Abstract C20: Understanding disparities in cancer survivorship: Introducing the Cancer Survivorship in Metropolitan Detroit Cohort Study
Authors: Hastert Theresa A. , Baird Tara , Ruterbusch Julie J. , Albrecht Terrance L. , Schwartz Ann G. , Beebe-Dimmer Jennifer L. 
Published: May 2016

Background: Recent successes in cancer diagnosis and treatment have led to improved survival overall; however, African-Americans (AA) continue to experience worse survival outcomes than whites for many cancers, and AA survivors in Detroit often experience poorer outcomes than those in other parts of the country. The reasons underlying these differing survivorship outcomes and disparities relative to white survivors are not clear. We have established the Cancer Survivorship in Metropolitan Detroit cohort study to evaluate potential contributors to disparities in outcomes including socioeconomic factors, health behaviors, social support, and comorbidities.

Methods: AA and white adults (ages 20-79) seen at the Karmanos Cancer Institute and identified through the Metropolitan Detroit Cancer Surveillance System as having been diagnosed with a first primary breast, colorectal, lung, or prostate cancer since January 1, 2013 are eligible to join the cohort. To date, 232 of the targeted 1,000 survivors have completed the self-administered online survey which collects information on demographic and socioeconomic characteristics, medical history, health behaviors, and social support. An interviewer-administered option is available to participants in need of assistance or without access to the Internet. Participants are also asked to consent to provide a saliva sample and access to medical records, and to participate in annual follow-up for up to four years. Data are available on both short-term outcomes such as quality of life and treatment, and long-term outcomes including cancer progression and recurrence and total and cancer-specific survival.

Results: Of the first wave of participants contacted, 60% have completed the baseline questionnaire. The average age of participants is 62, 61% of initial respondents are AA and 66% are women. Overall, 30% of initial questionnaires have been completed online without assistance, including 46% completed by white survivors and 18% by AA survivors. Selected preliminary data suggest several differences between AA and white survivors in the cohort. The majority (62%) of white survivors reported household incomes of at least $40,000 compared with 18% of AA survivors (p&lt;0.001). Relative to whites,fewer AA cancer survivors were married (21% vs 65%, p&lt;0.001), or employed full time (11% vs. 24%, p=0.006) at baseline, and fewer owned or leased a vehicle (55% vs. 89%, p&lt;0.001). A lower proportion of AA survivors (56%) had any form of private health insurance compared with whites (83%, p&lt;0.001). AA survivors reported suffering from 3.3 comorbid conditions on average, compared with 2.7 among whites (p=0.014). A higher proportion of AA survivors reported that pain interfered with day-to-day activities (26% vs. 16%, p=0.06), while a higher proportion of whites reported high levels of fatigue (33% vs. 22%, p=0.06). A greater proportion of AA survivors reported current smoking (33% vs. 14%, p=0.005) and eating fast food regularly (46% vs. 25%, p=0.001), while a lower proportion participated in regular physical activity (24% vs. 42%, p=0.006). Alcohol and fruit and vegetable consumption were similar in white and AA survivors. Social support was also similar among the two groups, with a majority (75-80%) reporting usually or always having someone to help with chores, errands, or if they were confined to bed.

Implications: These preliminary data suggest that AA and white cancer survivors in Detroit vary with regard to a number of health-related factors that may impact outcomes. These data can be used to further understand and address survival disparities and improve outcomes among AA cancer survivors, and may be instructive to other investigators implementing cohort studies among cancer survivors, particularly those wishing to incorporate online data collection.

Citation Format: Theresa A. Hastert, Tara Baird, Julie J. Ruterbusch, Terrance L. Albrecht, Ann G. Schwartz, Jennifer L. Beebe-Dimmer. Understanding disparities in cancer survivorship: Introducing the Cancer Survivorship in Metropolitan Detroit Cohort Study. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C20.