Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan.
Department of Oncology, School of Medicine, Wayne State University, Detroit, Michigan.
Cancer Epidemiol Biomarkers Prev. 2019 Apr;28(4):666-674. doi: 10.1158/1055-9965.EPI-18-0123. Epub 2018 Nov 27.
African Americans are often diagnosed with advanced stage cancer and experience higher mortality compared with whites in the United States. Contributing factors, like differences in access to medical care and the prevalence of comorbidities, do not entirely explain racial differences in outcomes.
The Detroit Research on Cancer Survivors (ROCS) pilot study was conducted to investigate factors related to short- and long-term outcomes among patients with cancer. Participants completed web-based surveys, and mailed saliva specimens were collected for future genetic studies.
We recruited 1,000 participants with an overall response rate of 68%. Thirty-one percent completed the survey without any interviewer support and the remaining participated in an interviewer-administered survey. Seventy-four percent provided a saliva specimen and 64% consented for tumor tissue retrieval. African American survivors required more interviewer support ( < 0.001); however, their response rate (69.6%) was higher than non-Hispanic whites (65.4%). African Americans reported poorer overall cancer-related quality of life compared with non-Hispanic whites, measured by FACT-G score ( < 0.001), however, this relationship was reversed after controlling for socioeconomic factors, marital status, and the presence of comorbidities.
In this pilot study, we demonstrated that a web-based survey supplemented with telephone interviews and mailed saliva kits are cost-effective methods to collect patient-reported data and DNA for large studies of cancer survivors with a high proportion of minority patients. The preliminary data collected reinforces differences by race in factors affecting cancer outcomes. Our efforts continue as we expand this unique cohort to include more than 5,000 African American cancer survivors.
Formal investigation of factors influencing adverse outcomes among African American cancer survivors will be critical in closing the racial gap in morbidity and mortality.
在美国,非裔美国人常常被诊断出患有晚期癌症,且死亡率高于白人。造成这种差异的原因,如获得医疗保健的机会不同和合并症的流行程度等,并不能完全解释结果方面的种族差异。
底特律癌症幸存者研究(ROCS)是一项旨在调查癌症患者短期和长期结果相关因素的试点研究。参与者完成了在线调查,并邮寄了唾液样本,以备将来进行遗传研究。
我们招募了 1000 名参与者,总体响应率为 68%。31%的参与者在没有任何采访者支持的情况下完成了调查,其余的则参与了采访者管理的调查。74%的参与者提供了唾液样本,64%的参与者同意提取肿瘤组织。非裔美国幸存者需要更多的采访者支持(<0.001);然而,他们的响应率(69.6%)高于非西班牙裔白人(65.4%)。非裔美国人报告的整体癌症相关生活质量较差,与 FACT-G 评分相比(<0.001),但在控制社会经济因素、婚姻状况和合并症存在后,这种关系发生了逆转。
在这项试点研究中,我们证明了一种基于网络的调查方法,辅之以电话访谈和邮寄唾液试剂盒,是一种收集患者报告数据和 DNA 的经济有效的方法,可用于对具有高比例少数族裔患者的癌症幸存者进行大型研究。收集的初步数据强化了种族差异在影响癌症结果的因素方面的作用。随着我们将这一独特的队列扩大到包括 5000 多名非裔美国癌症幸存者,我们的工作仍在继续。
对影响非裔美国癌症幸存者不良结果的因素进行正式调查对于缩小发病率和死亡率方面的种族差距至关重要。