Transcript Document

NORTHERN CALIFORNIA
CANCER CENTER
(NCCC)
OVERVIEW OF RESEARCH PORTFOLIO
January 2007
PURPOSE OF OVERVIEW
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To introduce members of the Stanford Comprehensive
Cancer Center (SCCC) to on-going research at the
Northern California Cancer Center (NCCC)
To identify common and/or complementary research
interests and expertise among SCCC and NCCC program
members
To stimulate interactions and collaborations between
SCCC and NCCC program members
Contact information for specific scientists at NCCC:
www.nccc.org or cancer.stanford.edu/find/
Or contact Esther M. John, Co-Leader of Program 9
[email protected]
Population Sciences Program – Associate Director
Dee W. West, NCCC/SU
NCCC members - Program 9
Ellen Chang
Tina Clarke Dur
Sally L. Glaser
Scarlett Lin Gomez
Pamela L. Horn-Ross
Esther M. John, Program Co-Leader
Theresa Keegan
Peggy Reynolds
Rudy Rull
NCCC members - Program 10
Bang H. Nguyen
Ingrid Oakley-Girvan
MAIN AREAS OF RESEARCH
AT NCCC
• Cancer Surveillance
• Cancer Etiology
• Cancer Outcomes
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Research focus on
racial, ethnic, cultural, and other groups
with an unequal burden of cancer
SURVEILLANCE RESEARCH
What is Cancer Surveillance Research?
“…a discipline in which systematically collected data on
cancer patients and population characteristics are
analyzed and interpreted to examine and test hypotheses
about cancer predictors, incidence, and outcomes in
geographically defined populations over time.” (Glaser et
al., 2005)
Lead Investigators:
S. Glaser
T. Clarke
S. Gomez
T. Keegan
D. West
SURVEILLANCE RESEARCH
Goals
• Address cancer occurrence patterns and issues of public health
relevance
• Use creative methodologies to collect and present data
• Work with interdisciplinary research teams
• Identify cancer patients for etiology and outcomes research studies
Data Sources
• Cancer registry
 Greater Bay Area Cancer Registry (Greater Bay Area data)
 California Cancer Registry (statewide data)
 SEER Program (data from around the nation)
 International Cancer Registry (world wide data)
• Population risk factor data
 California Health Interview Survey - CHIS
 Behavioral Risk Factor Surveillance System - BRFSS
• Linkage to Medicare data
• Linkage to Medi-Cal data
SURVEILLANCE RESEARCH
Research Examples
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Breast cancer
Hodgkin lymphoma
Non-Hodgkin lymphoma
Racial/ethnic variation
Survival
SURVEILLANCE RESEARCH
Breast Cancer
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Incidence and survival patterns
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Trends over time (e.g. cancer in Marin county)
Racial/ethnic variation
Prevalence of risk factors
Mammography utilization
Treatment choices
Breast cancer in females and males
SURVEILLANCE RESEARCH
Hodgkin Lymphoma
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Incidence and survival
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Trends over time
Socio-economic variation
HIV-associated disease
Non-Hodgkin Lymphoma
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Subtype classification methods
Incidence trends over time
Socio-economic variation
SURVEILLANCE RESEARCH
Racial/ethnic variation
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Incidence
Treatment
Survival
Trends in Asian subgroups, African-Americans & Hispanics
Methods for racial/ethnic and immigration classification
Cancer risk factor profiles
SES and stage at diagnosis
Cancer in Asia and in Asian Americans
CANCER ETIOLOGY
Cohort studies
• California Teachers Study
Family-based studies
• Breast Cancer Family Registry
• Colon Cancer Family Registry
Case-control studies
• Population-based case-control studies
of specific cancers
CANCER ETIOLOGY
Focus on
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Breast cancer
Endometrial cancer
Ovarian cancer
Thyroid cancer
Prostate cancer
Lymphomas
Leukemia
Racial/ethnic disparities
Environmental risk factors
Nutrition
Social and built environment
Genetic susceptibility
CANCER ETIOLOGY
California Teachers Study
Lead investigators: P. Horn-Ross, P. Reynolds, D. West
• Cohort study of 133,479 women established in 1995
• Collected risk data by questionnaires and cancer data
through linkage with cancer registries
• Diet, alcohol, phytochemicals, body composition,
smoking, environmental exposures, physical activity,
hormone treatment, psychosocial factors, family history
• Genetic susceptibility
• Breast, ovarian, endometrial, and thyroid cancers,
melanoma, NHL
CANCER ETIOLOGY
Family Registry for Breast Cancer
Lead investigator: E. John, D. West
• Family Registry established in 1995 at 6 international sites
• Over 2,800 high-risk and sporadic breast cancer families
from San Francisco Bay area
• Over-sampling of minorities and early-onset breast cancer
• Research focus on:
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BRCA1 and BRCA2, ATM, CHK2, TGFB, IGF, other genes
GxE and GxG interactions (G=Gene; E=Environment)
CANCER ETIOLOGY
Multiethnic Case-Control Study of Breast Cancer
Lead investigator: E. John
• Over 4,900 Hispanic, African-American and white women
• Racial/ethnic differences in risk factors
• Modifiable lifestyle factors
Physical activity, body size, sun exposure, vitamin D,
dietary intake, heterocyclic amines,
occupational exposures, exposures in adolescence,
migration, acculturation
Genetic susceptibility (VDR, IGF, OB-R, AR, LOX, TGFB, POR)
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• Genetic admixture in Hispanics and African-Americans
CANCER ETIOLOGY
Breast Cancer and HLA / Immune Function
Lead investigator: S. Glaser
• HLA genotype and variation across racial/ethnic groups
Breast Cancer and Hygiene Hypothesis
Lead investigator: T. Clarke
• Reduced/delayed exposure to microbes, particularly in
childhood, may reduce risk
• Markers of microbial exposure, including childhood
social class, day care attendance, exposure to farming
CANCER ETIOLOGY
Breast Cancer and Epstein-Barr Virus
Lead investigator: S. Glaser
• Controversy regarding EBV presence in breast tumors
• Developed a range of EBV assays and applied them to tumors
from women at high and low risk of breast cancer
Breast Cancer Risk in Nail Salon Workers
Lead investigator: P. Reynolds
• Preliminary study of characteristics of nail salon workers
in Alameda County
CANCER ETIOLOGY
Breast Cancer and Early Life Exposures
Lead investigator: P. Reynolds
• Association of birth characteristics/childhood SES
• Linkage with birth certificate information
Growth and Lifestyle Study
Lead investigator: P. Horn-Ross
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Cohort study of 215 girls aged 10-13 years
Followed for 2 years
Effect of soy intake on age at menarche
Modification of effect by variants of genes that regulate
steroid hormones
CANCER ETIOLOGY
Northern CA Childhood Leukemia Study
Lead investigator: P. Reynolds
• Population-based case-control study, 35 counties
• Environmental risk factors
• Variability in risk by molecular subtypes
Leukemia and Exposure Insights with GIS
Lead investigators: P. Reynolds, R. Rull
• GIS (Geographic Information System) neighborhood attribute
data on environmental exposures
• Neighborhood information on agricultural pesticide
applications, traffic density, measured air quality
CANCER ETIOLOGY
EBV and Hodgkin Lymphoma
Lead investigator: S. Glaser
• Large case-series from California
• Cancer registry demographic and tumor data with tumor EBV
status determined from archival tumor specimens
Genetic Susceptibility and Hodgkin Lymphoma
Lead investigator: S. Glaser
• Pilot study to assess familial factors and genetic
susceptibility
CANCER ETIOLOGY
Collaborative Work on Etiologic Study of non-Hodgkin
and Hodgkin Lymphomas in Scandinavia
Lead investigator: E. Chang
• Large case-control study in Denmark and Sweden
• Infections, medical history, diet and alcohol intake,
sunlight exposure, family history
• Genetic susceptibility
CANCER ETIOLOGY
Risk Factors for Advanced Prostate Cancer
Lead investigator: E. John
• Modifiable lifestyle factors
Sun exposure, vitamin D, physical activity,
body size, diet, heterocyclic amines, NSAIDS
• Genetic susceptibility (VDR, AR)
• Genetic admixture
CANCER ETIOLOGY
Social and Built Environment and Cancer Risk
Lead investigator: S. Gomez
• Assessment of social and built environment through
community-level geo-spatial data
Population and housing density, housing characteristics,
immigration/acculturation, racial/ethnic composition,
medical care, businesses/services, walkability, commute,
residential segregation, unemployment
• Impact of built environment on physical activity and breast
cancer risk
• Impact of nutrition environment on dietary patterns and
cancer risk
OUTCOMES RESEARCH
Focus on
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Early detection and screening
Survival
Treatment
Quality of life
Quality of care
Co-morbidity
Social and built environment
OUTCOMES RESEARCH
Colorectal Screening in Vietnamese
Lead investigator: B. Nguyen
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Controlled intervention trial
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Radio, TV, and newspaper articles and ads
Vietnamese language booklets and flyers
Physician training DVD’s
Evaluation of pre- and post-intervention screening
attitudes and behaviors
OUTCOMES RESEARCH
Determinants of Hepatitis B Awareness and Screening
in Chinese and Chinese Americans
Lead investigator: E. Chang
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Pilot study using focus groups to develop
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Motivational messages to promote hepatitis B screening,
vaccination, and clinical follow-up
Knowledge and behavior surveys
Foundation for large community intervention study
OUTCOMES RESEARCH
SEER Patterns of Care Studies
Lead investigator: T. Keegan
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NCCC has participated in these studies for over 10 years
Variation in patterns of treatment for a variety of cancer
sites by
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Type of community and treatment facility
Age and racial/ethnic groups
Time period
Insurance status
Effects of co-morbidity and other conditions on treatment
OUTCOMES RESEARCH
Breast Cancer Treatment Choices
Lead investigator: S. Gomez
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Pilot study to develop linguistically- and culturallyappropriate survey instrument
Incorporation of mixed methodology: qualitative, focus
groups, cognitive, epidemiologic pilot interviews
Focus on:
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Cultural factors in decision-making processes for
early-stage breast cancer
Family influences on decision-making
Treatment impacts on quality of life
Provider perspectives
OUTCOMES RESEARCH
Treatment Choice and Quality of Life for Men with
Localized Prostate Cancer
Lead investigator: I. Oakley-Girvan
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Multi-center Prospective Cohort
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Questionnaire prior to treatment
Questionnaire after 6 months of follow-up
Factors influencing treatment decisions
OUTCOMES RESEARCH
Prostate Cancer Progression and Survival
Lead investigator: I. Oakley-Girvan
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Equal-access HMO based multi-ethnic cohort
Effect of racial differences in
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Health care usage
SES
Co-morbidity
on racial differences in disease progression, recurrence, and
survival
OUTCOMES RESEARCH
Cancer Care Outcomes Research and Surveillance
Consortium (CanCORS)
Lead investigator: D. West
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Multi-center cohort study of 10,000 newly diagnosed lung
and colorectal cancer patients (2,000 from NCCC)
Characteristics and beliefs of cancer patients, caregivers,
and providers
Characteristics and systems of organizations delivering
cancer care
Impact on:
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Effective treatment and good outcomes (measured from
medical record reviews)
Continuum of care (diagnosis to recovery or death)
Disparities (age, gender, race/ethnicity, insurance,
residence)
OUTCOMES RESEARCH
Cancer Survival Following Screenable Cancers in Asians
Lead investigator: S. Gomez
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Analysis of linked SEER-Medicare and California cancer
registry data
Survival patterns among specific Asian subgroups
Association of survival with:
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Socio-demographic factors (e.g., census SES)
Clinical factors (e.g., treatment)
Co-morbidity (other medical conditions)
OUTCOMES RESEARCH
Social and Built Environment and Cancer Outcomes
Lead investigator: S. Gomez
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Impact of social and built environment and residential
segregation on racial/ethnic disparities in cancer outcomes
Individual- and institutional-level discrimination in cancer
medical care and quality of life
Impact of built environment on physical activity and breast
cancer survival
OUTCOMES RESEARCH
Survival in High-risk Breast Cancer Families
Lead investigator: D. West
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Association of survival with genetic factors
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Family history of cancer
BRCA1 and BRCA2 mutations
Polymorphisms in low penetrance genes
Association of survival with non-genetic factors
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Hormonal and lifestyle factors
OUTCOMES RESEARCH
Young Breast Cancer Survivors - 10 Years Later
Lead investigator: I. Oakley-Girvan
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10 year follow-up of breast cancer survivors diagnosed at
age <50 years
Concerns of 10 year survivors compared to friend controls
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Physical well-being
Psychological well-being
Social well-being
Spiritual well-being
Concerns of 10 year survivors vs. 5 year survivors
OUTCOMES RESEARCH
Bone Health in Young Breast Cancer Survivors
Lead investigator: I. Oakley-Girvan
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Randomized intervention trial of 400 breast cancer
patients aged <50 years at diagnosis and with recently
completed chemotherapy
Effect of one year exercise intervention on:
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Frequency and duration of resistance and aerobic exercise
Bone mineral loss as measured by spine DXA and
biochemical markers of bone turnover
Body composition (body mass index, lean body mass, fat
mass)
Mental and physical health
OUTCOMES RESEARCH
APECC Study:
Bladder Cancer, Colorectal Cancer, and Leukemia
Lead investigator: I. Oakley-Girvan
• Population-based study of 750 cancer survivors
 2-5 year survivors
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Approx. equal enrollment by race/ethnicity and gender
• Focus groups with 30 participants each
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Patient care, patient participation in care, health outcomes, and
social support
Patient preference for involvement in medical decisionmaking and information seeking
Unmet information needs, sources for information, and information
barriers
Patient attitudes towards discussing psychosocial issues, health
history, and co-morbidity
OUTCOMES RESEARCH
FOCUS Study:
Breast, Colorectal, Endometrial, Ovarian, and Prostate Cancer
Lead investigator: I. Oakley-Girvan
• Population-based study of 1600 cancer survivors
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4-13 year survivors
Equal enrollment by race/ethnicity and gender
• Interviews on frequency, content and setting of follow-up care
• Improvement of follow-up care for the increasing number of
people living with cancer