Michele L Cote

Neighborhood disorder and ovarian cancer survival in Black women

Abstract Ovarian cancer (OC) is the fifth leading cause of cancer mortality among women in the US. Black women experience significantly lower OC survival than White women. Evidence suggests that this disparity is not solely the result of barriers to healthcare access but may also be impacted by other factors, including neighborhood social characteristics. To investigate this further, this study developed an approach for remotely estimating the degree of physical disorder (PD) in neighborhoods using structured audits of Google Street View imagery for participants in the AACES, a multi-site population-based study of Black women newly diagnosed with OC. We then assessed whether neighborhood disadvantage (ND) and PD were associated with overall survival. We fit Weibull accelerated failure time models to assess the association of both PD and ND with survival among 471 Black women with OC (n = 317 deaths). Both PD (event time ratio (ETR), 0.99; 95% CI, 0.98, 1.00) and Area Deprivation Index (ETR: 0.96, 95% CI: 0.94, 1.00) were associated with shorter survival. The results suggest that both physical and social neighborhood characteristics may impact survival in woman with OC, but further research is warranted.

Comorbid conditions and survival among Black women with ovarian cancer

AbstractBackgroundBlack women with epithelial ovarian cancer (EOC) have worse survival and a higher burden of comorbid conditions compared with other racial groups. This study examines the association of comorbid conditions and medication use for these conditions with survival among Black women with EOC.MethodsIn a prospective study of 592 Black women with EOC, the Charlson comorbidity index (CCI) based on self‐reported data, three cardiometabolic comorbidities (type 2 diabetes, hypertension, and hyperlipidemia), and medication use for each cardiometabolic comorbidity were evaluated. Cox proportional hazards regression models were used to examine the association of comorbid conditions and related medication use with all‐cause mortality while adjusting for relevant covariates overall and by histotype (high‐grade serous [HGS]/carcinosarcoma vs. non‐HGS/carcinosarcoma) and stage (I/II vs. III/IV).ResultsA CCI of ≥2 was observed in 42% of the cohort, and 21%, 67%, and 34% of women had a history of type 2 diabetes, hypertension, and hyperlipidemia, respectively. After adjusting for prognostic factors, a CCI ≥2 (vs. 0; hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.04–1.71) and type 2 diabetes (HR, 1.42; 95% CI, 1.10–1.84) were associated with an increased risk of mortality. The increased risk of mortality for type 2 diabetes was present specifically among women with HGS/carcinosarcoma (HR, 1.47; 95% CI, 1.10–1.97) and among women with stage III/IV disease (HR, 1.47; 95% CI, 1.10–1.98). The authors did not find evidence that hypertension, hyperlipidemia, or medication use for the cardiometabolic comorbidities meaningfully impacted survival.ConclusionComorbid conditions, especially type 2 diabetes, had a significant adverse impact on survival among Black women with EOC.

A Comparison of Neighborhood Socioeconomic Deprivation Measures and the Association with Survival among Black and White Women with Endometrial Cancer

Abstract Background: Black women with endometrial cancer have twice the mortality compared with White. Survival disparities remain after accounting for individual-level socioeconomic and cancer-related factors. We investigated associations between area-based deprivation and survival and explored whether area-based deprivation attenuates the association between race and survival, among a cohort of Black and White women. Methods: Data from endometrial cancers diagnosed between 2013 and 2022 were collected from a comprehensive cancer registry covering Metropolitan Detroit. Addresses at diagnosis were linked to the area deprivation (ADI) and social vulnerability (SVI) indices. Adjusted Fine and Gray models and Cox proportional hazard models were run investigating associations between area-based deprivation measures and survival; analyses were conducted estimating the proportion of the association between race and survival that was attenuated by area-based measures. Results: Higher deprivation was associated with poorer survival, adjusted for race, insurance status, and tumor characteristics. Compared with the least disadvantaged quartile, the quartile with the highest disadvantage using ADI and SVI had 1.18 [95% confidence interval (CI), 0.99–1.43] and 1.40 (1.14–1.71) times the hazard of endometrial cancer–specific mortality, respectively. ADI and SVI attenuated 18% (3%–38%) and 27% (10%–48%) of associations between race and mortality overall and 24% (95% CI, 3%–61%) and 40% (95% CI, 16%–78%) among those with high-grade histology. Conclusions: This study demonstrates a clear association between neighborhood-level disadvantage and survival among women with endometrial cancer living in Metropolitan Detroit. Neighborhood disadvantage attenuates the relationship between race and survival, particularly among those with high-grade histology. Impact: These findings serve as motivation to understand how neighborhood affects cancer outcomes.

Quality of life in endometrial cancer survivors by grade of disease

AbstractBackgroundEndometrial cancer (EC) is the most common gynecologic malignancy in developed countries, with overall incidence increasing, particularly high‐grade disease. There is sparse information regarding quality of life (QOL) in EC survivors with a focus on grade of disease.MethodsA total of 259 women with EC diagnosed between 2016 and 2020 were identified via the Metropolitan Detroit Cancer Surveillance System and consented to enroll in the Detroit Research on Cancer Survivors cohort study (if African American, n = 138) or completed the baseline interview (if non‐Hispanic white, n = 121). Each respondent provided information about their health history, educational attainment, health behaviors, and demographics. The Functional Assessment of Cancer Therapy‐General (FACT‐G) and Endometrial‐specific (FACT‐En) were used to assess QOL.ResultsWomen diagnosed with high‐grade (n = 112) and low‐grade (n = 147) EC participated in this study. EC survivors with high‐grade disease reported significantly lower QOL compared to survivors with low‐grade disease (85 vs. 91, respectively, p value = 0.025) as assessed by the FACT‐G. This difference was driven by lower physical and functional subscales among women with high‐grade disease compared to those with low‐grade disease (p value = 0.016 and p = 0.028, respectively). Interestingly, EC‐specific QOL measures, as assessed by the FACT‐En, did not differ by grade.ConclusionGrade of disease impacts QOL in EC survivors, as well as socioeconomic, psychological, and physical factors. Most of these factors are amenable to interventions and should be assessed in patients after an EC diagnosis.

Racial Differences in the Tumor Immune Landscape and Survival of Women with High-Grade Serous Ovarian Carcinoma

Abstract Background: Tumor-infiltrating lymphocytes (TIL) confer a survival benefit among patients with ovarian cancer; however, little work has been conducted in racially diverse cohorts. Methods: The current study investigated racial differences in the tumor immune landscape and survival of age- and stage-matched non-Hispanic Black and non-Hispanic White women with high-grade serous ovarian carcinoma (HGSOC) enrolled in two population-based studies (n = 121 in each racial group). We measured TILs (CD3+), cytotoxic T cells (CD3+CD8+), regulatory T cells (CD3+FoxP3+), myeloid cells (CD11b+), and neutrophils (CD11b+CD15+) via multiplex immunofluorescence. Multivariable Cox proportional hazard regression was used to estimate the association between immune cell abundance and survival overall and by race. Results: Overall, higher levels of TILs, cytotoxic T cells, myeloid cells, and neutrophils were associated with better survival in the intratumoral and peritumoral region, irrespective of tissue compartment (tumor, stroma). Improved survival was noted for T-regulatory cells in the peritumoral region and in the stroma of the intratumoral region, but no association for intratumoral T-regulatory cells. Despite similar abundance of immune cells across racial groups, associations with survival among non-Hispanic White women were consistent with the overall findings, but among non-Hispanic Black women, most associations were attenuated and not statistically significant. Conclusions: Our results add to the existing evidence that a robust immune infiltrate confers a survival advantage among women with HGSOC; however, non-Hispanic Black women may not experience the same survival benefit as non-Hispanic White women with HGSOC. Impact: This study contributes to our understanding of the immunoepidemiology of HGSOC in diverse populations.

Hypertension and Risk of Endometrial Cancer: A Pooled Analysis in the Epidemiology of Endometrial Cancer Consortium (E2C2)

Abstract Background: The incidence rates of endometrial cancer are increasing, which may partly be explained by the rising prevalence of obesity, an established risk factor for endometrial cancer. Hypertension, another component of metabolic syndrome, is also increasing in prevalence, and emerging evidence suggests that it may be associated with the development of certain cancers. The role of hypertension independent of other components of metabolic syndrome in the etiology of endometrial cancer remains unclear. In this study, we evaluated hypertension as an independent risk factor for endometrial cancer and whether this association is modified by other established risk factors. Methods: We included 15,631 endometrial cancer cases and 42,239 controls matched on age, race, and study-specific factors from 29 studies in the Epidemiology of Endometrial Cancer Consortium. We used multivariable unconditional logistic regression models to estimate ORs and 95% confidence intervals (CI) to evaluate the association between hypertension and endometrial cancer and whether this association differed by study design, race/ethnicity, body mass index, diabetes status, smoking status, or reproductive factors. Results: Hypertension was associated with an increased risk of endometrial cancer (OR, 1.14; 95% CI, 1.09–1.19). There was significant heterogeneity by study design (Phet < 0.01), with a stronger magnitude of association observed among case–control versus cohort studies. Stronger associations were also noted for pre-/perimenopausal women and never users of postmenopausal hormone therapy. Conclusions: Hypertension is associated with endometrial cancer risk independently from known risk factors. Future research should focus on biologic mechanisms underlying this association. Impact: This study provides evidence that hypertension may be an independent risk factor for endometrial cancer.