Crook, Jennifer

Abstract Background: Nutritional and inflammatory factors collected in routine cancer labs, neutrophil percentage to albumin ratio (NPAR), neutrophil lymphocyte ratio (NLR), monocyte lymphocyte ratio (MLR), and platelet lymphocyte ratio (PLR), have been shown feasible in identification of patients at risk of increased treatment complications, decreased cognition, anxiety and depression, and increased mortality. These have proven sensitive to multiple cancer types and stages, though little is known about causal pathways. The Vitamin/Mineral and Inflammatory Correlations To Understand Chronic Stress in the U.S. (The VICTUS Study) sought to elucidate a relationship between diet and food insecurity within these panels. Methods: Using NHANES 2017/2018 surveys, adults > 18 years without renal or hepatic disorders, pregnancy, alcohol, or supplement use were included. NPAR, NLR, MLR, and PLR were categorized as quartiles and compared to demographic, food security, plasma micronutrient statuses [vitamins A, B9, C, D, E, calcium (Ca), ferritin (Fe), phosphorus (P), potassium (K), sodium (Na)], and smoking, activity level, and sun exposure, using chi-square and ANOVA. ANOVA models compared food security and poverty to NPAR, NLR, MLR, and PLR means. Results: From 3,317 participants, 50.2% were male, 54.3% non-Hispanic White, 33.7%, food insecure, 51.1% food stamp recipients, 27.7% smokers, with a mean age of 42.5 (SD 0.44), poverty to income ratio 2.79 (SD 0.08), CRP 3.90 (SD 0.18), NPAR 14.1 (SD 0.14), NLR 2.07 (SD 0.04), MLR 0.28 (SD 0.003), and PLR 118.7 (SD 1.61). CRP was found to be statistically significantly associated with all biomarker ratios (p < 0.018). Significant micronutrient biomarker-inflammatory biomarker associations were identified in Fe [NPAR, MLR, PLR (p < 0.001)], P [NPAR, NLR, MLR, PLR (p < 0.033)], C [NPAR, NLR (p < 0.008)], E [MLR, PLR (p < 0.016)], K [NPAR, NLR, MLR, PLR (p < 0.015)], Ca [NPAR, PLR (p < 0.04)], A [NPAR (p < 0.023)] and D [NLR (p < 0.035)]. Significant micronutrient intake-inflammatory biomarker associations were detected in vitamin A [NPAR, PLR (p < 0.013)], lycopene [NLR, PLR (p < 0.035)], and B12 [NLR, PLR (p < 0.031)]. Age [NPAR, NLR, MLR, PLR (p < 0.001)], gender [NPAR, MLR, PLR (p < 0.001)], ethnicity [NPAR, NLR, MLR (p < 0.006)], and sedentariness [MLR, PLR (p < 0.039)] were also associated with inflammatory markers. Poverty was significantly associated with NPAR, NLR, MLR, and CRP (p < 0.018). Food insecurity was significantly associated with NPAR (p < 0.001) and CRP (p < 0.001). Discussion: Food insecurity and poverty were significantly associated with NPAR, a ratio implicated in overall poorer cancer health outcomes. Multiple inadequate micronutrient intakes and plasma biomarkers were associated with inflammatory panels, though neither nutritional biomarker nor food insecurity statuses and their contributions to inflammatory processes are routinely surveilled within cancer disease and treatment. Citation Format: Jennifer Crook, Eunkyung Lee, Rui Xie, Opeyemi Bolajoko, Victoria Loerzel. Nutritional mediators of inflammation: A cause for increased surveillance [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2171.

Abstract BACKGROUND: Despite decades of effort and proposed solutions to increase diversity in clinical trial participation, African Americans remain underrepresented. Race-specific review of clinical trial participation challenges suggests that engagement with African American physicians influence successful recruitment and appropriate enrollment of underrepresented groups in clinical research. Tailoring best-practices for minoritized populations cannot be sustainably facilitated without trusted community-academic partnerships. Engagement with African American community physicians creates capacity for leveraging resources critical to participation of African Americans in decentralized clinical trials (DCT). The Northeast Florida Clinical Trials and Translational Science (NEF-CTaTS) Consortium was formed in 2022 to address cancer health disparities experienced by minoritized, marginalized and underserved communities in NE Florida. AIM:The NEF-CTaTS Consortium convened a Focus Group with 22 African American community physicians who care for minoritized patients to solicit their input in fostering active research, research training, community outreach and engagement, and to address advantages of and barriers to forming a research network of minority physicians to conduct decentralized clinical trials and translational research. METHODS: Practicing community primary care physician members of the Northeast Florida Medical Society, a chapter of the National Medical Association where invited to participate. Physician demographic and practice information was collected from physicians who consented to participate prior to the Focus Group discussion. A Clinical Trial Needs Assessment was completed by each participating physician. The Physician Focus Group discussion was moderated by a skilled African American community physician member of the NEF-CTaTS consortium with extensive experience in conducting clinical trials. The discussion was recorded and transcribed for data analysis. IRB approval was obtained prior to informed consent, data collection and Focus Group Discussion. RESULTS: Qualitative analysis of the raw data is currently ongoing at the time of this submission. Transcribed discussion details and the observational notes identified thematic framework for descriptive statements, indexing, and sifting data. Mapping and interpretation of data is being analyzed for relationships, internal consistency, intensity of comments and specificity of responses. Analysis is scheduled to be complete within 4 weeks of abstract submission. CONCLUSIONS: Efforts to appropriately address disparities in clinical trial participation and DCT participation of African Americans require distinct and deliberate efforts to engage African American physician stakeholders. Addressing issues of trust and the impact of social-determinants of health on minoritized populations can be culturally and appropriately addressed by community-academic partnerships. Citation Format: Floyd Willis, Folakemi Odedina, Kim Barbel Johnson, Rogers Cain, Jennifer Crook. Addressing African American physician engagement in decentralized clinical trial by clinical trials and translation science consortium focus group participation [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B035.

Abstract Background: To date, the disparate burden of prostate cancer (CaP) in Black men (BM) is still poorly understood. More disconcerting is the limited access to effective, culturally tailored behavioral interventions to support BM diagnosed with CaP, especially at the point of prostate cancer diagnosis (PPCD). From the PPCD, the transition to CaP survivorship can be mentally and physically trying, especially for those lacking emotional and financial support. It is important to provide psycho-oncology support, address social determinants of health (SDOH) and make emotional support available to ethnically diverse BM at the PPCD. We are addressing the CaP disparities experienced by BM at the PPCD through the Inclusive Cancer Care Research Equity (iCCaRE) for Black Men Consortium. Aim: As part of the iCCaRE for Black men Consortium, the specific aim of our project is to develop a PPCD-based Augmented Reality (AR) intervention program, the iCCaRE PPCD Virtual Robot Assistant (ViRA). The ViRA is based on the established efficacy of six CaP care and survivorship (CaPCaS) video interventions, and will support BM at the PPCD. Methodology: The efficacy of six CaPCaS videos were established through formative research that included 17 BM in Florida. Based on pre- and post-test design, data were collected from participants using a structured survey tailored to each CaPCaS intervention: Prevention, Detection, Diagnosis, Treatment, Survivorship and Advocacy form. Following the efficacy study, the iCCaRE PPCD ViRA was proposed as one of five iCCaRE Science of Survivorship (S.O.S) projects to improve the quality of life of BM. Results: Most of the participants for the efficacy study reported that they were: US-born BM; married; college educated; earn less than $60,000; retired; have health insurance; have annual health examination; have a regular doctor; and were screened within the last year. The CaPCaS videos were found to be efficacious in improving attitude towards CaP screening, beliefs about CaP screening, perceived behavioral control and CaP knowledge. Participants also rated the quality of the videos high and expressed high satisfaction with the videos. We are currently in the development phase of the PPCD iCCaRE ViRA, which is based on behavioral science and health communications model. The ViRA will provide SDOH navigation services, psycho-oncology support and emotional support. The acceptance and usability of the iCCaRE ViRA will be established at urology clinics in Florida as part of the iCCaRE Consortium HEROICA Phase I study. We will test the central hypothesis that improving SDOH factors and CaPCaS-related factors will lead to an improvement in patient reported outcomes. Conclusion: We established the efficacy of the CaPCaS interventions in supporting BM across the CaP care continuum. The iCCaRE ViRA under development will target intervention at the PPCD and deliver a smart and connected personalized AR-enabled intervention system that will positively impact CaP diagnosis experience of BM. Citation Format: Folakemi Odedina, Che Ngufor, Arnold Merriweather, Deidre Pereira, Jennifer Crook, Fathi Parisa, Roxana Dronca, Ernest Kaninjing, Solomon Rotimi, Kimlin Ashing, Manisha Salinas, Sha’Reff Rashad, John McCall, Ebenezer Erefah, Ayinde Yahaya, Wes Sholes. A point of prostate cancer diagnosis (PPCD) Virtual Robot Assistant (ViRA) intervention for newly diagnosed Black men: An iCCaRE consortium for prostate cancer in Black men project [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B028.

Abstract Background: Sub-Saharan African immigrants (SSAI) in the United States (US) constitute one of the fastest-growing segments of the immigrant population. Between 2010 and 2018, the SSAI population in the US increased by 53%, significantly outpacing the 12% growth rate for the overall foreign-born population in the US during that time frame. For the purposes of this study, we define SSAI as the 2 million individuals living in the US originally from the region of the African continent located south of the Saharan desert. Despite their growing numbers, little is published about the extent to which SSAI adapt to health behaviors more common in the US or remain immersed in the values, beliefs and practices reflective of their country of origin. Importantly, no study has comprehensively examined the social determinants of health factors among this population and its influence on health-seeking behaviors and decision-making regarding prostate cancer care and treatment options. This study employs the social determinant of migrant health framework to examine the impact of immigration on the health-seeking behaviors of SSAI including informed-decision making, psychosocial effects and coping mechanisms. This study will fill the void of research studies that link social determinant of health and immigration among SSAI. Methods: Grounded theory will guide the study design that include in-depth interviews to document the experiences of SSAI relative to health seeking behaviors, care, and treatment. We explore differences and similarities among participants based on country or region of origin in Africa. We employ the social determinants of migrant health framework to better understand the needs of SSAI prostate cancer survivors in the United States and how to effectively support these survivors. Results: We will present findings based on preliminary interviews conducted with SSAI prostate cancer survivors recruited from Florida or Minnesota. Additionally, we will report on the development of a SSAI social determinant of migration model that explains individual and structural factors that impact the health-seeking behaviors and coping mechanisms among this population. We will provide new understanding about specific social determinant of health factors that can be addressed in intervention studies among SSAI in the United States. Conclusion: This study examines the full range of racial, social, environmental, behavioral and structural factors that SSAI prostate cancer survivors experience. It will illuminate the decision-making process and overall quality of care among this understudied population. Citation Format: Ernie Kaninjing, Gladys Asiedu, Mary Ellen Young, Ebenezer Erefah, Folakemi Odedina, Roxana Dronca, Kimlin Ashing, Solomon Rotimi, Che Ngufor, Arnold Merriweather, Jennifer Crook, Manisha Salinas, Parisa Fathi, Sha’Reff Rashad, John McCall, Ayinde Yahaya. The iCCARE consortium for prostate cancer in Black men: Grounded theory study of the social determinant of health factors among African immigrant men diagnosed with prostate cancer [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B050.

Abstract Background: Black men across the world continue to bear the burden of prostate cancer (PCa). Although several factors account for this, studies have demonstrated that the adaptive constitutive biological factors associated with African ancestry contribute to the risk of disease development, disease aggression, and poor disease outcomes in Black men. However, the limited inclusion of Blacks in cancer biology studies limits the understanding of the extent to which biology influence outcomes among Blacks. Furthermore, beyond White-Black dichotomous disparity, there exists an under-exploited within-group geographical and ancestral disparities in the burden, clinical presentation, and outcomes of PCa among Black men globally. Aside from urological and sexual problems, Black PCa survivors experience poor mental health, with a concomitant reduction in the quality of life and overall survival. Hence, improving the overall well-being of PCa survivors requires an understanding of the biological determinants of mental health among diverse groups of Black PCa survivors. Methods: Structured questionnaires are being used to access fatigue, pain, depressive symptoms, health-related quality of life, and PCa-specific symptoms burden among within a cohort of ethnically diverse Black PCa survivors in Africa. This is linked with the salivary biomarkers of inflammation, hypothalamic-pituitary-adrenal axis activity, and tryptophan-kynurenine pathway in our studies population. Results: Data from fifty PCa survivors across different African ethnic groups (including, Yoruba, Igbo, Hausa) will be presented. This study will measure biological variables (e.g, inflammatory markers, cortisol, tryptophan, kynurenine, and serotonin) and survivors self-reported (e.g. health-related quality of life and psychoneurological symptoms) measures to better examine the interconnectedness between cancer-associated biomarkers and poor mental health. Conclusion: This study will lay an essential foundation for understanding the extent to which cancer associated-biological determinants contribute to the poor mental health of PCa survivors, unravels the within-group disparities in the mental health of Black PCa survivors, establish the contribution of genetics to poor mental health in Black PCa survivors and provide the opportunity for pharmacogenomic intervention that will improve the quality of life. Citation Format: Solomon O. Rotimi, Folakemi Odedina, Roxana Dronca, Kimlin Ashing, Ernest Kaninjing, Che Ngufor, Arnold Merriweather, Jennifer Crook, Manisha Salinas, Fathi Parisa, Sha’Reff Rashad, John McCall, Ebenezer Erefah, Ayinde Yahaya. Investigating the biological determinants of poor mental health among ethnically diverse Black prostate cancer survivors: An iCCaRE consortium for prostate cancer in Black men project [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A045.