SCIENTIFIC FOCUS
Our cancer control program has two primary aims
1. To decrease the incidence and slow the progression of cancer through genetic, molecular, biological, and behavioral mechanisms; and
2. To improve quality of life and increase survival in those who develop cancer through epidemiological studies, intervention trials to improve quality of life and survival, and health services research to improve access to treatment.
Within each of these aims are key areas of scientific focus that involve a high degree of collaboration. Interdigitating within both aims, we continue our long tradition of research with underserved populations as we attempt to reduce health disparities in cancer incidence, morbidity, mortality, and quality of life.
To achieve these aims, our Program focuses on three main stages of research within each aim: Fundamental/discovery research, translation or intervention research, and dissemination/program delivery (adapted from Best et al., 2003 and Reuben, 2005, President’s Cancer Panel 2004-05Annual Report).
1. Decrease the incidence and slow the progression of cancer
Decreasing the incidence and slowing the progression of cancer is an important focus of our Program. This aim is achieved through epidemiologic studies that focus on genetic susceptibility and nutritional and environmental factors that increase one’s risk for cancer; behavioral interventions to decrease cancer risk, and screening for early detection.
- Epidemiologic studies to determine risk
1.) Genetic and molecular epidemiology to identify people at risk. Our research in molecular epidemiology focuses largely on prostate cancer and benefits from the cross-disciplinary synergy provided by the Prostate Center of Excellence. Identification of genes that increase or modify prostate cancer risk is important for understanding the etiology of the disease and will ultimately lead to improved prevention, earlier diagnosis, and targeted treatment. The majority of this work focuses on identifying genes that increase prostate cancer risk by applying multiple approaches, including 1) genetic linkage studies of prostate cancer to identify chromosomal locations that harbor prostate cancer susceptibility genes, 2) positional cloning of prostate susceptibility genes in the identified chromosomal regions, and 3) association studies to systematically evaluate genes in several important pathways and throughout the entire genome.
Two new areas of research include: 1) using an integrated approach to comprehensively assess genes by simultaneously examining all three potential mechanisms: germline changes, somatic genetic changes, and epigenetic changes; and 2) assessing the joint effects of gene-gene and gene-environmental (dietary) interaction in cancer risk.
2.) Nutrition and environmental risks. This work focuses on our strengths in assessing dietary and environmental exposures, as well as the interaction between these factors and genetic susceptibility (e.g., the work of Drs. Chang, Xu, and Vitolins on diet and genetic susceptibility of prostate cancer). Translational research centers around epidemiologic and laboratory research in vitamin D and prostate cancer, the role of dietary soy and prostate cancer, and the effect of green tobacco sickness and pesticide exposure among Hispanic farmworkers. Some of this research has moved from discovery to translation to dissemination. The work in vitamin D and soy provide excellent examples of an explicit goal of the Program to enhance translational work and interaction with other Programs. Dr. Arcury’s work in farmworker green tobacco sickness and pesticide exposure began as observational studies that led to interventions designed to improve farmworker exposure to harmful carcinogens. His work is now in the dissemination phase that involves communicating results to farmworker and service provider communities.
- Behavioral/pharmacological interventions
Behavioral interventions are a critical component of cancer control. Our interventions to reduce cancer risk and progression have focused largely on dietary factors (vitamin D and soy) and smoking. We currently have four ongoing trials of vitamin D and three studies in the area of soy. Our work in the area of smoking is in the dissemination phase. Building on their award winning Tobacco Intervention Program, Drs. Spangler and Foley have developed a web-based smoking cessation program designed to teach medical students how to counsel patients to reduce smoking. Other projects in this area explore the impact of pharmacological interventions used to prevent cancer (e.g., tamoxifen, raloxifene) on cognitive function.
Early detection or screening represents an important area of cancer control research to detect cancer in its early stages when treatment is more effective. Cancer Control members at WFU have a long history of conducting research in screening and early detection, particularly among underserved populations. The populations in our region, coupled with alliances forged with Winston-Salem State University (an historically Black University) have led to studies among diverse populations in terms of race/ethnicity (African-Americans, Hispanics, Native Americans), geography (rural/urban), and income. Screening studies have focused on Pap smear, mammography, and colorectal screening, and used a variety of interventions such as lay health advisors, local health providers, telephone calls from providers, videotapes, and interactive computer programs.
2. Survivorship: Improve quality of life and increase survival among those who develop cancer
Quality of life (QOL) is a growing area of interest among clinicians, the general public, and researchers. With an estimated 10.1 million cancer survivors in the U.S., QOL issues are particularly important for cancer patients and survivors. In recognition of these large numbers, the Office of Cancer Survivorship (OCS) was established by NCI in 1996. Our projects focus on observational studies of QOL issues, interventions designed to improve QOL, and dissemination studies on patterns of care.
- Epidemiologic studies of cancer survivors
Our research in this area focuses on increasing our knowledge of QOL issues for targeted populations of cancer survivors who have been understudied (e.g., premenopausal women and long-term cancer survivors), and to identify new areas or approaches to develop interventions to improve QOL. In 2001, we were funded by the Department of Defense (DOD) as one of four Behavioral Centers of Excellence in Breast Cancer. The purpose of this Center is to explore QOL issues for breast cancer survivors across the lifespan. Additional survivorship studies focus on understanding how QOL issues change over time and the development of a new QOL measure for long-term cancer survivors.
- Improving quality of life of survivors through symptom management and behavioral interventions
As an outgrowth of our observational studies among cancer survivors, we are developing and testing interventions targeted towards improving the QOL of cancer patients and survivors through exercise and symptom management. One area of research focuses on the role of exercise in improving QOL and preventing lymphedema among breast cancer patients, a troubling and understudied area for breast cancer survivors. Another area focuses on the role of complementary and alternative medicine (CAM) approaches to symptom management. Several studies examine different CAM approaches (acupuncture, yoga, St. John’s Wort, and soy) for relieving hot flashes for women in the general population, breast and ovarian cancer survivors, and men undergoing hormonal therapy for prostate cancer.
Stemming from our existing expertise in health services research and the growing importance of healthcare delivery, we have targeted this area for growth and development. This research explores the systematic variation in how non-medical attributes (e.g. age, race, ethnicity, gender, socioeconomic status, and insurance) and medical attributes (e.g. co-morbidities) affect the care patients receive. It covers such questions as how people access care, the quality of that care received, and the impact of care on quality of life. In addition, Program members are studying the effectiveness and late effects of cancer treatments. Much of this research is conducted through the use of large databases, such as Medicaid or Medicare. This research has particular relevance to our focus on health disparities, since these non-medical attributes are often found to impact the care people receive. By our definition, this research falls under the dissemination stage; however, findings from this research often lead to new questions that lead back to fundamental research.