Kimlin T. Ashing-Giwa

De novo sequencing of circulating miRNAs identifies novel markers predicting clinical outcome of locally advanced breast cancer

BackgroundMicroRNAs (miRNAs) have been recently detected in the circulation of cancer patients, where they are associated with clinical parameters. Discovery profiling of circulating small RNAs has not been reported in breast cancer (BC), and was carried out in this study to identify blood-based small RNA markers of BC clinical outcome.MethodsThe pre-treatment sera of 42 stage II-III locally advanced and inflammatory BC patients who received neoadjuvant chemotherapy (NCT) followed by surgical tumor resection were analyzed for marker identification by deep sequencing all circulating small RNAs. An independent validation cohort of 26 stage II-III BC patients was used to assess the power of identified miRNA markers.ResultsMore than 800 miRNA species were detected in the circulation, and observed patterns showed association with histopathological profiles of BC. Groups of circulating miRNAs differentially associated with ER/PR/HER2 status and inflammatory BC were identified. The relative levels of selected miRNAs measured by PCR showed consistency with their abundance determined by deep sequencing. Two circulating miRNAs, miR-375 and miR-122, exhibited strong correlations with clinical outcomes, including NCT response and relapse with metastatic disease. In the validation cohort, higher levels of circulating miR-122 specifically predicted metastatic recurrence in stage II-III BC patients.ConclusionsOur study indicates that certain miRNAs can serve as potential blood-based biomarkers for NCT response, and that miR-122 prevalence in the circulation predicts BC metastasis in early-stage patients. These results may allow optimized chemotherapy treatments and preventive anti-metastasis interventions in future clinical applications.

Diagnostic and therapeutic delays among a multiethnic sample of breast and cervical cancer survivors

Several publications reporting on health disparities document that ethnic minorities disproportionately experience delays in healthcare access, delivery, and treatment. However, few studies examine factors underlying access and receipt of healthcare among cancer survivors from the patient perspective. This study explores diagnostic and therapeutic care delays among a multiethnic sample of breast and cervical cancer survivors and examines contextual factors influencing diagnostic and therapeutic care delays.

Understanding the cultural health belief model influencing health behaviors and health-related quality of life between Latina and Asian-American breast cancer survivors.

PurposeThe purpose of this study was to (1) describe health behaviors and health-related quality of life (HRQOL) of Latina and Asian-American breast cancer survivors (BCS), (2) estimate possible culturally driven predictors of health behaviors and HRQOL, and (3) compare pathways for predicting health behaviors and HRQOL between the two groups.Materials and methodsSecondary data were used to investigate health behaviors and HRQOL among 183 Latina and 206 Asian Americans diagnosed with breast cancer. The study methodology was guided by the health belief model and the contextual model of HRQOL. Structural equation modeling was used to test cultural predictors on health behaviors of BCS.ResultsAsian Americans reported higher emotional and physical well-being scores than Latina-Americans. Confirmatory factor analyses demonstrated the adequacy of the two-factor model (“powerful others” and “sociocultural factors”) in the cultural health belief construct for Latina and Asian-American BCS. In the structural model, Latinas and Asian Americans showed different pathways in the predicted relationships among the variables. For Latina-Americans, doctor–patient relationship was positively related to exercise, and in turn, influenced physical and emotional well-being. For Asian Americans, treatment decisions and the “sociocultural factor” were significantly related to stress management.ConclusionThis study adds to the existing literature in that no study has focused on cultural health beliefs and health behaviors between Latina and Asian-American BCS. Evidence that Latinas and Asian Americans varied in the patterns of cultural factors influencing health behaviors and HRQOL might lead to the development of culturally sensitive breast cancer interventions for promoting positive health behavior and ultimately increasing HRQOL.

Are survivorship care plans responsive to African-American breast cancer survivors?: voices of survivors and advocates

PurposeAfrican-American breast cancer survivors (AABCS) suffer the greatest from cancer recurrence, morbidity, and mortality in part due to the lack of cancer follow-up care and surveillance. To improve survival and survivorship, the Institute of Medicine advises that cancer survivors be provided a survivorship care plan (SCP). The current study investigated AABCS’ understanding of SCP and gathered preliminary feedback on infusing cultural and socioecological responsiveness.MethodsThe study embraced a community-based participatory research framework. Three facilitated, structured, consensus meetings were conducted with AABCS (N = 25) and advocates (N = 3) to provide information towards identifying the content domains of an SCP that are culturally responsive to AABCS.ResultsAABCS recommended inclusion of patient-centered information on the purpose and use of the SCP. They raised concerns that higher mortality in AABCS may be due to greater comorbidities and inadequate surveillance and follow-up care. Participants recommended that the SCP document all comorbidities and medications, regardless of relationship to cancer; referrals for cancer-related providers; and culturally informed health advisories.ConclusionStudy findings indicate that the available SCP template lacked adequate content on health history, comorbidity, health promotion, and functioning. These factors constitute the underlying clinical, psychosocial, and behavioral risks for poor disease outcomes that may be exacerbated in AABCS.Implications for Cancer SurvivorsSCPs are intended to educate and activate patients to join their oncology care team as informed partners. However, the emerging science and implementation of SCPs seem void of patient input. Our investigation suggests a practical approach for survivor engagement in the SCP discourse to increase their cultural responsiveness and patient-centeredness.

Depressive symptomatology among Latina breast cancer survivors.

Healthcare professionals are providing care for a growing number of Latinas who are breast cancer survivors (BCS) and at greater risk for distress. This study reports on the prevalence of depressive symptomatology among a cohort of Latina BCS.

Examining the effect of minority status and neighborhood characteristics on cervical cancer survival outcomes

OBJECTIVE Understanding the factors that contribute to mortality and survival is central to health outcome research. The purpose of this study was to investigate the following: (1) differences in survival status by ethnicity and neighborhood median income level; and (2) individual- and neighborhood-level factors influencing cervical cancer survival. METHODS This study was based on data from 1811 cervical cancer cases obtained through the California Cancer Surveillance Program. The dependent variable was days of survival from date of cancer diagnosis. Zip code-based neighborhood-level variables were obtained from Census 2000 data. RESULTS Ethnicity was significantly associated with survival (χ²=20.58; p<0.001), with African-Americans showing the shortest survival. The 5-year survival rates of European-, African-, Latino-, and Asian-American patients for all stages combined were 85%, 75%, 85%, and 84%, respectively. Differences in survival between high- and low-income regions were not observed. However, when ethnicity was considered, Asian-Americans who lived in high-income regions showed longer survival than their low-income community counterparts (χ²=4.531; p<0.05). The multilevel model demonstrated ethnicity, age at diagnosis, and cancer stage stratified by surgery to be significantly associated with cervical cancer survival at the individual level. At the neighborhood level, residing in neighborhoods with a high proportion of African-Americans increased the risk of death by 1%. CONCLUSIONS The neighborhood context may be an influential contributor to survival for Asian- and African-Americans specifically. These findings necessitate closer examination of the unique contribution of ethnicity and neighborhood on cancer survival to disentangle the role of ethnic group membership, socio-ecological contexts and stress, and medical factors on disease outcomes.

Surviving cervical cancer: Does health-related quality of life influence survival?

OBJECTIVE This study investigates the association between health-related quality of life (HRQOL) outcomes and survival status among a population-based cohort diagnosed with invasive cancer of the cervix uteri. METHODS This study is based on data from 353 multiethnic cervical cancer survivors (CCS) recruited through the California Cancer Surveillance Program. The independent variable is HRQOL measured by the FACT-CX (FACT-G plus additional items) and the SF-12. The dependent variable is survival from date of the HRQOL survey. Kaplan-Meier estimates and univariate and multivariate Cox Proportional Hazards Regression models were used to examine the relationship between HRQOL and survival. RESULTS In the Kaplan-Meier analyses, the FACT-CX functional well-being score equal to or above the median score was significantly associated with improved overall survival (X(2)=7.19; p=0.007). Significant differences in survival were observed for the SF-12 physical and mental health component scores. In the multivariate Cox regression analyses, the final model indicated that the FACT-CX total scores, functional well-being, and additional cervical cancer concerns subscales, and the SF-12 physical and mental component summary scores significantly influenced survival, after controlling for medical characteristics. However, the FACT components that do not include cervical cancer specific items including mean standardized FACT-G and physical, emotional, and social/family well-being subscales were not predictors of survival before and after adjustment for covariates. CONCLUSIONS The results of this study advance the current scientific knowledge by confirming that HRQOL outcomes, in particular the physical, function and mental health dimensions are associated with survival for CCS. These findings highlight the utility of cancer site specific HRQOL data to inform the psychosocial and symptom management aspects, as well as the medical follow-up care practice and research that may extend life.

The impact of cultural characteristics on colorectal cancer screening adherence among Filipinos in the United States: a pilot study.

Objectives: Studies on colorectal cancer screening among specific Asian American groups are limited despite the fact that Asians are comprised of culturally distinct subgroups. The purpose of this study was to investigate the impact of cultural characteristics on colorectal cancer screening adherence among Filipinos in the United States.

Assessing health-related quality of life of Chinese-American breast cancer survivors: a measurement validation study.

This study reports on the internal consistency and construct validity of the Functional Assessment of Cancer Therapy – General (FACT‐G v.4) and 12‐item Short Form Health Survey (SF‐12 v.2) health‐related quality of life (HRQOL) instruments with Chinese‐American breast cancer survivors (BCS).

Evaluation of therapeutic care delay among Latina- and European-American cervical cancer survivors

OBJECTIVES Cervical cancer (CCA) ranks among the deadliest of cancers. Globally CCA claims 275,000 lives yearly. Severe delays, in cancer diagnostic or therapeutic care, that approach ≥ 60 days negatively affect survival and survivorship outcomes. This study investigated socioeconomic and healthcare system factors influencing therapeutic care delays among cervical cancer survivors (CCS). METHODS 291 CCS (132 European-, 50 English-proficient (EP) Latina- and 109 limited English-proficient (LEP) Latina-Americans) were recruited from cancer registries. CCS retrospectively noted the days of delay in obtaining therapeutic care and reasons for delays. RESULTS CCS who were LEP Latina-Americans, had lower income and education reported severe therapeutic delays (≥ 60 days). LEP Latina-Americans experienced delays due to financial issues, doctors delay, and healthcare system issues (p < 0.001). Doctor and healthcare system delays significantly influenced therapeutic care delay in the logistic regression model. CONCLUSIONS Healthcare system delays are primary contributors to ethnic differences in access to appropriately-timed care observed in this study. Healthcare professionals need to develop a fuller appreciation of the multilevel factors that contribute to healthcare barriers to better inform effective interventions to increase access to life saving care.