The science of cancer

“We need to address all barriers to cancer treatment and survivorship. I fight cancer by caring for patients with compassion and learning what matters most to them so we can provide personalized cancer care.”

— Sukeshi Patel Arora, MD, Associate Professor; Leader of Gastrointestinal Oncology Program

Understanding the Hispanic cancer journey

U.S. Hispanics face a staggering 142% projected rise in cancer cases by 2030.

After a cancer diagnosis, Hispanics often fare worse than their white peers.

While the survivorship experience differs significantly among racial and ethnic groups, research on Hispanic cancer survivors is vital, as this population experiences many unique burdens before and after a cancer diagnosis. For instance, limited research in Hispanic survivorship suggests that they are more likely to present with advanced disease and report more significant symptom burden and poorer health-related quality of life.

Researchers at the Mays Cancer Center at The University of Texas Health Science Center at San Antonio and the Sylvester Comprehensive Cancer Center at the University of Miami have teamed up to investigate population-specific barriers to cancer survival among Hispanics. Avanzando Caminos (Leading Pathways): The Hispanic/Latino Cancer Survivorship Study will recruit a diverse cohort of 3,000 Hispanic breast, colorectal, kidney, lung, prostate, stomach and cervical cancer survivors.

These include 1,500 Hispanic cancer survivors from South Texas via the Mays Cancer Center and the Texas Cancer Registry and 1,500 Hispanic cancer survivors from Miami’s Sylvester Comprehensive Cancer Center and the Florida Statewide Cancer Registry. This first-of-its-kind national cohort study is funded by a six-year, $9.8 million grant from the National Cancer Institute. The study aims to investigate the social, cultural, behavioral, psychosocial, biological and medical influences on post-cancer life in Hispanic cancer survivors to fill a crucial gap in knowledge about their survivorship experience.

The study’s principal investigators are Amelie G. Ramirez, DrPH, MPH, chair of Population Health Sciences at UT Health San Antonio and associate director of Cancer Outreach and Engagement at the Mays Cancer Center, and Frank J. Penedo, PhD, director of Cancer Survivorship and Behavioral Translational Sciences at the Sylvester Comprehensive Cancer Center.

Unpacking cancer survivorship factors

From 2021 to 2027, researchers from both teams will study how various factors — discrimination, depression, chronic stress, diet, biological markers, genetics and more — impact these Hispanic survivors’ symptom burdens, health-related quality of life and disease activity. They will document and analyze all aspects of the Hispanic cancer survivorship journey and 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, Hispanic heritage.
Medical factors: cancer type, stage, comorbidities.

“Until now, no national cohort study has comprehensively assessed and mapped the journey of this specific population,” Ramirez said. The opportunity to assess multiple determinants of quality of life and health outcomes among Hispanic cancer survivors will help guide interventions that promote optimal well-being, she added.

“Cancer hurts many of our abuelos, moms, dads and others we love. I fight cancer because I want to create a better future for Latino families, with culturally competent care that addresses the social needs of every patient — from prevention to survivorship.”

— Amelie Ramirez, DrPH, MPH, Chair and Professor of Population Health Sciences; Director, Institute for Health Promotion Research; Associate Director, Cancer Outreach and Engagement

Why San Antonio and Miami?

Patients recruited for the study experience economic disparities that can impact their access to medical care. For instance, 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 10 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.

The San Antonio region is home to 4.9 million people, of whom 69% are Hispanic and mostly identify as 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% do not complete high school.

“This region faces substantial disparities in liver, cervical and stomach cancers,” said Ramirez.

The Miami region is home to 6 million people, of whom 44% are Hispanic, including 44% Cubans, 18% South Americans, 14% Central Americans, 10% Puerto Ricans and 5% Mexicans. A greater percentage of residents live in poverty (14% vs. 11%) and have limited access to formal health care (24% vs. 13%) than the rest of the U.S. population.

“Significantly higher rates of cervical and prostate cancers plague this region,” Penedo said.

Anticipated outcomes

Researchers expect the study to provide novel information to guide cancer prevention efforts and interventions to improve cancer survivorship for this demographic. The new project adds to the Mays Cancer Center’s diverse portfolio of research and outreach to address the cancer burden of the predominantly Hispanic population in South Texas and to advance critical cancer research — from prevention through survivorship — for medically underserved communities.

This outreach includes co-hosting the Advancing the Science of Cancer in Latinos conference alongside UT Health San Antonio’s Institute for Health Promotion Research.