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1.
Int J Cancer ; 148(1): 99-105, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32930425

RESUMO

Polygenic hazard score (PHS) models are associated with age at diagnosis of prostate cancer. Our model developed in Europeans (PHS46) showed reduced performance in men with African genetic ancestry. We used a cross-validated search to identify single nucleotide polymorphisms (SNPs) that might improve performance in this population. Anonymized genotypic data were obtained from the PRACTICAL consortium for 6253 men with African genetic ancestry. Ten iterations of a 10-fold cross-validation search were conducted to select SNPs that would be included in the final PHS46+African model. The coefficients of PHS46+African were estimated in a Cox proportional hazards framework using age at diagnosis as the dependent variable and PHS46, and selected SNPs as predictors. The performance of PHS46 and PHS46+African was compared using the same cross-validated approach. Three SNPs (rs76229939, rs74421890 and rs5013678) were selected for inclusion in PHS46+African. All three SNPs are located on chromosome 8q24. PHS46+African showed substantial improvements in all performance metrics measured, including a 75% increase in the relative hazard of those in the upper 20% compared to the bottom 20% (2.47-4.34) and a 20% reduction in the relative hazard of those in the bottom 20% compared to the middle 40% (0.65-0.53). In conclusion, we identified three SNPs that substantially improved the association of PHS46 with age at diagnosis of prostate cancer in men with African genetic ancestry to levels comparable to Europeans.

2.
PLoS One ; 15(8): e0236836, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790674

RESUMO

BACKGROUND: Cancer is the second leading cause of death in the United States. Cancer screenings can detect precancerous cells and allow for earlier diagnosis and treatment. Our purpose was to better understand risk factors for cancer screenings and assess the effect of cancer screenings on changes of Cardiovascular health (CVH) measures before and after cancer screenings among patients. METHODS: We used The Guideline Advantage (TGA)-American Heart Association ambulatory quality clinical data registry of electronic health record data (n = 362,533 patients) to investigate associations between time-series CVH measures and receipt of breast, cervical, and colon cancer screenings. Long short-term memory (LSTM) neural networks was employed to predict receipt of cancer screenings. We also compared the distributions of CVH factors between patients who received cancer screenings and those who did not. Finally, we examined and quantified changes in CVH measures among the screened and non-screened groups. RESULTS: Model performance was evaluated by the area under the receiver operator curve (AUROC): the average AUROC of 10 curves was 0.63 for breast, 0.70 for cervical, and 0.61 for colon cancer screening. Distribution comparison found that screened patients had a higher prevalence of poor CVH categories. CVH submetrics were improved for patients after cancer screenings. CONCLUSION: Deep learning algorithm could be used to investigate the associations between time-series CVH measures and cancer screenings in an ambulatory population. Patients with more adverse CVH profiles tend to be screened for cancers, and cancer screening may also prompt favorable changes in CVH. Cancer screenings may increase patient CVH health, thus potentially decreasing burden of disease and costs for the health system (e.g., cardiovascular diseases and cancers).


Assuntos
Neoplasias da Mama/diagnóstico , Doenças Cardiovasculares/diagnóstico , Neoplasias do Colo/diagnóstico , Aprendizado Profundo , Neoplasias do Colo do Útero/diagnóstico , Adulto , Área Sob a Curva , Detecção Precoce de Câncer , Feminino , Guias como Assunto , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Fatores de Risco
3.
Eur Urol ; 78(3): 316-320, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32409115

RESUMO

Although men of African ancestry have a high risk of prostate cancer (PCa), no genes or mutations have been identified that contribute to familial clustering of PCa in this population. We investigated whether the African ancestry-specific PCa risk variant at 8q24, rs72725854, is enriched in men with a PCa family history in 9052 cases, 143 cases from high-risk families, and 8595 controls of African ancestry. We found the risk allele to be significantly associated with earlier age at diagnosis, more aggressive disease, and enriched in men with a PCa family history (32% of high-risk familial cases carried the variant vs 23% of cases without a family history and 12% of controls). For cases with two or more first-degree relatives with PCa who had at least one family member diagnosed at age <60 yr, the odds ratios for TA heterozygotes and TT homozygotes were 3.92 (95% confidence interval [CI] = 2.13-7.22) and 33.41 (95% CI = 10.86-102.84), respectively. Among men with a PCa family history, the absolute risk by age 60 yr reached 21% (95% CI = 17-25%) for TA heterozygotes and 38% (95% CI = 13-65%) for TT homozygotes. We estimate that in men of African ancestry, rs72725854 accounts for 32% of the total familial risk explained by all known PCa risk variants. PATIENT SUMMARY: We found that rs72725854, an African ancestry-specific risk variant, is more common in men with a family history of prostate cancer and in those diagnosed with prostate cancer at younger ages. Men of African ancestry may benefit from the knowledge of their carrier status for this genetic risk variant to guide decisions about prostate cancer screening.

4.
Cancer Epidemiol Biomarkers Prev ; 29(1): 169-175, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31685560

RESUMO

BACKGROUND: The effect of metformin use on survival among patients with pancreatic ductal adenocarcinoma (PDAC) is controversial. Furthermore, there are no data on African American patients. To address these, we analyzed data from the United States Veterans Health Administration (VHA). METHODS: A population-based retrospective cohort study evaluating overall survival among 3,811 patients with PDAC with preexisting diabetes mellitus, diagnosed with PDAC within the VHA between 1998 and 2013. We calculated HRs and 95% confidence intervals (CI) using multivariable adjusted time-varying Cox proportional hazards regression to control for immortal time bias and confounders. RESULTS: Metformin use was not associated with overall survival in the complete analyses (HR = 1.05; 95% CI, 0.92-1.14; P = 0.28). However, among patients who were metformin naïve at the time of PDAC diagnosis (N = 1,158), metformin use was associated with improved overall survival in non-Hispanic white patients (HR = 0.78; 95% CI, 0.61-0.99; P = 0.04), but not African American patients (HR = 1.20; 95% CI, 0.75-1.93; P = 0.45). The survival benefit among non-Hispanic whites was limited to patients with metastatic disease (HR = 0.67; 95% CI, 0.44-1.01; P = 0.06). Among African American patients with metastatic disease, HR was 1.30 (95% CI, 0.77-2.53; P = 0.28). There was a suggestion of heterogeneity by race in patients with metastatic disease (P heterogeneity = 0.05). CONCLUSIONS: We observed no associations between metformin use and survival in patients with PDAC, but there appears to be a survival benefit among non-Hispanic white patients who were metformin naïve at the time of PDAC diagnosis. IMPACT: If confirmed in other studies, our findings suggest that metformin as an adjunctive treatment for PDAC may not improve survival among African American patients.

5.
Urology ; 134: 181-185, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31419432

RESUMO

OBJECTIVE: To compare test performance of multiparametric magnetic resonance imaging (mpMRI) for detection of prostate cancer (PCa) in African-American men (AAM) and white men (WM) using the Prostate Imaging Reporting and Data System in unmatched groups as well as a cohort matched for clinical factors. METHODS: We examined our database of men who underwent prostate mpMRI prior to biopsy between October 2014 and June 2017 (n = 601; 60 AAM, 541 WM). Test performance was defined using Prostate Imaging Reporting and Data System classification 4 or 5 considered test positive and Gleason grade group 2 or greater from any biopsy core considered outcome positive. A subset analysis was performed using a propensity score caliper matching algorithm to match AAM to WM in a 1:2 ratio using the variables age, PSA, and PSA density. RESULTS: No significant differences in test performance were found with similar sensitivity (86.7% vs 83.6, P = 1.00), specificity (45.9% vs 49.1%, P = .71), positive predictive value (50.0% vs 46.9%), and negative predictive value (85.0% vs 84.8%, P = 1.00) for AAM and WM. Similar results were noted in our matched comparison. The rate of upgrading between targeted and systematic biopsy cores did not statistically differ between AAM and WM in both unmatched (12.2% vs. 15.8%, P = .66) and matched (12.2% vs 12.8%, P = .92) comparisons. CONCLUSION: Our findings provide supporting evidence that AAM have similar outcomes to WM in PCa detection using mpMRI. We suggest that mpMRI should not be withheld or offered preferentially on the basis of race when used for the detection of PCa.


Assuntos
Afro-Americanos , Grupo com Ancestrais do Continente Europeu , Imageamento por Ressonância Magnética Multiparamétrica , Neoplasias da Próstata/diagnóstico por imagem , Idoso , Algoritmos , Biópsia por Agulha , Humanos , Biópsia Guiada por Imagem , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Valor Preditivo dos Testes , Pontuação de Propensão , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/patologia , Sensibilidade e Especificidade , Ultrassonografia
6.
Am J Mens Health ; 13(2): 1557988319844353, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30982387

RESUMO

This study aims to evaluate follow-up activities completed by participants attending community prostate cancer (PCa) screening events. On-site surveys were collected from participants of 17 free PCa screening events from 2007 to 2011 in the St. Louis, MO metropolitan area. Follow-up action surveys were mailed to all on-site participants to assess medical (i.e., made an appointment with a doctor, got additional testing for PCa, made an appointment to be screened) and nonmedical activities (i.e., sought social support, health information-seeking, health behavior modifications) completed after the PCa screening event. Further, t tests and chi-square tests characterized participant information from the on-site survey and within each follow-up activity category for the mailed surveys. Among 1,088 on-site community PCa screening participants, the mean age was 50 years old, 94% were Black, and 30% responded to the mailed follow-up action survey. For the recorded follow-up activities, 65% of participants reported medically reported activities, of which "made an appointment to get a yearly physical" was the most common action (29%). Health behavior modifications were the most common nonmedically related activities (44%). Health information-seeking behaviors were the least reported follow-up action (22%). Men with higher incomes, married, with health insurance, and a primary care physician, most often participated in post-PSA screening activities, namely medically-related and social support activities. Understanding the most common activities completed by participants of a community PCa screening suggests the effectiveness of community events to re-engage underserved populations in the health-care system and provides insight on acceptable health promotion opportunities.


Assuntos
Continuidade da Assistência ao Paciente , Promoção da Saúde/métodos , Programas de Rastreamento/estatística & dados numéricos , Neoplasias da Próstata/diagnóstico , Demografia , Detecção Precoce de Câncer , Seguimentos , Comportamentos Relacionados com a Saúde , Humanos , Comportamento de Busca de Informação , Masculino , Pessoa de Meia-Idade , Missouri , Apoio Social , Inquéritos e Questionários , População Urbana
7.
Cancer Causes Control ; 29(11): 1143-1150, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30267174

RESUMO

PURPOSE: Metformin has been associated with a reduced incidence of prostate cancer and improved prostate cancer outcomes. However, whether race modifies the association between metformin use and prostate cancer aggressiveness remains uncertain. The association between metformin use and prostate cancer aggressiveness was examined separately in Black Americans (Blacks) and White Americans (Whites). METHODS: The study population consisted of 305 Black and 195 White research participants with incident prostate cancer and self-reported diabetes from the North Carolina-Louisiana Prostate Cancer Project. High-aggressive prostate cancer was defined using a composite measure of Gleason sum, prostate-specific antigen, and clinical stage. Multivariable logistic regression was used to assess the association between metformin use and high-aggressive prostate cancer at diagnosis, separately among Whites and Blacks, with adjustment for age, screening history, site, education, insurance, and body mass index. RESULTS: Metformin use was associated positively with high-aggressive prostate cancer in Blacks (OR 2.01; 95% CI 1.05, 3.83). By contrast, a weak inverse association between metformin use and high-aggressive prostate cancer was found in Whites (OR 0.80, 95% CI 0.34, 1.85). CONCLUSIONS: The association between metformin use and prostate cancer aggressiveness may be modified by race.


Assuntos
Afro-Americanos/etnologia , Diabetes Mellitus/tratamento farmacológico , Grupo com Ancestrais do Continente Europeu/etnologia , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Neoplasias da Próstata/etnologia , Neoplasias da Próstata/patologia , Adulto , Idoso , Índice de Massa Corporal , Complicações do Diabetes/etnologia , Humanos , Incidência , Louisiana/epidemiologia , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , North Carolina/epidemiologia , Antígeno Prostático Específico , Neoplasias da Próstata/complicações , Fatores Raciais , Autorrelato , Estados Unidos/epidemiologia
8.
Cancer Causes Control ; 29(7): 685-697, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29774450

RESUMO

PURPOSE: In Trinidad and Tobago (TT), prostate cancer (CaP) is the most commonly diagnosed malignancy and the leading cause of cancer deaths among men. TT currently has one of the highest CaP mortality rates in the world. METHODS: 6,064 incident and 3,704 mortality cases of CaP occurring in TT from January 1995 to 31 December 2009 reported to the Dr. Elizabeth Quamina Cancer population-based cancer registry for TT, were analyzed to examine CaP survival, incidence, and mortality rates and trends by ancestry and geography. RESULTS: The age-standardized CaP incidence and mortality rates (per 100,000) based on the 1960 world-standardized in 2009 were 64.2 and 47.1 per 100,000. The mortality rate in TT increased between 1995 (37.9 per 100,000) and 2009 (79.4 per 100,000), while the rate in the US decreased from 37.3 per 100,000 to 22.1 per 100,000 over the same period. Fewer African ancestry patients received treatment relative to those of Indian and mixed ancestry (45.7%, 60.3%, and 60.9%, respectively). CONCLUSIONS: Notwithstanding the limitations surrounding data quality, our findings highlight the increasing burden of CaP in TT and the need for improved surveillance and standard of care. Our findings highlight the need for optimized models to project cancer rates in developing countries like TT. This study also provides the rationale for targeted screening and optimized treatment for CaP to ameliorate the rates we report.


Assuntos
Neoplasias da Próstata/epidemiologia , Idoso , Países em Desenvolvimento , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Trinidad e Tobago/epidemiologia
9.
Am J Mens Health ; 12(4): 760-765, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29540091

RESUMO

Long-term follow-up care among prostate cancer patients is important as biochemical recurrence can occur many years after diagnosis, with 20%-30% of men experiencing biochemical recurrence within 10 years of treatment. This study examined predictors of follow-up care among 1,158 radical prostatectomy patients, treated at the Washington University in St. Louis, within 6 months, 1 year, and 2 years post surgery. Predictors examined included age at surgery, race (Black vs. White), rural/urban status, education, marital status, and prostate cancer aggressiveness. Multivariable logistic regression was used to assess the association between the predictors and follow-up visits with a urologist in 6 months, the 1st year, and the 2nd year post surgery. In a secondary analysis, any follow-up visit with a prostate-specific antigen (PSA) test was included, regardless of provider type. Men that were Black ( 6 months OR: 0.60; 95% CI [0.36, 0.99], 1 year OR: 0.34; 95% CI [0.20, 0.59], 2 year OR: 0.41; 95% CI [0.25, 0.68]), resided in a rural residence ( 1 year OR: 0.61; 95% CI [0.44, 0.85], 2 year OR: 0.41; 95% CI [0.25, 0.68]), or were unmarried ( 2 year OR: 0.69; 95% CI [0.49, 0.97]) had a reduced odds of follow-up visits with a urologist. In models where any follow-up visit with a PSA test was examined, race remained a significant predictor of follow-up. The results indicate that Black men, men residing in a rural residence, and unmarried men may not receive adequate long-term follow-up care following radical prostatectomy. These men represent a high-risk group that could benefit from increased support post treatment.


Assuntos
Afro-Americanos , Continuidade da Assistência ao Paciente , Cooperação do Paciente , Prostatectomia , Neoplasias da Próstata/cirurgia , Sobreviventes , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Missouri , Estudos Prospectivos , Prostatectomia/métodos
10.
Int J Cancer ; 142(10): 2011-2018, 2018 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-29270988

RESUMO

The decades before prostate cancer diagnosis represent an etiologically relevant time period for prostate cancer carcinogenesis. However, the association of weight gain in young adulthood with subsequent biochemical recurrence among men with prostate cancer is not well studied, particularly among smokers. We conducted a prospective cohort study of 1,082 men with prostate cancer and treated with either radical prostatectomy or radiation between 2003 and 2010. The association of weight at age 20, weight at age 50 and weight change from age 20 to age 50 with biochemical recurrence was assessed using Cox Proportional Hazards with adjustment for confounders. Stratum-specific hazard ratio (HR) estimates by smoking status were evaluated. In the overall cohort, weight at age 20 (HR per 30 kg: 1.56, 95% confidence interval (CI): 1.02, 2.38, p-trend: 0.039), weight at age 50 (HR per 30 kg: 1.80, 95% CI: 1.32, 2.47, p-trend: <0.001) and weight change from age 20 to age 50 (HR per 30 kg: 1.84, 95% CI: 1.24, 2.74, p-trend: 0.003) were associated with biochemical recurrence. In stratified analyses, weight change from age 20 to age 50 was significantly associated with biochemical recurrence only in former smokers (HR per 30 kg: 3.87, 95% CI: 1.88, 8.00, p-trend: <0.001) and ever smokers (HR per 30 kg: 2.38, 95% CI: 1.27, 4.45, p-trend: 0.007). No significant association was observed between weight gain in young adulthood and biochemical recurrence in never smokers. Our study adds further evidence that weight gain during early adult years conveys long-term risk for adverse cancer outcomes.


Assuntos
Trajetória do Peso do Corpo , Recidiva Local de Neoplasia/epidemiologia , Neoplasias da Próstata/epidemiologia , Fumar/epidemiologia , Adulto , Estudos de Coortes , Humanos , Masculino , Pessoa de Meia-Idade , Missouri/epidemiologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Risco , Adulto Jovem
11.
J Natl Cancer Inst ; 109(8)2017 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29117387

RESUMO

Prostate cancer incidence is 1.6-fold higher in African Americans than in other populations. The risk factors that drive this disparity are unknown and potentially consist of social, environmental, and genetic influences. To investigate the genetic basis of prostate cancer in men of African ancestry, we performed a genome-wide association meta-analysis using two-sided statistical tests in 10 202 case subjects and 10 810 control subjects. We identified novel signals on chromosomes 13q34 and 22q12, with the risk-associated alleles found only in men of African ancestry (13q34: rs75823044, risk allele frequency = 2.2%, odds ratio [OR] = 1.55, 95% confidence interval [CI] = 1.37 to 1.76, P = 6.10 × 10-12; 22q12.1: rs78554043, risk allele frequency = 1.5%, OR = 1.62, 95% CI = 1.39 to 1.89, P = 7.50 × 10-10). At 13q34, the signal is located 5' of the gene IRS2 and 3' of a long noncoding RNA, while at 22q12 the candidate functional allele is a missense variant in the CHEK2 gene. These findings provide further support for the role of ancestry-specific germline variation in contributing to population differences in prostate cancer risk.


Assuntos
Grupo com Ancestrais do Continente Africano/genética , Loci Gênicos , Predisposição Genética para Doença , Polimorfismo de Nucleotídeo Único , Neoplasias da Próstata/etnologia , Neoplasias da Próstata/genética , Estudos de Casos e Controles , Quinase do Ponto de Checagem 2/genética , Cromossomos Humanos Par 13 , Cromossomos Humanos Par 22 , Frequência do Gene , Estudo de Associação Genômica Ampla , Humanos , Proteínas Substratos do Receptor de Insulina/genética , Masculino
12.
Spine (Phila Pa 1976) ; 42(23): 1785-1791, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-28498289

RESUMO

STUDY DESIGN: Level III, Retrospective observational study. OBJECTIVE: To determine if there is an increased risk of developing cancer after exposure to high-dose recombinant human bone morphogenetic protein-2 (rhBMP-2) and if risk is dose and/or exposure-dependent. SUMMARY OF BACKGROUND DATA: Concerns have been raised regarding a relationship between rhBMP-2 and cancer. METHODS: A total of 642 adult deformity patients from a single institution receiving a cumulative rhBMP-2 dose ≥40 mg from July, 2002 to July, 2009 were identified. Patients with a history of surveillance, epidemiology, and end result (SEER) cancer before rhBMP-2 exposure were excluded. To determine the occurrence of a cancer event, questionnaires were mailed and telephone follow up attempted for nonresponders. Only cancers tracked by the National Cancer Institute (NCI) SEER registry were included. Observed cancer counts were compared to expected cancer counts based on general population incidence rates within 5-year age strata. Cumulative incidence competing risk (CICR) modeling was used to evaluate the association between rhBMP-2 exposure and cancer controlling for potential confounding variables. RESULTS: Forty-nine patients were lost-to-follow up, leaving 593 patients (92.4%; 138 males/455 females) available for analysis. Mean age was 52.8 years at the time of first exposure. Mean cumulative rhBMP-2 dose was 113.5 mg with 85% having one exposure (range: 1-8). Mean follow-up [date of exposure to date of death (regardless of cause) or returned completed questionnaire] was 5.6 ±â€Š1.9 years; median follow up was 5.4 years. A total of 342 patients have greater than 5-year follow up. Minimum follow up was 2.0 years or until occurrence of a SEER cancer. Our total 8-year cumulative incidence of new SEER cancer accounting for the competing risk of death was 7.4% for 30 cancers in 593 patients. Fewer cancers were observed than expected based on general population rates, though the difference was not statistically significant (expected = 34; standardized incidence ratio = 0.88, 95% confidence interval, CI = 0.60-1.26). CICR found neither cumulative rhBMP-2 dose (hazard ratio, HR = 0.995, 95% CI 0.988-1.003; P = 0.249) nor number of exposures (HR = 0.776, 95% CI 0.359-1.677; P = 0.519) increased the risk of developing a postexposure cancer after controlling for known cancer risk factors. CONCLUSION: The incidence of a SEER cancer after rhBMP-2 exposure was similar to incidence reported by the NCI. There were no significant rhBMP-2 dose or multi-exposure related risks of developing a life-threatening cancer. LEVEL OF EVIDENCE: 3.


Assuntos
Proteína Morfogenética Óssea 2/uso terapêutico , Neoplasias/epidemiologia , Doenças da Coluna Vertebral/tratamento farmacológico , Fator de Crescimento Transformador beta/uso terapêutico , Adulto , Idoso , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Proteínas Recombinantes/uso terapêutico , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Programa de SEER
13.
J Psychosoc Oncol ; 35(4): 409-423, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28398149

RESUMO

PURPOSE: The aim of this study was to explore the African American prostate cancer survivorship experience following radical prostatectomy and factors contributing to quality of life during survival. DESIGN: African American men who were part of a larger prostate cancer cohort were invited to participate in a focus group. Eighteen open-ended questions were designed by the study team and an experienced moderator to elicit participants' survivorship experiences. RESULTS: Twelve men consented to participate in the study. Emergent themes included views of prostate cancer in the African American community, perceptions of normalcy, emotional side effects following radical prostatectomy, and social support involvement and impact during recovery. CONCLUSIONS: Previous findings suggest that African American men may experience more distress than Caucasian men when facing typical prostate cancer side effects. Traditional masculine role norms and negative perceptions of "disease disclosure" in the African American community could be contributing to the distress reported by some in this study. Strengthening social support systems by promoting more prosocial coping and help-seeking behaviors early in the survivorship journey may help bypass the detrimental health effects associated with masculine role identification, resulting in improved quality of life throughout the lengthy survival period anticipated for these men.


Assuntos
Afro-Americanos/psicologia , Prostatectomia/psicologia , Neoplasias da Próstata/etnologia , Qualidade de Vida/psicologia , Apoio Social , Sobreviventes/psicologia , Adaptação Psicológica , Afro-Americanos/estatística & dados numéricos , Idoso , Estudos de Coortes , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Prostatectomia/efeitos adversos , Neoplasias da Próstata/psicologia , Neoplasias da Próstata/cirurgia , Estresse Psicológico/etnologia , Sobreviventes/estatística & dados numéricos
14.
J Community Psychol ; 45(1): 17-32, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-29302128

RESUMO

Although the importance of community engagement in research has been previously established, there are few evidence-based approaches for measuring the level of community engagement in research projects. A quantitative community engagement measure was developed, aligned with 11 engagement principles (EPs) previously established in the literature. The measure has 96 Likert response items; 3-5 quality items and 3-5 quantity items measure each EP. Cronbach's alpha is used to examine the internal consistency of items that measure a single EP. Every EP item group had a Cronbach's alpha > .85, which indicates strong internal consistency for all question groups across both scales (quality and quantity). This information determines the level of community engagement, which can be correlated with other research outcomes.


Assuntos
Participação da Comunidade , Projetos de Pesquisa , Pesquisa , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Participação dos Interessados , Inquéritos e Questionários
15.
J Cancer Educ ; 32(1): 51-58, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-26341221

RESUMO

Before the burgeoning field of biospecimen collection can advance prevention and treatment methods, researchers must access diverse molecular data samples. However, minorities, especially African-American men, remain reticent to join these studies. This study, using theory-based approaches, investigated African-American men's barriers to participating in biorepository research. Fourteen focus groups were conducted among 70 African-American men (ages 40 to 80). The groups were stratified by prostate cancer history and educational attainment background. Participants identified perceived factors that promoted or hindered study participation when questioned about their knowledge and attitudes about biospecimen research. Ninety-four percent of participants indicated never participating in a study that collected biological samples. Barriers to their participation included lack of knowledge and understanding regarding biospecimen research practices and uses. In addition, they extensively cited a prevalent mistrust of the medical community and discomfort with study recruitment practices. African-American males were more willing to participate in biorepository studies with physician endorsement or if they understood that participation could benefit future generations. Men also wanted more recruitment and advertising done in familiar places.


Assuntos
Afro-Americanos/estatística & dados numéricos , Seleção de Pacientes , Neoplasias da Próstata/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Pesquisa Biomédica , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/prevenção & controle , Manejo de Espécimes/métodos , Estados Unidos
16.
J Cancer Educ ; 32(4): 836-844, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27037699

RESUMO

The US Department of Health and Human Services addresses clear communication in the informed consent process as part of the Notice of Proposed Rulemaking for revisions to the Common Rule. However, prior research has shown that participants may not fully comprehend research studies despite completion of an informed consent process. Our main goal was to provide plain language information about donation processes to a cancer biobank to supplement an informed consent form. We developed and conducted cognitive testing with supplemental brochures that clearly communicated information about three different models for consent (notice, broad and study-specific) to future use of biospecimens. During the brochure development process, we conducted qualitative, semi-structured, individual, in-person cognitive interviews among 14 women to examine participants' perceptions of the brochures. Each participant provided feedback regarding the understandability, graphics and layout, and cultural appropriateness of the brochures. Our findings demonstrate that these methods may be used to tailor consent form brochures, such as the ones developed here, to other populations. This study therefore adds to our understanding of how best to present content to help women from two different racial groups make informed decisions about participation in a cancer biobank.


Assuntos
Bancos de Espécimes Biológicos/estatística & dados numéricos , Compreensão , Consentimento Livre e Esclarecido/psicologia , Idioma , Folhetos , Adulto , Afro-Americanos , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Pessoa de Meia-Idade , Estados Unidos
17.
Support Care Cancer ; 25(4): 1151-1158, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27999951

RESUMO

PURPOSE: Physical activity is recognized as a complementary therapy to improve physical and physiological functions among prostate cancer survivors. Little is known about communication between health providers and African-American prostate cancer patients, a high risk population, regarding the health benefits of regular physical activity on their prognosis and recovery. This study explores African-American prostate cancer survivors' experiences with physical activity prescription from their physicians. METHODS: Three focus group interviews were conducted with 12 African-American prostate cancer survivors in May 2014 in St. Louis, MO. Participants' ages ranged from 49 to 79 years, had completed radical prostatectomy, and their time out of surgery varied from 7 to 31 months. RESULTS: Emerged themes included physician role on prescribing physical activity, patients' perceived barriers to engaging in physical activity, perception of normalcy following surgery, and specific resources survivors' sought during treatment. Of the 12 men who participated, 8 men (67%) expressed that their physicians did not recommend physical activity for them. Although some participants revealed they were aware of the importance of sustained physical activity on their prognosis and recovery, some expressed concerns that urinary dysfunction, incontinence, and family commitments prevented them from engaging in active lifestyles. CONCLUSIONS: Transitioning from post radical prostatectomy treatment to normal life was an important concern to survivors. These findings highlight the importance of physical activity communication and prescription for prostate cancer patients.


Assuntos
Afro-Americanos , Terapia por Exercício/métodos , Exercício Físico , Papel do Médico , Neoplasias da Próstata/terapia , Idoso , Comunicação , Terapias Complementares/métodos , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Neoplasias da Próstata/etnologia , Neoplasias da Próstata/cirurgia , Sobreviventes , Estados Unidos
18.
J Clin Oncol ; 34(35): 4231-4237, 2016 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-27903157

RESUMO

Purpose Evidence on overweight, obesity, and an increased risk of cancer continues to accumulate and was updated in the 2016 handbook on weight control from the International Agency for Research on Cancer (IARC). The underlying primary data, together with dose-response meta-analysis and, finally, pooled analysis of individual participant data, add insight into the relation between obesity and cancer risk and prognosis. We summarize the evidence for mortality from prostate cancer, hematologic malignancies, and kidney cancer. Methods We reviewed pooled analysis of rare end points across cohorts, regardless of primary results reported from the individual studies, further reducing risk of publication bias. Of these cancer sites, only kidney cancer was included in the IARC 2002 report, although mortality from prostate cancer and hematologic malignancies was noted in the American Cancer Society prospective cohort study in 2003. The 2016 update from the IARC added details for prostate and hematologic malignancies, classifying the evidence as sufficient to conclude that avoiding excess body fatness lowers the risk of multiple myeloma but found that the evidence for it lowering the risk of prostate cancer mortality or diffuse large B-cell lymphoma was limited. Results A higher body mass index is associated with an increased risk of advanced prostate cancer and prostate cancer mortality and is associated with worse survival in most subtypes of hematologic malignancies, in a dose-response fashion. Evidence for kidney cancer is built mostly on retrospective data, which supports an obesity paradox in patients with the clear cell variant; however, population-based cohort data indicate that a higher cohort-entry body mass index is associated with worse kidney cancer-specific survival. Conclusion Together, these data add support to the evidence for a growing cancer burden caused by adiposity in both early adult and later adult life, yet leave open the question of the means of weight management after diagnosis as a strategy to improve survival.


Assuntos
Neoplasias Hematológicas/complicações , Neoplasias Renais/complicações , Obesidade/complicações , Neoplasias da Próstata/complicações , Feminino , Neoplasias Hematológicas/mortalidade , Humanos , Neoplasias Renais/mortalidade , Masculino , Prognóstico , Neoplasias da Próstata/mortalidade , Fatores de Risco
19.
Cancer Prev Res (Phila) ; 9(12): 933-941, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27651069

RESUMO

Little information exists on diet and prostate cancer progression. We examined the association between intakes of total red meat, processed and unprocessed red meat, poultry, fish, and eggs and prostate cancer recurrence. We conducted a prospective study of 971 men treated with radical prostatectomy for prostate cancer between 2003 and 2010. Men completed a food frequency questionnaire at diagnosis. We used logistic regression to study the association between diet and high-grade or advanced-stage disease. We used Cox models to study the risk of progression [N = 94 events, mainly prostate-specific antigen (PSA) recurrence]. Total red meat intake was marginally associated with risk of high-grade disease [Gleason ≥ 4+3; adjusted OR top vs. bottom quartile: 1.66; 95% confidence interval (CI), 0.93-2.97; Ptrend = 0.05], as was very high intake of eggs (OR top decile vs. bottom quartile: 1.98; 95% CI, 1.08-3.63, Ptrend = 0.08). Well-done red meat was associated with advanced disease (≥pT3; OR top vs. bottom quartile: 1.74, 95% CI, 1.05-2.90; Ptrend = 0.01). Intakes of red meat, fish, and eggs were not associated with progression. Very high poultry intake was inversely associated with progression (HR top decile vs. bottom quartile: 0.19; 95% CI, 0.06-0.63; Ptrend = 0.02). Substituting 30 g/d of poultry or fish for total or unprocessed red meat was associated with significantly lower risk of recurrence. Lower intakes of red meat and well-done red meat and higher intakes of poultry and fish are associated with lower risk of high grade and advanced prostate cancer and reduced recurrence risk, independent of stage and grade. Cancer Prev Res; 9(12); 933-41. ©2016 AACR.


Assuntos
Dieta , Ovos , Peixes , Recidiva Local de Neoplasia/epidemiologia , Aves Domésticas , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/patologia , Carne Vermelha , Animais , Estudos de Coortes , Progressão da Doença , Ingestão de Alimentos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia/prevenção & controle , Estadiamento de Neoplasias , Estudos Prospectivos , Prostatectomia , Neoplasias da Próstata/cirurgia , Fatores de Risco , Inquéritos e Questionários
20.
BMC Res Notes ; 9: 346, 2016 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-27431491

RESUMO

BACKGROUND: Biorepository research has substantial societal benefits. This is one of the few studies to focus on male willingness to allow future research use of biospecimens. METHODS: This study analyzed the future research consent questions from a prostate cancer biorepository study (N = 1931). The consent form asked two questions regarding use of samples in future studies (1) without and (2) with protected health information (PHI). Yes to both questions of use of samples was categorized as Yes-Always; Yes to without and No to with PHI was categorized as Yes-Conditional; No to without PHI was categorized as Never. We analyzed this outcome to determine significant predictors for consent to Yes-Always vs. Yes-Conditional. RESULTS: 99.33 % consented to future use of samples; 88.19 % consented to future use without PHI, and among those men 10.2 % consented to future use with PHI. Comparing Yes Always and Yes Conditional responses, bivariate analyses showed that race, family history, stage of cancer, and grade of cancer (Gleason), were significant at the α = 0.05 level. Using stepwise multivariable logistic regression, we found that African-American men were significantly more likely to respond Yes Always when compared to White men (p < 0.001). Those with a family history of prostate cancer were significantly more likely to respond Yes Always (p = 0.002). CONCLUSIONS: There is general willingness to consent to future use of specimens without PHI among men.


Assuntos
Troca de Informação em Saúde/estatística & dados numéricos , Registros de Saúde Pessoal/psicologia , Consentimento Livre e Esclarecido/psicologia , Neoplasias da Próstata/psicologia , Grupo com Ancestrais do Continente Africano , Idoso , Grupo com Ancestrais do Continente Europeu , Troca de Informação em Saúde/ética , Registros de Saúde Pessoal/ética , Humanos , Consentimento Livre e Esclarecido/ética , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Próstata/patologia , Próstata/cirurgia , Neoplasias da Próstata/etnologia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Inquéritos e Questionários , Bancos de Tecidos/ética
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