significant burden and is often challenged by financial, caregiving and other challenges the community is facing.”
On the data side, researchers have found their methodology to be user-friendly, reliable and valid for assessing the study measures.
The next four years will paint a much more detailed picture of how the factors being evaluated in the study impact Hispanics after cancer treatment. Sylvester’s experience and continued commitment to working with South Florida’s Hispanic cancer community position the organization to tackle the study’s challenges.
“As an NCI-designated cancer center with a proven track record for community engagement and research efforts to address the unique needs of our community, the NCI took notice,” Dr. Penedo said. “NCI also noted the infrastructure that we have in place and how we work so well with the community to address cancer’s burden. That, along with the collaborative nature and expertise of our investigators and our history of working with the Mays Cancer Center, made all this come together.”
Tags: Avanzando Caminos, cancer research, Dr. Frank Penedo, Sylvester Comprehensive Cancer Center