By Cliff Despres
Latinos with cancer face a tough survivorship journey. Many suffer advanced disease, poor quality of life, and stressful social and economic inequities.
This is why a new, first-of-its-kind national cohort study will unpack the social, cultural, behavioral, psychosocial, biological, and medical influences on post-cancer life in Latino cancer survivors to fill a crucial gap in knowledge about their survivorship experience.
The study, “Avanzando Caminos (Leading Pathways): The Hispanic/Latino Cancer Survivorship Study,” is funded by a six-year, $9.8 million grant from the National Cancer Institute (NCI) that will team up two of its Cancer Centers, the Mays Cancer Center, home to UT Health San Antonio MD Anderson, and the Sylvester Comprehensive Cancer Center at the University of Miami.
Avanzando Caminos will recruit a diverse cohort of 3,000 Latino breast, colorectal, kidney, lung, prostate, stomach or cervical cancer survivors in Miami and San Antonio.
Cancer researchers will study how different issues ─ discrimination, depression, chronic stress, diet, biological markers, genetics and many more ─ impact these Latino survivors’ symptom burdens, health-related quality of life and disease activity.
“Our study will tell us important information we can use to help future Latino cancer survivors heal, recover and reduce the chances of cancer coming back,” said Amelie G. Ramirez, DrPH, study co-principal investigator at The University of Texas Health Science Center at San Antonio (UT Health San Antonio) and associate director of cancer outreach and engagement at the Mays Cancer Center, an NCI-designated Cancer Center.
“The opportunity to assess multiple determinants of quality of life and health outcomes among Latino cancer survivors who are diverse in regard to country of origin and geographic location in the U.S. will help us better understand how social, cultural, behavioral, psychosocial and biological factors impact cancer outcomes, and to guide interventions that promote optimal well-being,” said Frank J. Penedo, PhD, study co-principal investigator at the Sylvester Comprehensive Cancer Center.
Why Latino cancer survivors?
Cancer survivorship is a critical emerging area of research.
Research on Latino cancer survivors is especially important, as this population experiences many unique burdens before and after a cancer diagnosis.
U.S. Latinos face a staggering 142% projected rise in cancer cases by 2030.
Latinos have a higher risk for certain cancers, such as liver cancer, compared to whites. This stems from cultural barriers to care, low screening rates, underrepresentation in clinical studies, and data that fails to reflect the diversity within the U.S. Latino population.
After a cancer diagnosis, Latinos often fare worse than their peers, too.
Limited work in Latino survivorship suggests that they are more likely to present with advanced disease and report greater symptom burden and poorer health-related quality of life.
“Latino cancer survivors are more likely to report lower socioeconomic status, rates of educational attainment and insurance coverage, and greater barriers to stable housing, transportation and healthy food than their peers,” Dr. Penedo said. “These challenges are often compounded by greater exposure to chronic stressors and discrimination, with subsequent greater rates of anxiety and depression.”
How Will the ‘Avanzando Caminos’ study help Latino cancer survivors?
Drs. Ramirez and Penedo have a long history of tackling Latino cancer.
Dr. Ramirez created and led the NCI-funded Redes En Acción national Latino cancer research network for 20 years. Dr. Penedo led one of the network’s regional sites for 10 years.
Redes conducted a six-city study in 2013 that proved that patient navigation reduces Latinas’ delay between abnormal screening results and cancer diagnosis and treatment.
Based on that success, Drs. Ramirez and Penedo wanted to test patient navigation’s impact on Latino cancer survivors.
Together they found Latino cancer survivors who have a “next-level” patient navigator — one who regularly calls to offer support and culturally tailored materials — have better health-related quality of life than survivors with a more passive navigator, according to their 2020 study of 288 Latino cancer survivors in San Antonio and Chicago, published in the journal Cancer.
“Based on our Redes studies, we have learned the importance of understanding the different factors that impact Latino survivors compared to their peers, as these issues are so closely linked with the social determinants of health, genetics and the Afro-Caribbean to European ancestry of Latinos,” Dr. Ramirez said.
Now, Avanzando Caminos will enable Drs. Ramirez and Penedo to look closer at Latino survivors.
The duo and their teams will spend the next six years from 2021 to 2027 documenting and analyzing all aspects of the Latino cancer survivorship journey.
They will examine:
- Sociocultural factors: acculturation, health literacy, access to care;
- Stress factors: chronic stress, discrimination, trauma;
- Psychosocial factors: emotions, social cohesion, social support;
- Lifestyle factors: diet, physical activity, substance use;
- Biological factors: cardiometabolic markers, gene expression;
- Demographic factors: age, gender, rural/urban location, Latino heritage; and
- Medical factors: cancer type, stage, comorbidities.
“Until now, no national cohort study has comprehensively assessed and mapped the journey of this specific population,” Dr. Ramirez said. “We expect Avanzando Caminos to provide novel, critically needed information to inform and guide cancer prevention efforts and identify modifiable psychosocial, behavioral and biological mechanisms that may be targeted via interventions or clinical management to improve survivorship outcomes.”
Why Latino cancer survivors in San Antonio?
For Avanzando Caminos, Dr. Ramirez will recruit 1,500 Latino cancer survivors from South Texas via the Mays Cancer Center and the Texas Cancer Registry.
The region is home to 4.9 million people, of whom 69% are Latino (mostly Mexican Americans). Nearly half of the residents in the area speak Spanish as their primary language. About 25% of people live in poverty and 26% did not complete high school.
“This region faces substantial disparities in liver, cervical and stomach cancers,” Dr. Ramirez said.
The new project adds to the Mays Cancer Center’s diverse portfolio of research and outreach to address the cancer burden of the largely Latino population in South Texas.
This includes the Advancing the Science of Cancer in Latinos conference, co-hosted biennially by Dr. Ramirez’s Institute for Health Promotion Research and the Mays Cancer Center.
The first two conferences in 2018 and 2020 brought together 80 guest speakers and more than 600 prominent attendees from 25 states, from the District of Columbia and New York to California and Puerto Rico, including esteemed researchers, physicians, health care professionals, patient advocates and aspiring students. The conferences sparked ideas for research, practice and communication to address Latino cancer health disparities, and led to multidisciplinary collaborations to build substantial advancements in cancer, from prevention through survivorship.
The next Advancing the Science of Cancer in Latinos conference is set for Feb. 23-25, 2022, in San Antonio. The event is co-hosted by Dr. Ramirez’s institute and the Mays Cancer Center.
“Advancing cancer research in Latinos is a critical part of our mission to eliminate cancer in South Texas and beyond,” said Ruben Mesa, MD, FACP, executive director of the Mays Cancer Center. “We are excited to partner with the Sylvester Comprehensive Cancer Center on this new work.”
Why Latino cancer survivors in Miami?
For Avanzando Caminos, Dr. Penedo will recruit 1,500 Latino cancer survivors from Miami’s Sylvester Comprehensive Cancer Center and the Florida Statewide Cancer Registry.
The region is home to 6 million people, of whom 44% are Latino (including 44% Cubans, 18% South Americans,14% Central Americans, 10% Puerto Ricans and 5% Mexicans). A greater percentage of residents lack prose literacy (33% vs. 15% in the U.S.), live in poverty (14% vs. 11%) and have limited access to formal health care (24% vs. 13%) than the rest of the U.S.
“Significantly higher rates of cervical and prostate cancers plague this region,” Dr. Penedo said.