bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract A42: Optimizing health care systems recruitment and retention practices for medically underserved populations: Impact of ENACCT cancer clinical trial staff training
Authors: Blakeney Natasha C. , Michaels Margo , Britton Abbey , Swords Liz , Bitow Naomi , Gibbs Brian , Yeun Samantha , Rytkonen Bruce , Goodman Robert , Greene Amanda , Jarama Lisbeth 
Published: December 2010

Abstract
Cancer clinical trials (CCTs) are essential to making progress in cancer care, yet many cancer care sites within health care systems struggle with improving adult trial participation, which nationally is less than 5%, even lower among communities of color. Challenges to improving participation include patient barriers such as fear, lack of awareness and costs as well as institutional barriers (limited staff and resources, study design, provider attitudes and behaviors) that can limit patient access to trials, particularly among minority and medically underserved populations.
The Education Network to Advance Cancer Clinical Trials (ENACCT) seeks to improve access to CCTs through education and collaboration with communities, health care providers, and researchers. ENACCT's Pilot Education Program (PEP), was a 3-year community-based intervention designed to enhance access, awareness and accrual to trials. Implemented in three communities nationwide, training was targeted to key stakeholders in trial participation, including CCTs staff.
Using an interactive learning format, PEP training for CCT staff focused on the impact of culture and changing demographics within the clinical research setting; the relationship of cultural competency and Culturally and Linguistically Appropriate Services (CLAS) Standards to CCTs participation; and assisted CCT staff to design an action plan to adopt CLAS Standards in the conduct of research at one's own institution. Additionally, local sites addressed policy barriers to enhance access. PEP impact was evaluated using pre and post tests, follow-up assessments, as well as interview and focus group data. PEP trained 61 CCTs staff (70% nurses). Post-training, at first assessment, 94% of CCT staff indicated increased commitment to advocate for adoption of CLAS standards within their institutions and 84% indicated intention to discuss with their peers the importance of cultural competency on patient recruitment and retention. Site initiatives to address access barriers included implementation of consent short forms for limited English proficiency patients, use of Six Sigma quality improvement measures to improve hospital recruitment processes and launching city-wide symposia on CCTs reaching community leaders and health care providers. A total of 3027 website sessions and 88 unique patient profiles were created with a national CCTs matching service associated with PEP.
Results from PEP suggest that training CCT staff in strategies to enhance cultural competency in the research setting may positively impact awareness and access to CCTs among medically underserved populations.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A42.
Abstract A44: Minority enrollment to clinical trials: Experience at the Dan L. Duncan Cancer Center
Authors: Mims Martha P. , Blaney Susan , Grilley Bambi , Heslop Helen , Osborne C. Kent , Maria L. , Jibaja Weiss , Dan L. 
Published: December 2010

Abstract
Background: The Dan L Duncan Cancer Center (DLDCC) is located in Houston, Texas, and provides care to uninsured and minority patients in several large hospitals including Ben Taub General Hospital, The Michael E. DeBakey VA Medical Center, and Texas Children's Hospital. The catchment area for the DLDCC is Harris County, an urban area with a population of nearly 4 million; approximately 18% of county residents are African American and 39% are Hispanic. While the percentage of African Americans in Harris County is nearly equal in all age groups, Hispanics make up nearly 45% of residents less than 30 years old, but only 10% of residents over 60, those most likely to develop cancer. One-third of the county population has no health insurance.
Objective: In 2006 the DLDCC set out to increase overall enrollment to therapeutic clinical trials while maintaining enrollment of patients belonging to racial and ethnic minorities.
Methods: A four-pronged strategy was used to maintain and improve accrual of racial and ethnic minority patients to cancer-related clinical trials while increasing overall accrual. First, the DLDCC invested significant resources in establishing research infrastructure in the hospitals including hiring bilingual coordinators and nurses, translating consents into Spanish, and underwriting the cost for conduct of NCI-sponsored trials. Second, the DLDCC partnered with hospitals to make office space available for research personnel, to provide discounted investigational pharmacy services and to obtain access to laboratory and imaging data and pathology samples. Third, the DLDCC introduced programs to make minority residents aware of clinical trials and build relationships and trust in the community including the establishment of a community advisory board, sponsorship of plays by minority playwrights that carry a cancer message, sponsorship of community health events, and creation of clinical trials newsletters and websites. Finally, the DLDCC pioneered and gained IRB approval for a form designed to collect accurate racial and ethnic data from trial participants.
Results: Overall enrollment to DLDCC therapeutic clinical trials increased by more than 50% between 2005/2006 and 2009 to an average of 13.4% of new cancer patients enrolled on trial. In 2009, 16.8% of subjects enrolled to therapeutic trials were African American, and 35.4% were Hispanic. Accrual of minority subjects was equivalent in pediatric and adult programs and on therapeutic and nontherapeutic trials.
Conclusion: Recruitment of pediatric and adult members of underserved minorities to clinical trials is possible with targeted strategies, dedicated research staff, hospital partnership and community involvement.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A44.
Abstract A45: Patterns of care regarding surgical choice and application of adjuvant radiation therapy for preinvasive and early-stage breast cancer in rural Appalachia
Authors: Freeman Andrew , Huang Bin , Dragun Anthony 
Published: December 2010

Abstract
Objective: To conduct a cross-sectional registry analysis of women in Appalachian Kentucky with the diagnosis of early-stage breast cancer to identify factors affecting surgical choice [breast conserving surgery (BCS) versus mastectomy] and appropriate use of adjuvant radiation therapy (RT).
Methods: Database collection was performed through the Kentucky Cancer Registry. Inclusion criteria included female breast cancer patients diagnosed between 1998 and 2007. All patients were ≥ 20 years of age diagnosed with DCIS or AJCC stage I or II disease as a first primary diagnosis. Database search was limited to Appalachian residents and were stratified by Beale codes 1-3 for urban locales and 4-9 for rural. Statistics including univariate, multivariate, and Cox survival analyses were performed to identify factors affecting surgical choice, receipt of RT and variables relating to survival.
Results: Analysis was based on 5541 evaluable Appalachian patients, of whom 86.2% lived in a rural location and 13.8% were urban. The overall distribution of primary surgery slightly favored BCS (54.1 %) over mastectomy (45.9%). On multivariate analysis, the most significant factors for mastectomy as the initial surgical procedure were advanced stage (OR 2.571, P&lt;0.0001), rural location (OR 2.075, p&lt;0.0001), and insurance status (OR 1.546, p&lt;0.0001). Of patients choosing BCS, 56.2% received adjuvant RT. On multivariate analysis age &gt;70 (OR 2.506, p&lt;0.0001), rural location (OR 2.416, p&lt;0.0001), and lack of insurance (OR 1.651, p=0.0168) were the strongest predictors for not receiving adjuvant RT. Cox survival analysis correlated with receipt of RT after BCS, ER/PR status, age, smoking history, insurance status, stage, and tumor size.
Conclusions: The rate of mastectomy remains higher and the rate of RT after BCS is significantly lower in Appalachian women compared to other contemporary studies of women with preinvasive and early stage breast cancer. Within the Appalachian population, these disparities are most apparent among rural and uninsured women. Further studies are needed to advance awareness of and access to health care initiatives to improve quality of breast cancer care for the underserved.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A45.
Abstract A46: Neighborhood socioeconomic deprivation and all-cause, cancer-, and CVD-specific mortality: NIH-AARP Study
Authors: Major Jacqueline M. , Doubeni Chyke A. , Freedman Neal D. , Park Yikyung , Lian Min , Hollenbeck Albert R. , Schatzkin Arthur , Graubard Barry I. , Sinha Rashmi 
Published: December 2010

Abstract
Background: The impact of person-level socioeconomic status (SES) on mortality is well documented. However, residing in deprived areas may increase the risk of mortality beyond that explained by a person's own SES-related factors and lifestyle. As few studies possess both person-level and area-level data, the interaction between these measures, though potentially of significant importance, is poorly understood. The large longitudinal NIH-AARP Study provides a rich resource to personal characteristics and health risk factors and is linked to census tract data which details the composition and socioeconomic context of each participant's local environment. The purpose of the present study was to examine the relation between neighborhood socioeconomic deprivation and all-cause, cancer-and cardiovascular disease (CVD)-specific mortality for men and women after accounting for education and other important person-level risk factors.
Design, Setting, and Participants: In the longitudinal National Institutes of Health (NIH)-AARP (formerly known as the American Association of Retired Persons) Diet and Health Study, we analyzed data from healthy participants, ages 50-71 years at baseline. Deaths (n=33831) were identified through linkage to Social Security Administration Death Master File and National Death Index from recruitment (1995-1996) to December 31,2005. Information on census tracts was obtained from the 2000 US Census. A multilevel analysis approach was employed; marginal and random effects (frailty) models for Cox proportional hazards regression, which account for correlation of individuals residing within the same census track, estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for quintiles of neighborhood deprivation. Multivariable models were adjusted for person-level risk factors, including age, education, smoking, physical activity, body mass index, and diet.
Results: During a median follow-up of 9.5 years, 21843 men and 11988 women died. Participants residing in the highest vs. lowest quintile of the deprivation index had elevated risks for overall mortality (HRmen=1.17,95% CI=1.10-1.24; HRwomen=1.13,95% CI=1.05-1.22) and marginally increased risk for cancer mortality (HRmen=1.09,95% CI=1.00-1.20; HRwomen=1.09,95% CI=0.99-1.22). Regarding CVD mortality, associations appeared stronger in men (HR=1.33,95% CI=1.19-1.49) than women (HR=1.18,95% CI=1.01-1.38). There was no evidence of an effect modification by education.
Conclusion: Higher neighborhood socioeconomic deprivation was associated with modest increases in all-cause mortality, cancer mortality, and cardiovascular disease mortality in both men and women even after accounting for a large number of established risk factors.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A46.
Abstract A55: Regional differences in breast cancer biomarkers in American Indian and Alaska Native women
Authors: Kaur Judith S. , Vierkant Robert , Myers Shannon 
Published: December 2010

Abstract
Introduction: Breast cancer is a major cause of cancer mortality in American Indian and Alaska Native (AIAN) women. However regional differences are striking with lowers rates in Arizona and highest in Alaska with almost a three-fold difference in incidence and mortality between the two states. These differences may be due in part to varying levels of biologic tumor aggressiveness. To evaluate this, we compared a panel of biomarkers on consecutively diagnosed AIAN breast cancer cases from AZ (N=53) and AK (N=42).
Methods: Retrospective analysis of tissue blocks measured expression levels for the following panel of biomarkers: ER and PR (ordinally coded as positive vs. negative); her2, BCL-2, and EGFR (coded 0.1.2. and 3+) and P53, MIB-1 and cyclin D (continuous percent of cells stained). Distributions of biomarker values were compared across state of residence using t-tests for continuous and ordinally scaled markers and chi-square tests of significance for binary markers. Age adjusted analyses were also carried out using linear and logistic regression models as appropriate to account for possible differences in age at diagnosis across states. Chart reviews recorded demographics and treatment characteristics.
Results: The following demographics were observed with 95 cases of AIAN women with breast cancer analyzed. Average age at diagnosis was similar in the two states (mean, 58.4 for AZ vs. 56.1 for AK, t-test p value=0.45). 74% presented with a palpable mass. 32% had lumpectomy and axillary node dissection. 28% were premenopausal. 8% had a first-degree relative with breast cancer. 46% received adjuvant chemotherapy. 54% received adjuvant hormonal therapy. Cases from AK had higher levels of p53 staining (40.3 vs. 18.5, p=0.004) and lower levels of both EGFR (mean ordinal scaling 0.15 vs. 0.53, p=0.02) and Her2 (mean ordinal scaling 0.81 vs. 1.32, p=0.02) tan those from AZ. No differences in distribution were observed for MIB-1, Cyclin D, BCL-2, ER or PR. When examined together, the triple negative combination of ER/PR/Her2 also did not differ across states (12% for AK vs.13%forAZ, p=0.85).
Conclusions: Our findings indicate that regional differences in biomarker expression levels of P53, EGFR and Her2 may exist in AIAN women. Further research is needed to confirm our results and determine to what extent these differences may explain the observed differences in mortality. Genetic testing for BRCA1,2 or other genetic associations with breast cancer have not been done in these populations and may also be useful to examine the reasons for differences in incidence and mortality. In addition, AIAN women are more likely to present with palpable masses representing higher risk stages of breast cancer. Outreach activities in this population continue to be highly important to change mortality. Supported in part by NCI U01 114609 Spirit of Eagles Community Network Program
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A55.
Abstract A57: Progress on a universal classifier for tumor samples
Authors: Jackson Nia , Enkemann Steven 
Published: December 2010

Abstract
Gene expression arrays are widely used to analyze tumor samples with the intention of identifying tumor identity or aspects of the tumors that may influence disease prognosis. Although arrays have illustrated the large diversity of individual tumors, most research efforts have focused on classifying tumors according to currently established classification systems. In this study we directly tested whether the pathological classification of tumor samples was necessary or sufficient to group tumors into subgroups based on biological similarity. Microarray data obtained from tumor samples was obtained from public databases. Individual data files were rigorously screened to remove poor quality samples. The samples were initially grouped according to large pathological divisions and training sets and test sets were created. Working back and forth between clustering samples and selecting genes an optimal grouping of samples was achieved in the training data along with the list of genes that defined each group. The final classification was then tested on the independent data sets to validate the classification of the tumor groups. We found the glioblastoma tumors clearly subclassified into distinct groups based on tumor grade whereas most other tumor classes did not. Interestingly, ovarian tumors, endometrial tumors and a few breast tumors classified as one single tumor group that might be further subgrouped, but not by site of origin. For cases of sarcoma the observed subclasses only partially recapitulate pathologically defined tumor types. Only with adenocarcinoma tumors did the major subclassification depend on the tumor site of origin. A preliminary classification scheme is presented where tumors are classified on a primary, secondary, and sometimes a tertiary level. One implication of this analysis is that many tumor classes that have been traditionally separated for clinical trials may be similar enough to consider combined trials and other groups of tumors may be inappropriately combined in current trials.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A57.
Abstract A59: Developing novel peptide inhibitors to chromosomal cohesion using mRNA display for nanodrug delivery in breast cancer therapy
Authors: McCullum Elizabeth O. , Pati Debananda 
Published: December 2010

Abstract
Several specific molecular networks mediate the cellular proliferation of tumorogenic cells. One signaling pathway of interest is the transition from metaphase to anaphase which is dependent on cleavage of the cohesin protein complex by separase, an endopeptidase. A normal transition allows the protein complex to form, sister chromatid cleavage and the onset of anaphase. However, failure to properly assemble or maintain the integrity of this complex results in the premature separation of chromatids (PCS), mitotic arrest and apoptosis in cultured cells. This research effort will focus on the identification of cohesin Rad21, a proapoptotic protein that is over-expressed in breast cancer cells, mimcs for the induction of apoptosis in the cohesin-disrupted tumors. Using mRNA display, Rad21 mimetopes will be selected to bind a SMC-1 target in the formation of standard cohesin complex assembly. The pool of isolated peptides will be further characterized for their specificity, induction of PCS, mitotic arrest and apopotosis both in vitro and in vivo. Finally, peptides will be conjugated to a RAFT-peptide scaffold drug delivery system to exclusively target rapidly proliferating breast tumor cells. The potential advantages provide an area of promising therapeutics for antitumor effects when coupled with chemotherapy at the point of early detection.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A59.
Abstract A7: Ethnic variations in trusted sources of prostate cancer information among American, Jamaican, and Bahamian black men
Authors: Williams Shanita D. , Ross Louie , Hinton Lisa , Woods V. Diane , Roberts Robin 
Published: December 2010

Abstract
Introduction: Prostate cancer is the leading cancer and the second leading cause of cancer deaths among men in the United States. African American (AA) and West Indian men are at greater risk than white and other racial/ethnic social groups in both incidence and mortality related to prostate cancer. AA men also have a greater likelihood of presenting at higher stage and grade with poorer treatment and health outcomes. Little is known about how black men obtain information about prostate cancer and if there is variation in trusted sources of information. The purpose of this study was to explore how black men obtain information about prostate cancer and screening and to identify sociodemographic and other ethnocultural characteristics that are associated with trusted sources of health information regarding prostate cancer.
Methods: U.S.-born/American, Jamaican, and the Bahamian black men age 40 or older were asked questions about their trusted sources of health information related to prostate cancer and screening using DRE and PSA. The study used a convenience sample of 448 AA men and 48 Jamaican men residing in the Southeastern U.S. and 55 Bahamian men in the Bahamas. Data were self-reported survey responses and analyzed using SAS.
Results: Study participants were likely married (54%), had some college or technical training (78%), and employed (60%). Over 90% of the men reported hearing of the DRE and 77% had heard of the PSA test. The major sources of health information were television news (65%), news/talk radio (54%), print materials (47%), and the Internet (45%). There were no significant ethnic differences in trusted source of health information. Further analysis revealed two information source subfactors: (1) oral (word of mouth)-oriented and (2) print-oriented preferences. Reporting good or excellent health, higher income, and having health insurance were associated with oral (word of mouth) information preferences. Reporting good or excellent health, higher levels of education and income, being employed, married, AA ethnicity, nonveteran status, and having had a recent health checkup and having heard of the PSA test and DRE were associated with print-oriented information preferences. In addition, printed sources of information were associated with awareness of DRE and PSA, but not recent screening.
Conclusions: Blacks in the U.S. and Caribbean bear a greater burden of prostate cancer among men. Therefore it is important to understand what information sources are trusted and preferred within diverse cultures along with ethnocultural factors that may influence health information preferences. Future studies are needed to further explore the relationship between black men's information preferences and their prostate cancer-related outcomes.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A7.