Cancer survivorship is an emerging area of research, yet the survivorship experience differs significantly between racial-ethnic groups. Latinos with cancer, for example, face a challenging survivorship journey marked by advanced disease, poor quality of life, and stressful socioeconomic inequities.
The Mays Cancer Center, home to UT Health San Antonio MD Anderson Cancer Center, is working to increase diverse patient populations, including Latinos, in clinical trials. A founding member of the Advancing Inclusive Research® Site Alliance, Mays Cancer Center, and its partners will test population-specific recruitment and retention approaches and establish best practices to achieve health equity for cancer patients.
Researchers at the Mays Cancer Center and the Sylvester Comprehensive Cancer Center at the University of Miami have teamed up to investigate population-specific barriers to cancer survival amongst Latinos. This first-of-its-kind national cohort 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).
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. This study will investigate how various factors—discrimination, depression, chronic stress, diet, biological markers, genetics, and more─ impact Latino survivors’ symptom burdens, disease activity, and health-related quality of life. This study will unpack how social, cultural, behavioral, psychosocial, biological, and medical factors influence post-cancer life for Latino cancer survivors, filling a crucial gap in knowledge about their survivorship experience.
Advancing treatment for the Latino population is crucial
Compared to non-Hispanic white individuals, Latinos are at increased risk for certain cancers, especially liver, stomach, and cervical cancers. ¹Disparities in cancer diagnosis rates result 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.
In addition to the increased incidence of certain cancers among Hispanics, this population also experiences worse clinical outcomes and increased cancer-related mortality rates. Latinos diagnosed with liver cancer are twice as likely to die than their non-Hispanic white counterparts. The mortality rate amongst Latina women diagnosed with stomach or cervical cancers is 20% more than non-Hispanic white women.¹
U.S. Latinos face a staggering 142% projected rise in cancer cases by 2030. This demographic is currently 18% of the U.S. population and will rise to 30% by 2050, highlighting the urgent need for community-specific interventions.² Because Latinos represent 64% of San Antonio’s population and 84% of other areas in South Texas, advancing treatment for this community is a critical step in eliminating cancer in the region.
Aside from disparities in cancer-related mortality and other clinical outcomes, Latinos’ cancer survivorship experience is relatively understudied. However, limited research in this field suggests that Latinos are more likely to present with advanced disease and report more symptom burden and inferior health-related quality of life.
Latinos are underrepresented in clinical trials, despite bearing a large burden of disease
The lack of robust representative data in clinical trials has significantly impeded medical and scientific advances, further exacerbating existing health disparities. Ideally, clinical research should reflect real-world disease demographics so that it can be generalizable across patient populations. Yet, fewer than 10% of U.S. patients participate in clinical trials, and of those, only 1% are Latino. While cancer is the leading cause of death amongst Latinos, only 1.3% of eligible Latino cancer patients participate in cancer-related clinical trials.³ Distrust in the health care system, lack of access to nearby trial sites, and insufficient engagement with underserved communities are among the known drivers of these disparities.
Recognizing the lack of representation of Latinos and other ethnic populations in clinical research studies, the Mays Cancer Center became a founding partner of the Advancing Inclusive Research® Site Alliance. City of Hope O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, and West Cancer Center join the Mays Cancer Center as founding partners. In partnership with Genentech, a member of the Roche Group, these clinical research sites facilitate the participation of historically underrepresented patient groups in Genentech’s oncology trials, working collaboratively to share key learnings and explore innovative ways to increase clinical trial access for patients who might benefit. The ultimate goal of the Alliance is to build a robust and sustainable clinical research ecosystem that actively includes diverse patient groups.
“Avanzando Caminos (Leading Pathways): The Hispanic/Latino Cancer Survivorship Study” is one example of Mays Cancer Center’s demonstrated commitment to diversity and inclusion in clinical research. The Mays Cancer Center and its partner, the Sylvester Comprehensive Cancer Center, seek to investigate multiple determinants of quality of life and health outcomes among Latino cancer survivors to understand how social, cultural, behavioral, psychosocial, and biological factors impact cancer outcomes.
Avanzando Caminos will recruit 1500 Latino cancer survivors from South Texas via the Mays Cancer Center and the Texas Cancer Registry and 1,500 Latino cancer survivors from Miami’s Sylvester Comprehensive Cancer Center and the Florida Statewide Cancer Registry. South Texas is home to 4.9 million people, 84% of whom are Latino (primarily Mexican Americans), and Miami is home to 6 million people, 44% of whom are Latino (mostly Cubans). In both regions, Latinos face substantial disparities in cancers– liver, cervical, and stomach in South Texas and cervical and prostate in Miami.
The patients recruited for the study experience economic disparities that can impact their access to medical care. Both study regions have poverty rates above the national average. One in four South Texas residents and one in seven Miami residents live below the federal poverty line—compared to one in ten U.S. residents. The poverty rate in Miami has resulted in a quarter of its residents lacking access to formal health care—nearly twice the national average.
Language, literacy, and education are social factors that also play a role in health outcomes. Nearly half the residents of South Texas speak Spanish as their primary language, and a quarter of the residents did not complete high school. Similarly, one in three Miami residents lacks prose literacy.
The Caminos cohort is a representative sample of Latino cancer survivors, who are more likely to report lower socioeconomic status and rates of educational attainment and insurance coverage in addition to barriers to stable housing, transportation, and food security. These challenges, compounded by greater exposure to chronic stressors and discrimination and consequently higher rates of anxiety and depression, contribute to the poor post-cancer outcomes seen amongst U.S. Latinos.
Avanzando Caminos: a revolutionary research study
Avanzando Caminos is the first national cohort study of its kind to comprehensively assess and map the Latino survivorship experience. Researchers expect the study to provide novel information to guide cancer prevention efforts and interventions to improve cancer survivorship for this demographic.
The study’s principal investigators, Amelie G. Ramirez, DrPH, Professor and Chair of Population Health Sciences, Associate Director of Cancer Outreach and Engagement, Mays Cancer Center, and Frank J. Penedo, Ph.D., Director of Cancer Survivorship & Behavioral Translational Sciences, Sylvester Comprehensive Cancer Center, have spent much of their careers investigating cancer amongst Latinos, contributing much-needed research to this understudied area. Dr. Ramirez created and led the NCI’s Redes En Acción: The National Latino Cancer Research Network for 20 years, and Dr. Penedo led one of the Network’s regional sites for ten years.
Under the leadership of Dr. Ramirez, Redes conducted the Redes En Accion Survivorship study across six cities to investigate an innovative patient navigation intervention for Latinas with breast cancer. The study, which began in 2013, concluded that patient navigation reduces Latinas’ delay between abnormal screening results and cancer diagnosis and treatment.
The success of the Redes En Accion Survivorship study led Drs. Ramirez and Penedo to study the impact of patient navigation on Latino cancer survivors. Their 2020 study, which included 288 Latino cancer survivors from San Antonio and Chicago, revealed that Latino cancer survivors had a better health-related quality of life if their patient navigator routinely checked in and provided culturally specific health education materials—establishing the need for culturally and linguistically appropriate materials for Latino cancer patients.
The results of both Redes studies confirm that social determinants of health, genetics, and Latinos’ heterogeneous ancestry play a role in survivorship disparities. The Avanzando Caminos study will take a closer look at these factors and their impact on health-related quality of life for U.S. Latinos.
Avanzando Caminos, which will occur from 2021 to 2027, will document and analyze all aspects of the Latino cancer survivorship journey.
Specifically, the study 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 characteristics: age, gender, rural/urban location, Latino heritage; and
- Medical factors: cancer type, stage, comorbidities.
Avanzando Caminos is just the latest in the Mays Cancer Center’s impressive portfolio of research and outreach to address the cancer burden of the majority Latino population in South Texas. The Center also co-hosts the biennial Advancing the Science of Cancer in Latinos conference, alongside Dr. Ramirez’s Institute for Health Promotion Research. The next conference is scheduled for February 23-25, 2022.
Drs. Ramirez and Penedo’s research has sparked research and innovation to address Latino cancer health disparities. UT Health San Antonio will continue participating in multidisciplinary collaborations, such as the Avanzando Caminos study and the Alliance, to advance critical cancer research—from prevention through survivorship—for medically underserved communities.
The Mays Cancer Center is one of only four National Cancer Institute-designated Cancer Centers in Texas and the only center in Central and South Texas. The Mays Cancer Center provides leading-edge cancer care, propels innovative cancer research and educates the next generation of clinicians to decrease the burden of cancer in San Antonio, South Texas and Beyond. Visit cancer.uthscsa.edu.
[1] Cancer and Hispanic Americans. Office of Minority Health. US Department of Health and Human Services. (2020, February 28). Retrieved July 26, 2021, from https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64
[2] Coakley M, Fadiran EO, Parrish LJ, Griffith RA, Weiss E, Carter C. Dialogues on diversifying clinical trials: successful strategies for engaging women and minorities in clinical trials. J Womens Health (Larchmt). 2012 Jul;21(7):713-6. doi: 10.1089/jwh.2012.3733. PMID: 22747427; PMCID: PMC3432572.
[3] Rangel ML, Heredia NI, Reininger B, McNeill L, Fernandez ME. Educating Hispanics About Clinical Trials and Biobanking. J Cancer Educ. 2019 Dec;34(6):1112-1119. doi: 10.1007/s13187-018-1417-6. PMID: 30112612; PMCID: PMC6377344.