Study explores disproportionately higher mortality among black cancer survivors

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May 19, 2017

Researchers from Barbara Ann Karmanos Cancer Institute and Wayne State University School of Medicine received a 5-year, $9 million grant from NCI to investigate why mortality rates are higher among black cancer survivors.

“Disparities in cancer survivorship that disproportionately burden African Americans are the product of the complex interactions occurring among genetic and biological factors and social, behavioral and environmental factors,” Ann G. Schwartz, PhD, MPH, professor and deputy center director for population sciences at Karmanos Cancer Institute and Wayne State University School of Medicine, said in a press release. “It is crucial that we better understand why African Americans are often diagnosed with cancer at higher rates and why survival after that diagnosis is lower than in other populations.”

Ann G. Schwartz

Joanne W. Elena

Schwartz and colleagues secured the NCI funding with a pilot study supported by a $400,000 grant from the GM Foundation and additional funds from Karmanos Cancer Institute.

The Detroit Research on Cancer Survivors study will include 5,560 cancer survivors who live in the Detroit metropolitan area. Investigators will focus on individuals with four cancer types most often associated with poorer survival among black individuals: lung, breast, prostate and colorectal cancers.

Researchers also will assess how cancer diagnoses affect the mental, physical and financial health of cancer survivors’ family members and caregivers.

HemOnc Today spoke with Schwartz and Joanne W. Elena, PhD, MPH, program director in the Epidemiology and Genomics Research Program at NCI, about the study and the potential impact the findings will have for the clinical community.

Question: How did this study come about?

Schwartz: We have been studying racial disparities in cancer incidence and survival for several years. We are home to one of NCI’s SEER programs, and we have been collecting cancer data in the Detroit metropolitan area since 1973. The NCI released a mechanism that would allow us to apply for funds to build the infrastructure for collecting data on a very large cohort of patients with cancer. We applied for this grant to focus on what is happening in the Detroit area: African Americans, almost across the board, have higher cancer incidence rates and higher mortality rates than whites.

Q: What will the research entail?

Schwartz: We will identify African Americans with lung, breast, prostate and colon cancers from our metropolitan Detroit SEER registry and ask them to participate in a web-based or telephone interview. The questionnaire portion focuses on many topics, including behaviors such as diet, exercise, smoking and alcohol use. Other questions will assess family history of cancer, quality of life, treatment, and consequences of treatment, such as fatigue. We also will ask participants about financial hardships associated with cancer diagnosis and treatment, such as whether patients can pay for their treatment and how that affects outcomes.

Participants will be followed for 5 years. We plan to enroll throughout the 5-year period, and we will ask participants if we can contact them annually for follow-up. Saliva and tumor tissue will be collected and analyzed. The biospecimens will be used for studies of genetics and tumor biology. Caregivers of about half of these patients will be included in the study so we can understand the issues they face.

Q: What are some potential explanations for cancer d isparities in this population?

Schwartz: This is one of the reasons we are conducting this research. There are certain factors that we speculate may be involved, but a study of this magnitude has not been done, so these factors may vary by cancer type. There likely are issues of access to care, including newer, targeted therapies. Different distributions of prognostic factors, such as obesity or other comorbid conditions, may affect survival. There also may be biological differences.

Elena: Part of the impetuous for driving this study is that we truly do not know. However, the major areas that we suspect are access to care, environmental exposures, poverty, stress, discrimination, and possibly some biological causes, such as genetic susceptibilities to cancer. Investigators will study these areas for potential explanations.

Q: What effect do you hope the findings will have on the clinical community?

Schwartz: Our hope is that we can identify the factors that contribute to poorer outcomes in African Americans so we can design new interventions, whether they are more targeted therapies based upon tumor biology or whether they relate to navigating the health care system.

Elena: I hope researchers identify some points that we can use to intervene and make changes for cancer survivors by identifying modifiable risk factors so we can hopefully improve the overall survivor experience for African Americans, as well as all other cancer survivors.

Q: What does being a part of this study mean to you?

Schwartz: We have long recognized racial disparities in cancer risk and outcomes, and we finally have the opportunity to field a very large study that will help our community. The hope is to be able to move the science forward, and to demonstrate that what is happening in the African American community is important and we need to understand it so we can target issues that are specific to this population.

Q: Once this study is complete, do you anticipate future research?

Schwartz: As we conduct this study, when we see issues that need further research, we will be able to spin off studies and ask more detailed questions in those areas. We also hope to extend this beyond the initial four cancer types.

Q: Is there anything else that you would like to mention ?

Schwartz: This collaboration includes front-line clinicians, as well as other members of the health care community, such as genetic scientists, behavioral scientists and epidemiologists. We are going to get the most ‘bang for our buck’ by working as a multidisciplinary team so we address the big picture instead of focusing on smaller pieces of the problem individually.

Elena: We are excited about identifying factors that will affect cancer progression, recurrence, mortality and quality of life among African American cancer survivors to better impact health. – by Jennifer Southall

For more information:

Joanne W. Elena, PhD, MPH, can be reached at joanne.elena@nih.gov.

Ann G. Schwartz, PhD, MPH, can be reached at Karmanos Cancer Institute, 4100 John R St., Detroit, MI 48201; email: schwarta@karmanos.org.

Disclosure: Elena and Schwartz report no relevant financial disclosures.

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