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Williams, Christina D

Positions:

Assistant Professor in Medicine

Medicine, Medical Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

Ph.D. 2009

Ph.D. — University of North Carolina at Chapel Hill

Publications:

Cancer Incidence Among Patients of the U.S. Veterans Affairs Health Care System: 2010 Update.

Nearly 50,000 incident cancer cases are reported in Veterans Affairs (VA) Central Cancer Registry (VACCR) annually. This article provides an updated report of cancer incidence recorded in VACCR.Data were obtained from VACCR for incident cancers diagnosed in the VA health care system, focusing on 2010 data. Cancer incidence among VA patients is described by anatomical site, sex, race, stage, and geographic location, and was compared to the general U.S. cancer population.In 2010, among 46,170 invasive cancers, 97% were diagnosed among men. Approximately 80% of newly diagnosed patients were white, 19% black, and less than 2% were other minority races. Median age at diagnosis was 65 years. The three most frequently diagnosed cancers among VA were prostate (29%), lung/bronchus (18%), and colon/rectum (8%). Melanoma and kidney/renal pelvis tied for fourth (4%), and urinary bladder tied for sixth with liver and intrahepatic bile duct (3.4%). Approximately 23% of prostate, 21% of lung/bronchus, and 31% of colon/rectum cancers were diagnosed with Stage I disease. The overall invasive cancer incidence rate among VA users was 505.8 per 100,000 person-years.Although the composition of the VA population is shifting and includes a larger number of women, registry data indicate that incident cancers in VA in 2010 were most similar to those observed among U.S. men. Consistent reporting of VACCR data is important to provide accurate estimates of VA cancer incidence. This information can be used to plan efforts to improve quality of cancer care and access to services.

Authors
Zullig, LL; Sims, KJ; McNeil, R; Williams, CD; Jackson, GL; Provenzale, D; Kelley, MJ
MLA Citation
Zullig, LL, Sims, KJ, McNeil, R, Williams, CD, Jackson, GL, Provenzale, D, and Kelley, MJ. "Cancer Incidence Among Patients of the U.S. Veterans Affairs Health Care System: 2010 Update." Military medicine 182.7 (July 2017): e1883-e1891.
PMID
28810986
Source
epmc
Published In
Military medicine
Volume
182
Issue
7
Publish Date
2017
Start Page
e1883
End Page
e1891
DOI
10.7205/milmed-d-16-00371

Metformin, Diabetes, and Survival among U.S. Veterans with Colorectal Cancer-Response.

Authors
Paulus, JK; Williams, CD; Cossor, FI; Kelley, MJ; Martell, RE
MLA Citation
Paulus, JK, Williams, CD, Cossor, FI, Kelley, MJ, and Martell, RE. "Metformin, Diabetes, and Survival among U.S. Veterans with Colorectal Cancer-Response." Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 26.6 (June 2017): 977-. (Letter)
PMID
28506970
Source
epmc
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
26
Issue
6
Publish Date
2017
Start Page
977
DOI
10.1158/1055-9965.epi-16-1026

Next steps to improve disparities in lung cancer treatment clinical trial enrollment.

Authors
Zullig, LL; Carpenter, WR; Williams, CD
MLA Citation
Zullig, LL, Carpenter, WR, and Williams, CD. "Next steps to improve disparities in lung cancer treatment clinical trial enrollment." Annals of translational medicine 5.5 (March 2017): 118-.
PMID
28361083
Source
epmc
Published In
Annals of translational medicine
Volume
5
Issue
5
Publish Date
2017
Start Page
118
DOI
10.21037/atm.2017.01.25

Use of NCCN Guidelines, Other Guidelines, and Biomarkers for Colorectal Cancer Screening.

Colorectal cancer (CRC) remains a common cancer and significant public health burden. CRC-related mortality is declining, partly due to the early detection of CRC through robust screening. NCCN has established the NCCN Guidelines for CRC Screening to help healthcare providers make appropriate screening recommendations according to the patient's risk of developing CRC. This review describes the evolution of CRC screening guidelines for average-risk individuals, discusses the role of NCCN Guidelines for CRC Screening in cancer prevention, and comments on the current and emerging use of biomarkers for CRC screening.

Authors
Williams, CD; Grady, WM; Zullig, LL
MLA Citation
Williams, CD, Grady, WM, and Zullig, LL. "Use of NCCN Guidelines, Other Guidelines, and Biomarkers for Colorectal Cancer Screening." Journal of the National Comprehensive Cancer Network : JNCCN 14.11 (November 2016): 1479-1485. (Review)
PMID
27799515
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
14
Issue
11
Publish Date
2016
Start Page
1479
End Page
1485
DOI
10.6004/jnccn.2016.0154

Impact of Race on Treatment and Survival among U.S. Veterans with Early-Stage Lung Cancer.

Numerous reports suggest lower rates of surgical procedures and poorer survival for black patients with early-stage (stage I or II) NSCLC than for white patients. This study examined treatment trends among blacks and whites with early-stage NSCLC and determined whether racial disparities exist in survival among patients receiving similar treatment.A retrospective analysis of 18,466 patients in the Veteran Affairs Central Cancer Registry in whom stage I or II NSCLC was diagnosed in 2001-2010 was conducted. Patients were categorized as receiving an operation, radiation, or other/no treatment. Overall survival (OS) and lung cancer-specific survival (LCSS) were evaluated using Kaplan-Meier and multivariable Cox regression analyses.There was a statistically significant disparity between black and white patients receiving an operation that decreased over time to similar rates (p = 0.01). No significant racial differences in receipt of radiation were noted. Race was not associated with OS among all patients (hazard ratio [HR] = 0.97, 95% confidence interval [CI]: 0.93-1.02). Among patients who received an operation, no racial difference in OS was observed (HR = 0.94, 95% CI: 0.87-1.01), but the HR for blacks versus whites was 0.90 (95% CI: 0.82-0.98) for radiation treatment and 0.89 (95% CI: 0.81-0.97) for other/no treatment. Race was not associated with LCSS among all patients combined or within each treatment category.A racial disparity in the rate of operation was no longer apparent at the end of the study period. There was no racial difference in OS or LCSS among all patients in this equal access health care system. Long-documented racial differences in lung cancer treatment and mortality result from disparity of access to health care and delivery of recommended treatment.

Authors
Williams, CD; Salama, JK; Moghanaki, D; Karas, TZ; Kelley, MJ
MLA Citation
Williams, CD, Salama, JK, Moghanaki, D, Karas, TZ, and Kelley, MJ. "Impact of Race on Treatment and Survival among U.S. Veterans with Early-Stage Lung Cancer." Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer 11.10 (October 2016): 1672-1681.
PMID
27296104
Source
epmc
Published In
Journal of Thoracic Oncology
Volume
11
Issue
10
Publish Date
2016
Start Page
1672
End Page
1681
DOI
10.1016/j.jtho.2016.05.030

Metformin, Diabetes, and Survival among U.S. Veterans with Colorectal Cancer.

Metformin has been associated with improved colorectal cancer survival, but investigations are limited by small numbers of patients and confounding by diabetic severity. We examined the association between metformin use and overall survival (OS) in patients with diabetes and colorectal cancer in a large population of U.S. veterans, while adjusting for measures of diabetic severity.Patients diagnosed with colorectal cancer from January 2001 to December 2008 were identified from the Veterans Affairs Central Cancer Registry. Multivariable models were used to examine the adjusted association of OS with diabetes and use of antidiabetic medications.There were 21,352 patients diagnosed with colorectal cancer identified (n = 16,355 nondiabetic patients, n = 2,038 diabetic patients on metformin, n = 2,136 diabetic patients on medications other than metformin, n = 823 diabetic patients not on antidiabetic medication). Diabetic patients had a significantly worse OS than nondiabetic patients, but metformin users had only a 10% increase in death (HRadj 1.10; 95% CI, 1.03-1.17, P = 0.004), as compared with 22% for users of other antidiabetic medications (HRadj 1.22; 95% CI, 1.15-1.29, P < 0.0001). Among colorectal cancer patients with diabetes, metformin users had a 13% improved OS versus patients taking other antidiabetic medications (HRadj 0.87; 95% CI, 0.79-0.95, P = 0.003), while diabetic patients not on any antidiabetic medications did not differ with respect to OS (HRadj 1.02; 95% CI, 0.90-1.15, P = 0.76).Among diabetics with colorectal cancer, metformin use is associated with improved survival, despite adjustments for diabetes severity and other risk factors.These data lend further support to the conduct of randomized studies of possible anticancer effects of metformin among patients with colorectal cancer. Cancer Epidemiol Biomarkers Prev; 25(10); 1418-25. ©2016 AACR.

Authors
Paulus, JK; Williams, CD; Cossor, FI; Kelley, MJ; Martell, RE
MLA Citation
Paulus, JK, Williams, CD, Cossor, FI, Kelley, MJ, and Martell, RE. "Metformin, Diabetes, and Survival among U.S. Veterans with Colorectal Cancer." Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 25.10 (October 2016): 1418-1425.
PMID
27496094
Source
epmc
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
25
Issue
10
Publish Date
2016
Start Page
1418
End Page
1425
DOI
10.1158/1055-9965.epi-16-0312

Effect of age on the efficacy of adjuvant chemotherapy for resected non-small cell lung cancer.

BACKGROUND: Adjuvant chemotherapy after surgical resection improves outcomes for patients with early-stage non-small cell lung cancer (NSCLC). To the authors' knowledge, there are no published prospective trials to date of adjuvant chemotherapy after surgical resection administered exclusively in older patients. In the current study, the authors sought to evaluate the efficacy of adjuvant chemotherapy in older patients in a Veterans Health Administration cohort. METHODS: Patients who underwent surgical resection for American Joint Committee on Cancer stages IB to III NSCLC between 2001 and 2011 were analyzed. Data regarding patient demographics and comorbidities, tumor characteristics, and primary treatment were collected. Patients were divided into 2 groups based on age at diagnosis: those aged <70 years and those aged ≥70 years. The primary exposure was use of adjuvant chemotherapy. A Cox proportional hazards model was used to estimate the significance of patient characteristics. Survival curves were estimated using the Kaplan-Meier method and group comparisons were performed using the log-rank test. RESULTS: The analysis included 7593 patients who underwent surgical resection for stage IB to stage III NSCLC. Among these, 2897 patients (38%) were aged ≥70 years. The percentage of older patients who received adjuvant chemotherapy was approximately one-half that of younger patients who did so (15.3% vs 31.6%; P<.0001). Carboplatin-based doublets were used most often in all patients (64.6%). Both younger patients (hazard ratio, 0.79; 95% confidence interval, 0.72-0.86) and older patients (hazard ratio, 0.81; 95% confidence interval, 0.71-0.92) were found to have a lower risk of death with receipt of adjuvant chemotherapy. CONCLUSIONS: Older patients derive a similar magnitude of benefit from adjuvant chemotherapy as younger patients and therefore adjuvant chemotherapy should not be withheld based on age alone.

Authors
Ganti, AK; Williams, CD; Gajra, A; Kelley, MJ
MLA Citation
Ganti, AK, Williams, CD, Gajra, A, and Kelley, MJ. "Effect of age on the efficacy of adjuvant chemotherapy for resected non-small cell lung cancer." Cancer 121.15 (August 2015): 2578-2585.
PMID
25873330
Source
epmc
Published In
Cancer
Volume
121
Issue
15
Publish Date
2015
Start Page
2578
End Page
2585
DOI
10.1002/cncr.29360

Carbohydrate intake, glycemic index and prostate cancer risk.

Reported associations between dietary carbohydrate and prostate cancer (PC) risk are poorly characterized by race.We analyzed the association between carbohydrate intake, glycemic index (GI), and PC risk in a study of white (N = 262) and black (N = 168) veterans at the Durham VA Hospital. Cases were 156 men with biopsy-confirmed PC and controls (N = 274) had a PSA test but were not recommended for biopsy. Diet was assessed before biopsy with a self-administered food frequency questionnaire. Logistic regression models were used to estimate PC risk.In multivariable analyzes, higher carbohydrate intake, measured as percent of energy from carbohydrates, was associated with reduced PC risk (3rd vs. 1st tertile, OR = 0.41, 95% CI 0.21-0.81, P = 0.010), though this only reached significance in white men (p-trend = 0.029). GI was unrelated to PC risk among all men, but suggestively linked with reduced PC risk in white men (p-trend = 0.066) and increased PC risk in black men (p-trend = 0.172), however, the associations were not significant. Fiber intake was not associated with PC risk (all p-trends > 0.55). Higher carbohydrate intake was associated with reduced risk of high-grade (p-trend = 0.016), but not low-grade PC (p-trend = 0.593).Higher carbohydrate intake may be associated with reduced risk of overall and high-grade PC. Future larger studies are needed to confirm these findings.

Authors
Vidal, AC; Williams, CD; Allott, EH; Howard, LE; Grant, DJ; McPhail, M; Sourbeer, KN; Hwa, LP; Boffetta, P; Hoyo, C; Freedland, SJ
MLA Citation
Vidal, AC, Williams, CD, Allott, EH, Howard, LE, Grant, DJ, McPhail, M, Sourbeer, KN, Hwa, LP, Boffetta, P, Hoyo, C, and Freedland, SJ. "Carbohydrate intake, glycemic index and prostate cancer risk." The Prostate 75.4 (March 2015): 430-439.
PMID
25417840
Source
epmc
Published In
The Prostate
Volume
75
Issue
4
Publish Date
2015
Start Page
430
End Page
439
DOI
10.1002/pros.22929

Cisplatin and etoposide versus carboplatin and paclitaxel with concurrent radiotherapy for stage III non-small-cell lung cancer: an analysis of Veterans Health Administration data.

The optimal chemotherapy regimen to use with radiotherapy in stage III non-small-cell lung cancer is unknown. Here, we compare the outcome of patents treated within the Veterans Health Administration with either etoposide-cisplatin (EP) or carboplatin-paclitaxel (CP).We identified patients treated with EP and CP with concurrent radiotherapy from 2001 to 2010. Survival rates were compared using Cox proportional hazards regression models with adjustments for confounding provided by propensity score methods and an instrumental variables analysis. Comorbidities and treatment complications were identified through administrative data.A total of 1,842 patients were included; EP was used in 27% (n = 499). Treatment with EP was not associated with a survival advantage in a Cox proportional hazards model (hazard ratio [HR], 0.97; 95% CI, 0.85 to 1.10), a propensity score matched cohort (HR, 1.07; 95% CI, 0.91 to 1.24), or a propensity score adjusted model (HR, 0.97; 95% CI, 0.85 to 1.10). In an instrumental variables analysis, there was no survival advantage for patients treated in centers where EP was used more than 50% of the time as compared with centers where EP was used in less than 10% of the patients (HR, 1.07; 95% CI, 0.90 to 1.26). Patients treated with EP, compared with patients treated with CP, had more hospitalizations (2.4 v 1.7 hospitalizations, respectively; P < .001), outpatient visits (17.6 v 12.6 visits, respectively; P < .001), infectious complications (47.3% v 39.4%, respectively; P = .0022), acute kidney disease/dehydration (30.5% v 21.2%, respectively; P < .001), and mucositis/esophagitis (18.6% v 14.4%, respectively; P = .0246).After accounting for prognostic variables, patients treated with EP versus CP had similar overall survival, but EP was associated with increased morbidity.

Authors
Santana-Davila, R; Devisetty, K; Szabo, A; Sparapani, R; Arce-Lara, C; Gore, EM; Moran, A; Williams, CD; Kelley, MJ; Whittle, J
MLA Citation
Santana-Davila, R, Devisetty, K, Szabo, A, Sparapani, R, Arce-Lara, C, Gore, EM, Moran, A, Williams, CD, Kelley, MJ, and Whittle, J. "Cisplatin and etoposide versus carboplatin and paclitaxel with concurrent radiotherapy for stage III non-small-cell lung cancer: an analysis of Veterans Health Administration data." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 33.6 (February 2015): 567-574.
PMID
25422491
Source
epmc
Published In
Journal of Clinical Oncology
Volume
33
Issue
6
Publish Date
2015
Start Page
567
End Page
574
DOI
10.1200/jco.2014.56.2587

Lung and colorectal cancer treatment and outcomes in the Veterans Affairs health care system.

Lung cancer (LC) and colorectal cancer (CRC) are the second- and third-most commonly diagnosed cancers in the Veterans Affairs (VA) health care system. While many studies have evaluated the treatment quality and outcomes of various aspects of VA LC and CRC care, there are no known reviews synthesizing this information across studies. The purpose of this literature review was to describe LC and CRC treatment (ie, surgical and nonsurgical) and outcomes (eg, mortality, psychosocial, and other) in the VA health care system as reported in the existing peer-reviewed scientific literature. We identified potential articles through a search of published literature using the PubMed electronic database. Our search strategy identified articles containing Medical Subject Headings terms and keywords addressing veterans or veterans' health and LC and/or CRC. We limited articles to those published in the previous 11 years (January 1, 2003 through December 31, 2013). A total of 230 articles were retrieved through the search. After applying the selection criteria, we included 74 studies (34 LC, 47 CRC, and seven both LC and CRC). VA provides a full array of treatments, often with better outcomes than other health care systems. More work is needed to assess patient-reported outcomes.

Authors
Zullig, LL; Williams, CD; Fortune-Britt, AG
MLA Citation
Zullig, LL, Williams, CD, and Fortune-Britt, AG. "Lung and colorectal cancer treatment and outcomes in the Veterans Affairs health care system." Cancer management and research 7 (January 14, 2015): 19-35. (Review)
PMID
25609998
Source
epmc
Published In
Cancer Management and Research
Volume
7
Publish Date
2015
Start Page
19
End Page
35
DOI
10.2147/cmar.s75463

Racial disparities in cancer care in the Veterans Affairs health care system and the role of site of care.

OBJECTIVES: We assessed cancer care disparities within the Veterans Affairs (VA) health care system and whether between-hospital differences explained disparities. METHODS: We linked VA cancer registry data with VA and Medicare administrative data and examined 20 cancer-related quality measures among Black and White veterans diagnosed with colorectal (n = 12,897), lung (n = 25,608), or prostate (n = 38,202) cancer from 2001 to 2004. We used logistic regression to assess racial disparities for each measure and hospital fixed-effects models to determine whether disparities were attributable to between- or within-hospital differences. RESULTS: Compared with Whites, Blacks had lower rates of early-stage colon cancer diagnosis (adjusted odds ratio [AOR] = 0.80; 95% confidence interval [CI] = 0.72, 0.90), curative surgery for stage I, II, or III rectal cancer (AOR = 0.57; 95% CI = 0.41, 0.78), 3-year survival for colon cancer (AOR = 0.75; 95% CI = 0.62, 0.89) and rectal cancer (AOR = 0.61; 95% CI = 0.42, 0.87), curative surgery for early-stage lung cancer (AOR = 0.50; 95% CI = 0.41, 0.60), 3-dimensional conformal or intensity-modulated radiation (3-D CRT/IMRT; AOR = 0.53; 95% CI = 0.47, 0.59), and potent antiemetics for highly emetogenic chemotherapy (AOR = 0.87; 95% CI = 0.78, 0.98). Adjustment for hospital fixed-effects minimally influenced racial gaps except for 3-D CRT/IMRT (AOR = 0.75; 95% CI = 0.65, 0.87) and potent antiemetics (AOR = 0.95; 95% CI = 0.82, 1.10). CONCLUSIONS: Disparities in VA cancer care were observed for 7 of 20 measures and were primarily attributable to within-hospital differences.

Authors
Samuel, CA; Landrum, MB; McNeil, BJ; Bozeman, SR; Williams, CD; Keating, NL
MLA Citation
Samuel, CA, Landrum, MB, McNeil, BJ, Bozeman, SR, Williams, CD, and Keating, NL. "Racial disparities in cancer care in the Veterans Affairs health care system and the role of site of care." American journal of public health 104 Suppl 4 (September 2014): S562-S571.
PMID
25100422
Source
epmc
Published In
American journal of public health
Volume
104 Suppl 4
Publish Date
2014
Start Page
S562
End Page
S571
DOI
10.2105/ajph.2014.302079

Use and impact of adjuvant chemotherapy in patients with resected non-small cell lung cancer.

BACKGROUND: Despite clinical trials demonstrating improved survival with adjuvant chemotherapy (AC) for patients with American Joint Committee on Cancer stages I to III non-small cell lung cancer (NSCLC), it is unclear whether this survival benefit extends to broader populations. The current study evaluated patterns of AC use and examined the impact of AC on survival. METHODS: A retrospective analysis was conducted of patients in the Veterans Affairs Central Cancer Registry diagnosed with stages IB to IIIA NSCLC between 2001 and 2008. Descriptive statistics were used to examine patterns of AC use over an 8-year time period. Cox proportional hazards regression analyses were used to estimate hazards ratios (HR) and 95% confidence intervals (95% CIs) to compare mortality risk among patients treated with and without AC. RESULTS: Among 14,306 patients with stages IB to IIIA NSCLC, 4929 underwent surgery and 22% of these received AC. The percentages of patients diagnosed in 2001 through 2003, 2004 through 2005, and 2006 through 2008 receiving AC were 7.0%, 29.8%, and 29.5%, respectively. There was no survival benefit with AC noted for patients diagnosed between 2001 and 2003, but AC was associated with improved survival for the period between 2004 and 2005 (HR, 0.78; 95% CI, 0.67-0.91) and 2006 through 2008 (HR, 0.79; 95% CI, 0.69-0.91). Of those patients receiving AC, 89% received platinum-doublet chemotherapy. Carboplatin remained the most common agent, although cisplatin use reached 43% in the period between 2006 and 2008. The HR for cisplatin relative to carboplatin was 0.96 (95% CI, 0.80-1.15). CONCLUSIONS: There was a significant increase in the use of AC between 2001 and 2008 and AC was associated with an improvement in overall survival.

Authors
Williams, CD; Gajra, A; Ganti, AK; Kelley, MJ
MLA Citation
Williams, CD, Gajra, A, Ganti, AK, and Kelley, MJ. "Use and impact of adjuvant chemotherapy in patients with resected non-small cell lung cancer." Cancer 120.13 (July 2014): 1939-1947.
PMID
24668613
Source
epmc
Published In
Cancer
Volume
120
Issue
13
Publish Date
2014
Start Page
1939
End Page
1947
DOI
10.1002/cncr.28679

Cisplatin versus carboplatin-based regimens for the treatment of patients with metastatic lung cancer. An analysis of Veterans Health Administration data.

While platinum-based doublet chemotherapy is standard of care for patients presenting with metastatic non-small-cell lung cancer, the optimal platinum agent (cisplatin versus carboplatin) is unclear. We therefore compared survival and toxicity among persons receiving these agents at Department of Veterans Affairs hospitals.We used the Veterans Affairs Central Cancer Registry to identify veterans presented between 2001 and 2008 with metastatic non-small-cell lung cancer, then selected those receiving initial platinum doublet chemotherapy. We compared survival between those receiving cisplatin and carboplatin using multivariable Cox proportional hazards models and propensity score analyses to adjust for imbalances in demographics and clinical characteristics.We identified 4352 eligible persons; 4061 (93%) received carboplatin. Patients treated with cisplatin were younger (median age 61 versus 63, p < 0.01) and had less comorbidities (summary comorbidity score > 2, 7.7% versus 12.8%, p = 0.01) and higher eGFR (87 versus 84 mL/min/1.73 m). Median survival was similar for persons receiving cisplatin and carboplatin (8.1 versus 7.5 months, p = 0.54). In an adjusted survival analyses, the use of cisplatin was not associated with a better survival (hazard ratio 0.98, 95% confidence interval 0.84-1.14, p = 0.79). We performed subgroup analysis defined by histology and second agent, the hazard ratio for mortality ranged spanned 1 and none of these approached statistical significance (all p values > 0.20). Cisplatin-treated patients were more likely to have more hospitalization (1.7 versus 1.3, p < 0.01) and outpatient visits (11 versus 9.6, p < 0.01). Cisplatin-treated patient had more subsequent encounters for infection (41.6% versus 34.3%, p < 0.01) and acute kidney injury/dehydration (29.2% versus 15.5%, p < 0.01) CONCLUSIONS:: Patients receiving cisplatin and carboplatin-based doublets did not have significantly different survival, but cisplatin use was associated with an increase morbidity and healthcare use.

Authors
Santana-Davila, R; Szabo, A; Arce-Lara, C; Williams, CD; Kelley, MJ; Whittle, J
MLA Citation
Santana-Davila, R, Szabo, A, Arce-Lara, C, Williams, CD, Kelley, MJ, and Whittle, J. "Cisplatin versus carboplatin-based regimens for the treatment of patients with metastatic lung cancer. An analysis of Veterans Health Administration data." Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer 9.5 (May 2014): 702-709.
PMID
24662458
Source
epmc
Published In
Journal of Thoracic Oncology
Volume
9
Issue
5
Publish Date
2014
Start Page
702
End Page
709
DOI
10.1097/jto.0000000000000146

Cisplatin versus carboplatin-based regimens for the treatment of patients with metastatic lung cancer. An analysis of veterans health administration data

BACKGROUND:: While platinum-based doublet chemotherapy is standard of care for patients presenting with metastatic non-small-cell lung cancer, the optimal platinum agent (cisplatin versus carboplatin) is unclear. We therefore compared survival and toxicity among persons receiving these agents at Department of Veterans Affairs hospitals. METHODS:: We used the Veterans Affairs Central Cancer Registry to identify veterans presented between 2001 and 2008 with metastatic non-small-cell lung cancer, then selected those receiving initial platinum doublet chemotherapy. We compared survival between those receiving cisplatin and carboplatin using multivariable Cox proportional hazards models and propensity score analyses to adjust for imbalances in demographics and clinical characteristics. RESULTS:: We identified 4352 eligible persons; 4061 (93%) received carboplatin. Patients treated with cisplatin were younger (median age 61 versus 63, p < 0.01) and had less comorbidities (summary comorbidity score > 2, 7.7% versus 12.8%, p = 0.01) and higher eGFR (87 versus 84 mL/min/1.73 m). Median survival was similar for persons receiving cisplatin and carboplatin (8.1 versus 7.5 months, p = 0.54). In an adjusted survival analyses, the use of cisplatin was not associated with a better survival (hazard ratio 0.98, 95% confidence interval 0.84-1.14, p = 0.79). We performed subgroup analysis defined by histology and second agent, the hazard ratio for mortality ranged spanned 1 and none of these approached statistical significance (all p values > 0.20). Cisplatin-treated patients were more likely to have more hospitalization (1.7 versus 1.3, p < 0.01) and outpatient visits (11 versus 9.6, p < 0.01). Cisplatin-treated patient had more subsequent encounters for infection (41.6% versus 34.3%, p < 0.01) and acute kidney injury/dehydration (29.2% versus 15.5%, p < 0.01) CONCLUSIONS:: Patients receiving cisplatin and carboplatin-based doublets did not have significantly different survival, but cisplatin use was associated with an increase morbidity and healthcare use. © 2014 by the International Association for the Study of Lung Cancer.

Authors
Santana-Davila, R; Szabo, A; Arce-Lara, C; Williams, CD; Kelley, MJ; Whittle, J
MLA Citation
Santana-Davila, R, Szabo, A, Arce-Lara, C, Williams, CD, Kelley, MJ, and Whittle, J. "Cisplatin versus carboplatin-based regimens for the treatment of patients with metastatic lung cancer. An analysis of veterans health administration data." Journal of Thoracic Oncology 9.5 (2014): 702-709.
Source
scival
Published In
Journal of Thoracic Oncology
Volume
9
Issue
5
Publish Date
2014
Start Page
702
End Page
709
DOI
10.1097/JTO.0000000000000146

Use and impact of adjuvant chemotherapy in patients with resected non-small cell lung cancer

BACKGROUND Despite clinical trials demonstrating improved survival with adjuvant chemotherapy (AC) for patients with American Joint Committee on Cancer stages I to III non-small cell lung cancer (NSCLC), it is unclear whether this survival benefit extends to broader populations. The current study evaluated patterns of AC use and examined the impact of AC on survival. METHODS A retrospective analysis was conducted of patients in the Veterans Affairs Central Cancer Registry diagnosed with stages IB to IIIA NSCLC between 2001 and 2008. Descriptive statistics were used to examine patterns of AC use over an 8-year time period. Cox proportional hazards regression analyses were used to estimate hazards ratios (HR) and 95% confidence intervals (95% CIs) to compare mortality risk among patients treated with and without AC. RESULTS Among 14,306 patients with stages IB to IIIA NSCLC, 4929 underwent surgery and 22% of these received AC. The percentages of patients diagnosed in 2001 through 2003, 2004 through 2005, and 2006 through 2008 receiving AC were 7.0%, 29.8%, and 29.5%, respectively. There was no survival benefit with AC noted for patients diagnosed between 2001 and 2003, but AC was associated with improved survival for the period between 2004 and 2005 (HR, 0.78; 95% CI, 0.67-0.91) and 2006 through 2008 (HR, 0.79; 95% CI, 0.69-0.91). Of those patients receiving AC, 89% received platinum-doublet chemotherapy. Carboplatin remained the most common agent, although cisplatin use reached 43% in the period between 2006 and 2008. The HR for cisplatin relative to carboplatin was 0.96 (95% CI, 0.80-1.15). CONCLUSIONS There was a significant increase in the use of AC between 2001 and 2008 and AC was associated with an improvement in overall survival. Cancer 2014;120:1939-1947. © 2014 American Cancer Society.

Authors
Williams, CD; Gajra, A; Ganti, AK; Kelley, MJ
MLA Citation
Williams, CD, Gajra, A, Ganti, AK, and Kelley, MJ. "Use and impact of adjuvant chemotherapy in patients with resected non-small cell lung cancer." Cancer 120.13 (2014): 1939-1947.
Source
scival
Published In
Cancer
Volume
120
Issue
13
Publish Date
2014
Start Page
1939
End Page
1947
DOI
10.1002/cncr.28679

Evolution of the Quality Oncology Practice Initiative supportive care quality measures portfolio and conformance at a Veterans Affairs medical center.

A growing set of quality measures is being implemented to evaluate all components of cancer care, from diagnosis through the end of life. We investigated the Quality Oncology Practice Initiative (QOPI) quality measures portfolio. Additionally, we explored the effect of quality measure type on conformance.We performed QOPI data collections twice per year from fall 2007 through fall 2010 and spring 2012, using chart review of the Durham Veterans Administration outpatient oncology clinic. We categorized QOPI measures as nontreatment-related supportive care (NTSC), treatment-related supportive care (TSC), diagnostic, or therapeutic. Descriptive statistics and χ(2) were used to compare longitudinal conformance.The majority of QOPI measures in spring 2012 assess processes of chemotherapy treatment (therapeutic, 54.3%; TSC, 8.7%) or diagnostic modalities (19.6%). Measures targeting NTSC are few (17.4%) but increased from three measures in fall 2007 to eight measures in spring 2012. During those 5 years, average conformance to NTSC, TSC, diagnostic, and therapeutic measures was 71.4%, 86.1%, 89.3%, and 75.4%, respectively (P < .001). Within the NTSC measures, emotional well-being and constipation assessment were least documented (41.0% and 46.3%, respectively). In spring 2012, NTSC measure conformance (75.8%) remained significantly lower than diagnostic measure conformance (91.5%; P < .001).Most QOPI quality measures assess diagnosis or treatment processes of care and not supportive care. Aggregate conformance to the NTSC measures was lower than that of other categories. The differential conformance demonstrates the necessity of standardized documentation methods and quality improvement efforts that remain commensurate with the increasing portfolio of supportive care measures.

Authors
Nipp, RD; Kelley, MJ; Williams, CD; Kamal, AH
MLA Citation
Nipp, RD, Kelley, MJ, Williams, CD, and Kamal, AH. "Evolution of the Quality Oncology Practice Initiative supportive care quality measures portfolio and conformance at a Veterans Affairs medical center." Journal of oncology practice 9.3 (May 2013): e86-e89.
PMID
23942507
Source
epmc
Published In
Journal of Oncology Practice
Volume
9
Issue
3
Publish Date
2013
Start Page
e86
End Page
e89
DOI
10.1200/jop.2013.000923

Antioxidants and prevention of gastrointestinal cancers.

PURPOSE OF REVIEW: Gastrointestinal cancers account for 20% of all incident cancers in the United States. Much work has been done to understand the role dietary factors play in the prevention of gastrointestinal cancers, yet evidence regarding the potential preventive effect of antioxidants is conflicting. This review highlights the recent studies investigating the associations between dietary antioxidants and cancers of the gastrointestinal tract. RECENT FINDINGS: In-vitro and in-vivo studies in animals continue to support the hypothesis that antioxidants reduce the risk of gastrointestinal cancers. Results in human populations are not as supportive. Antioxidant nutrients and fruits and vegetables do not seem to confer protection against colorectal cancer, and certain antioxidants were found to increase the risk of distal colon cancer. Individual antioxidants also do not help prevent pancreatic cancer. Total antioxidant intake and plant-based foods seem promising for stomach cancer prevention, while vitamin C lowers the risk of esophageal cancer. Preventive effects for stomach and esophageal cancers were often limited to or stronger in smokers. Evidence is scarce regarding antioxidants and liver cancer. SUMMARY: Antioxidants do not aid in the prevention of gastrointestinal cancers in the general population; however, they may act as chemopreventive agents for stomach and esophageal cancers, especially in high-risk populations.

Authors
Williams, CD
MLA Citation
Williams, CD. "Antioxidants and prevention of gastrointestinal cancers." Current opinion in gastroenterology 29.2 (March 2013): 195-200. (Review)
PMID
23274317
Source
epmc
Published In
Current Opinion in Gastroenterology
Volume
29
Issue
2
Publish Date
2013
Start Page
195
End Page
200
DOI
10.1097/mog.0b013e32835c9d1b

Influence of comorbidity on racial differences in receipt of surgery among US veterans with early-stage non-small-cell lung cancer.

PURPOSE: It is unclear why racial differences exist in the frequency of surgery for lung cancer treatment. Comorbidity is an important consideration in selection of patients for lung cancer treatment, including surgery. To assess whether comorbidity contributes to the observed racial differences, we evaluated racial differences in the prevalence of comorbidity and their impact on receipt of surgery. PATIENTS AND METHODS: A total of 1,314 patients (1,135 white, 179 black) in the Veterans Health Administration diagnosed with early-stage non-small-cell lung cancer in 2007 were included. The effect of comorbidity on surgery was determined by using generalized linear models with a logit link accounting for patient clustering within Veterans Administration Medical Centers. RESULTS: Compared with whites, blacks had greater prevalence of hypertension, liver disease, renal disease, illicit drug abuse, and poor performance status, but lower prevalence of respiratory disease. The impact of most individual comorbidities on receipt of surgery was similar between blacks and whites, and comorbidity did not influence the race-surgery association in a multivariable analysis. The proportion of blacks not receiving surgery as well as refusing surgery was greater than that among whites. CONCLUSION: Blacks had a greater prevalence of several comorbid conditions and poor performance status; however, the overall comorbidity score did not differ by race. In general, the effect of comorbidity on receipt of surgery was similar in blacks and whites. Racial differences in comorbidity do not fully explain why blacks undergo lung cancer surgery less often than whites.

Authors
Williams, CD; Stechuchak, KM; Zullig, LL; Provenzale, D; Kelley, MJ
MLA Citation
Williams, CD, Stechuchak, KM, Zullig, LL, Provenzale, D, and Kelley, MJ. "Influence of comorbidity on racial differences in receipt of surgery among US veterans with early-stage non-small-cell lung cancer." J Clin Oncol 31.4 (February 1, 2013): 475-481.
PMID
23269988
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
31
Issue
4
Publish Date
2013
Start Page
475
End Page
481
DOI
10.1200/JCO.2012.44.1170

The association of race with timeliness of care and survival among Veterans Affairs health care system patients with late-stage non-small cell lung cancer.

Non-small cell lung cancer is the leading cause of cancer-related mortality in the United States. Patients with late-stage disease (stage 3/4) have five-year survival rates of 2%-15%. Care quality may be measured as time to receiving recommended care and, ultimately, survival. This study examined the association between race and receipt of timely non-small cell lung cancer care and survival among Veterans Affairs health care system patients.Data were from the External Peer Review Program, a nationwide Veterans Affairs quality-monitoring program. We included Caucasian or African American patients with pathologically confirmed late-stage non-small cell lung cancer in 2006 and 2007. We examined three quality measures: time from diagnosis to (1) treatment initiation, (2) palliative care or hospice referral, and (3) death. Unadjusted analyses used log-rank and Wilcoxon tests. Adjusted analyses used Cox proportional hazard models.After controlling for patient and disease characteristics using Cox regression, there were no racial differences in time to initiation of treatment (72 days for African American versus 65 days for Caucasian patients, hazard ratio 1.04, P = 0.80) or palliative care or hospice referral (129 days versus 116 days, hazard ratio 1.10, P = 0.34). However, the adjusted model found longer survival for African American patients than for Caucasian patients (133 days versus 117 days, hazard ratio 0.31, P < 0.01).For process measures of care quality (eg, time to initiation of treatment and referral to supportive care) the Veterans Affairs health care system provides racially equitable care. The small racial difference in survival time of approximately 2 weeks is not clinically meaningful. Future work should validate this possible trend prospectively, with longer periods of follow-up, in other veteran groups.

Authors
Zullig, LL; Carpenter, WR; Provenzale, DT; Weinberger, M; Reeve, BB; Williams, CD; Jackson, GL
MLA Citation
Zullig, LL, Carpenter, WR, Provenzale, DT, Weinberger, M, Reeve, BB, Williams, CD, and Jackson, GL. "The association of race with timeliness of care and survival among Veterans Affairs health care system patients with late-stage non-small cell lung cancer." Cancer management and research 5 (January 2013): 157-163.
PMID
23900515
Source
epmc
Published In
Cancer Management and Research
Volume
5
Publish Date
2013
Start Page
157
End Page
163
DOI
10.2147/cmar.s46688

Associations between Intake of Folate, Methionine, and Vitamins B-12, B-6 and Prostate Cancer Risk in American Veterans.

Prostate cancer (PC) is the second leading cause of cancer death in men. Recent reports suggest that excess of nutrients involved in the one-carbon metabolism pathway increases PC risk; however, empirical data are lacking. Veteran American men (272 controls and 144 PC cases) who attended the Durham Veteran American Medical Center between 2004-2009 were enrolled into a case-control study. Intake of folate, vitamin B12, B6, and methionine were measured using a food frequency questionnaire. Regression models were used to evaluate the association among one-carbon cycle nutrients, MTHFR genetic variants, and prostate cancer. Higher dietary methionine intake was associated with PC risk (OR = 2.1; 95%CI 1.1-3.9) The risk was most pronounced in men with Gleason sum <7 (OR = 2.75; 95%CI 1.32- 5.73). The association of higher methionine intake and PC risk was only apparent in men who carried at least one MTHFR A1298C allele (OR = 6.7; 95%CI = 1.6-27.8), compared to MTHFR A1298A noncarrier men (OR = 0.9; 95%CI = 0.24-3.92) (p-interaction = 0.045). There was no evidence for associations between B vitamins (folate, B12, and B6) and PC risk. Our results suggest that carrying the MTHFR A1298C variants modifies the association between high methionine intake and PC risk. Larger studies are required to validate these findings.

Authors
Vidal, AC; Grant, DJ; Williams, CD; Masko, E; Allott, EH; Shuler, K; McPhail, M; Gaines, A; Calloway, E; Gerber, L; Chi, J-T; Freedland, SJ; Hoyo, C
MLA Citation
Vidal, AC, Grant, DJ, Williams, CD, Masko, E, Allott, EH, Shuler, K, McPhail, M, Gaines, A, Calloway, E, Gerber, L, Chi, J-T, Freedland, SJ, and Hoyo, C. "Associations between Intake of Folate, Methionine, and Vitamins B-12, B-6 and Prostate Cancer Risk in American Veterans." J Cancer Epidemiol 2012 (2012): 957467-.
Website
http://hdl.handle.net/10161/6105
PMID
22927849
Source
pubmed
Published In
Journal of Cancer Epidemiology
Volume
2012
Publish Date
2012
Start Page
957467
DOI
10.1155/2012/957467

Dietary calcium and risk for prostate cancer: a case-control study among US veterans.

OBJECTIVE: The objective of this study was to examine the association between calcium intake and prostate cancer risk. We hypothesized that calcium intake would be positively associated with lower risk for prostate cancer. METHODS: We used data from a case-control study conducted among veterans between 2007 and 2010 at the Durham Veterans Affairs Medical Center. The study consisted of 108 biopsy-positive prostate cancer cases, 161 biopsy-negative controls, and 237 healthy controls. We also determined whether these associations differed for blacks and whites or for low-grade (Gleason score <7) and high-grade prostate cancer (Gleason score ≥7). We administered the Harvard food frequency questionnaire to assess diet and estimate calcium intake. We used logistic regression models to obtain odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Intake of calcium from food was inversely related to risk for prostate cancer among all races in a comparison of cases and biopsy-negative controls (P = .05) and cases and healthy controls (P = .02). Total calcium was associated with lower prostate cancer risk among black men but not among white men in analyses of healthy controls. The highest tertile of calcium from food was associated with lower risk for high-grade prostate cancer in a comparison of high-grade cases and biopsy-negative controls (OR, 0.37; 95% CI, 0.15-0.90) and high-grade cases and healthy controls (OR, 0.38; 95% CI, 0.17-0.86). CONCLUSION: Calcium from food is associated with lower risk for prostate cancer, particularly among black men, and lower risk for high-grade prostate cancer among all men.

Authors
Williams, CD; Whitley, BM; Hoyo, C; Grant, DJ; Schwartz, GG; Presti, JC; Iraggi, JD; Newman, KA; Gerber, L; Taylor, LA; McKeever, MG; Freedland, SJ
MLA Citation
Williams, CD, Whitley, BM, Hoyo, C, Grant, DJ, Schwartz, GG, Presti, JC, Iraggi, JD, Newman, KA, Gerber, L, Taylor, LA, McKeever, MG, and Freedland, SJ. "Dietary calcium and risk for prostate cancer: a case-control study among US veterans." Prev Chronic Dis 9 (2012): E39-.
PMID
22239754
Source
pubmed
Published In
Preventing Chronic Diseases: Public health research, practice, and policy
Volume
9
Publish Date
2012
Start Page
E39

A high ratio of dietary n-6/n-3 polyunsaturated fatty acids is associated with increased risk of prostate cancer.

Experimental studies suggest omega-3 (n-3) polyunsaturated fatty acids (PUFA) suppress and n-6 PUFA promote prostate tumor carcinogenesis. Epidemiologic evidence remains inconclusive. The objectives of this study were to examine the association between n-3 and n-6 PUFA and prostate cancer risk and determine if these associations differ by race or disease aggressiveness. We hypothesize that high intakes of n-3 and n-6 PUFA will be associated with lower and higher prostate cancer risk, respectively. A case-control study comprising 79 prostate cancer cases and 187 controls was conducted at the Durham VA Medical Center. Diet was assessed using a food frequency questionnaire. Logistic regression analyses were used to obtain odds ratios (ORs) and 95% confidence intervals (95% CI) for the associations between n-3 and n-6 PUFA intakes, the dietary ratio of n-6/n-3 fatty acids, and prostate cancer risk. Our results showed no significant associations between specific n-3 or n-6 PUFA intakes and prostate cancer risk. The highest dietary ratio of n-6/n-3 was significantly associated with elevated risk of high-grade (OR, 3.55; 95% CI, 1.18-10.69; P(trend) = 0.03), but not low-grade prostate cancer (OR, 0.95; 95% CI, 0.43-2.17). In race-specific analyses, an increasing dietary ratio of n-6/n-3 fatty acids correlated with higher prostate cancer risk among white men (P(trend) = 0.05), but not black men. In conclusion, our findings suggest that a high dietary ratio of n-6/n-3 fatty acids may increase the risk of overall prostate cancer among white men and possibly increase the risk of high-grade prostate cancer among all men.

Authors
Williams, CD; Whitley, BM; Hoyo, C; Grant, DJ; Iraggi, JD; Newman, KA; Gerber, L; Taylor, LA; McKeever, MG; Freedland, SJ
MLA Citation
Williams, CD, Whitley, BM, Hoyo, C, Grant, DJ, Iraggi, JD, Newman, KA, Gerber, L, Taylor, LA, McKeever, MG, and Freedland, SJ. "A high ratio of dietary n-6/n-3 polyunsaturated fatty acids is associated with increased risk of prostate cancer." Nutr Res 31.1 (January 2011): 1-8.
PMID
21310299
Source
pubmed
Published In
Nutrition Research
Volume
31
Issue
1
Publish Date
2011
Start Page
1
End Page
8
DOI
10.1016/j.nutres.2011.01.002

Antioxidant and DNA methylation-related nutrients and risk of distal colorectal cancer.

To investigate the relationship between antioxidant nutrients (vitamins C and E, beta-carotene, selenium) and DNA methylation-related nutrients (folate, vitamins B6 and B12) and distal colorectal cancer risk in whites and African Americans and to examine intakes from food only versus total (food plus dietary supplements) intakes.Data are from the North Carolina Colon Cancer Study-Phase II, a case-control study of 945 distal colorectal cancer (including sigmoid, rectosigmoid, and rectum) cases and 959 controls. In-person interviews captured usual dietary intake and various covariates. Multivariate logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (95% CI).High intakes of each antioxidant and DNA methylation-related nutrient were significantly associated with lower risk in whites. In African Americans, the highest category of selenium from food only had a marginally significant inverse association with distal colorectal cancer risk (Q4 vs. Q1 OR: 0.55, 95% CI 0.29-1.02). Supplements did not provide additional risk reduction beyond intakes from food.Our findings provide evidence that antioxidant and DNA methylation-related nutrients may lower the risk of distal colorectal cancer in whites, and selenium may lower risk in African Americans. Optimal micronutrient intakes from food alone may be more beneficial than supplementation.

Authors
Williams, CD; Satia, JA; Adair, LS; Stevens, J; Galanko, J; Keku, TO; Sandler, RS
MLA Citation
Williams, CD, Satia, JA, Adair, LS, Stevens, J, Galanko, J, Keku, TO, and Sandler, RS. "Antioxidant and DNA methylation-related nutrients and risk of distal colorectal cancer." Cancer causes & control : CCC 21.8 (August 2010): 1171-1181.
PMID
20352485
Source
epmc
Published In
Cancer Causes & Control
Volume
21
Issue
8
Publish Date
2010
Start Page
1171
End Page
1181
DOI
10.1007/s10552-010-9544-3

Associations of red meat, fat, and protein intake with distal colorectal cancer risk.

Studies have suggested that red and processed meat consumption elevate the risk of colon cancer; however, the relationship between red meat, as well as fat and protein, and distal colorectal cancer (CRC) specifically is not clear. We determined the risk of distal CRC associated with red and processed meat, fat, and protein intakes in Whites and African Americans. There were 945 cases (720 White, 225 African American) of distal CRC and 959 controls (800 White, 159 African American). We assessed dietary intake in the previous 12 mo. Multivariate logistic regression analyses were used to obtain odds ratios (OR) and 95% confidence intervals (95% CI). There was no association between total, saturated, or monounsaturated fat and distal CRC risk. In African Americans, the OR of distal CRC for the highest category of polyunsaturated fat intake was 0.28 (95% CI = 0.08-0.96). The percent of energy from protein was associated with a 47% risk reduction in Whites (Q4 OR = 0.53, 95% CI = 0.37-0.77). Red meat consumption in Whites was associated with a marginally significant risk reduction (Q4 OR = 0.66, 95% CI = 0.43-1.00). Our results do not support the hypotheses that fat, protein, and red meat increase the risk of distal CRC.

Authors
Williams, CD; Satia, JA; Adair, LS; Stevens, J; Galanko, J; Keku, TO; Sandler, RS
MLA Citation
Williams, CD, Satia, JA, Adair, LS, Stevens, J, Galanko, J, Keku, TO, and Sandler, RS. "Associations of red meat, fat, and protein intake with distal colorectal cancer risk." Nutrition and cancer 62.6 (January 2010): 701-709.
PMID
20661817
Source
epmc
Published In
Nutrition and Cancer
Volume
62
Issue
6
Publish Date
2010
Start Page
701
End Page
709
DOI
10.1080/01635581003605938

Adiponectin and prostate cancer mortality: to be or not to be skinny?

Authors
Freedland, SJ; Williams, CD; Masko, EM
MLA Citation
Freedland, SJ, Williams, CD, and Masko, EM. "Adiponectin and prostate cancer mortality: to be or not to be skinny?." Clin Chem 56.1 (January 2010): 1-3.
PMID
19892841
Source
pubmed
Published In
Clinical chemistry
Volume
56
Issue
1
Publish Date
2010
Start Page
1
End Page
3
DOI
10.1373/clinchem.2009.137406

Dietary patterns, food groups, and rectal cancer risk in Whites and African-Americans.

Associations between individual foods and nutrients and colorectal cancer have been inconsistent, and few studies have examined associations between food, nutrients, dietary patterns, and rectal cancer. We examined the relationship between food groups and dietary patterns and risk for rectal cancer in non-Hispanic Whites and African-Americans.Data were from the North Carolina Colon Cancer Study-Phase II and included 1,520 Whites (720 cases, 800 controls) and 384 African-Americans (225 cases, 159 controls). Diet was assessed using the Diet History Questionnaire. Multivariate logistic regression models were used to estimate odds ratios and 95% confidence intervals.Among Whites, non-whole grains and white potatoes were associated with elevated risk for rectal cancer whereas fruit, vegetables, dairy, fish, and poultry were associated with reduced risk. In African-Americans, high consumption of other fruit and added sugar suggested elevated risk. We identified three major dietary patterns in Whites and African-Americans. The high fat/meat/potatoes pattern was observed in both race groups but was only positively associated with risk in Whites (odds ratio, 1.84; 95% confidence interval, 1.03-3.15). The vegetable/fish/poultry and fruit/whole grain/dairy patterns in Whites had significant inverse associations with risk. In African-Americans, there was a positive dose-response for the fruit/vegetables pattern (P(trend) < 0.0001) and an inverse linear trend for the legumes/dairy pattern (P(trend) < 0.0001).Our findings indicate that associations of certain food groups and overall dietary patterns with rectal cancer risk differ between Whites and African-Americans, highlighting the importance of examining diet and cancer relationships in racially diverse populations.

Authors
Williams, CD; Satia, JA; Adair, LS; Stevens, J; Galanko, J; Keku, TO; Sandler, RS
MLA Citation
Williams, CD, Satia, JA, Adair, LS, Stevens, J, Galanko, J, Keku, TO, and Sandler, RS. "Dietary patterns, food groups, and rectal cancer risk in Whites and African-Americans." Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 18.5 (May 2009): 1552-1561.
PMID
19423533
Source
epmc
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
18
Issue
5
Publish Date
2009
Start Page
1552
End Page
1561
DOI
10.1158/1055-9965.epi-08-1146

Genes and Environmental Exposures in Veterans with Amyotrophic Lateral Sclerosis: the GENEVA study. Rationale, study design and demographic characteristics.

Recent reports of a potentially increased risk of amyotrophic lateral sclerosis (ALS) for veterans deployed to the 1990-1991 Persian Gulf War prompted the Department of Veterans Affairs to establish a National Registry of Veterans with ALS, charged with the goal of enrolling all US veterans with a neurologist-confirmed diagnosis of ALS. The Genes and Environmental Exposures in Veterans with ALS study (GENEVA) is a case-control study presently enrolling cases from the Department of Veterans Affairs registry and a representative sample of veteran controls to evaluate the joint contributions of genetic susceptibility and environmental exposures to the risk of sporadic ALS. The GENEVA study design, recruitment strategies, methods of collecting DNA samples and environmental risk factor information are described here, along with a summary of demographic characteristics of the participants (537 cases, 292 controls) enrolled to date.

Authors
Schmidt, S; Allen, KD; Loiacono, VT; Norman, B; Stanwyck, CL; Nord, KM; Williams, CD; Kasarskis, EJ; Kamel, F; McGuire, V; Nelson, LM; Oddone, EZ
MLA Citation
Schmidt, S, Allen, KD, Loiacono, VT, Norman, B, Stanwyck, CL, Nord, KM, Williams, CD, Kasarskis, EJ, Kamel, F, McGuire, V, Nelson, LM, and Oddone, EZ. "Genes and Environmental Exposures in Veterans with Amyotrophic Lateral Sclerosis: the GENEVA study. Rationale, study design and demographic characteristics." Neuroepidemiology 30.3 (2008): 191-204.
PMID
18421219
Source
pubmed
Published In
Neuroepidemiology
Volume
30
Issue
3
Publish Date
2008
Start Page
191
End Page
204
DOI
10.1159/000126911
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