Continued smoking after a cancer diagnosis contributes to several negative health outcomes. Although many cancer patients attempt to quit smoking, high smoking relapse rates have been observed. This highlights the need for a targeted, evidence-based smoking-relapse prevention intervention. The design, method, and baseline characteristics of a randomized controlled trial assessing the efficacy of a self-help smoking-relapse prevention intervention are presented. Cancer patients who had recently quit smoking were randomized to one of two conditions. The Usual Care (UC) group received the institution’s standard of care. The smoking relapse-prevention intervention (SRP) group received standard of care, plus 8 relapse-prevention booklets mailed over a 3 month period, and a targeted educational DVD developed specifically for cancer patients. Four hundred and fourteen participants were enrolled and completed a baseline survey. Primary outcomes will be self-reported smoking status at 6 and 12-months after baseline. Biochemical verification of smoking status was completed for a subsample. If found to be efficacious, this low-cost intervention could be easily disseminated with significant potential for reducing the risk of negative cancer outcomes associated with continued smoking.

We describe the series of iterative steps used to develop a smoking relapse-prevention intervention customized to the needs of cancer patients. Informed by relevant literature and a series of preliminary studies, an educational tool (DVD) was developed to target the unique smoking relapse risk factors among cancer patients. Learner verification interviews were conducted with 10 cancer patients who recently quit smoking to elicit feedback and inform the development of the DVD. The DVD was then refined using iterative processes and feedback from the learner verification interviews. Major changes focused on visual appeal, and the inclusion of additional testimonials and graphics to increase comprehension of key points and further emphasize the message that the patient is in control of their ability to maintain their smoking abstinence. Together, these steps resulted in the creation of a DVD titled Surviving Smokefree®, which represents the first smoking relapse-prevention intervention for cancer patients. If found effective, the Surviving Smokefree® DVD is an easily disseminable and low-cost portable intervention which can assist cancer patients in maintaining smoking abstinence.

Cigarette smoking is associated with a range of cancers and is related to five of seven leading causes of death in Puerto Rico. Minimal self-help interventions have shown promising results in reaching participants and preventing relapse from smoking. Specifically, a collection of 8 self-help booklets has demonstrated efficacy (Brandon et al., 2000; 2004). Those booklets have been transcreated into Spanish, with efforts to make them culturally appropriate across a range of Hispanic cultures. We conducted a pilot study in Ponce, Puerto Rico, to evaluate the Spanish version of our smoking relapse-prevention booklets. Qualitative, semi-structured interviews were conducted with 20 current and former smokers. Interviews were conducted to elicit feedback regarding the booklet’s content, cultural appropriateness, dissemination, and perceived availability of smoking cessation resources in Puerto Rico. Interviews were audio-taped and transcribed verbatim. Transcripts were coded using content analysis, with a priori codes based on the interview guide. Emergent themes were examined. Overall, participants liked the booklets’ content, perceived them to be culturally appropriate, easy to read and understand. Regarding dissemination, it was recommended that the booklets be disseminated by physicians and advertised through television. Most importantly, participants reported the best way to distribute and complement the booklets would be through support groups. Participants also reported having limited knowledge about resources provided in the community to aid smoking cessation. Overall, this pilot study was able to show the cultural acceptability of the booklets and highlights the need for the dissemination of these materials among current and former smokers in Puerto Rico.

Subgroups of Hispanics/Latinos (HL) experience up to 30% higher colorectal cancer (CRC) mortality than non-Hispanic Whites. This disparity is not fully explained by socio-demographics or access to care, suggesting that biology plays a role. However, biological factors have been underexplored, in part due to a lack of diversity in available datasets. To address this limitation, we established the Latino Colorectal Cancer Consortium (LC3) and examined the association between genetic ancestry and somatic mutation frequencies in HL and in non-HL from Total Cancer Care (Moffitt Cancer Center). We hypothesized that ancestral haplotypes that vary across racial/ethnic populations contribute to differential somatic mutational profiles. We identified 321 primary CRC cases (34% HL (majority of Mexican and Puerto Rican origin), 63% non-HL, 3% unknown) and whole exome sequencing data. Somatic mutations were called from tumor/normal pairs using a bioinformatic pipeline including Burrows-Wheeler Aligner, the Genome Analysis Toolkit (GATK), MuTect, and Strelka. High quality mutation calls were filtered to exclude variants at ≥1% in 1000 Genomes. Inherited variants for ancestry analysis were called using GATK. Global proportions of African (AFR), Asian (ASN), European (EUR), and Indigenous American (IA) ancestry were estimated using ADMIXTURE with exome-wide SNPs overlapping 1000 Genomes. The associations between genetic ancestry and somatic mutation status in 38 genes commonly over-mutated in CRC were examined using compositional analysis in the context of logistic regression. Among HL, ancestry proportions were: AFR (mean: 0.15; range: 2 × 10−03-0.63), ASN (0.07; 0.02-0.92), EUR (0.56, 0.08-0.85) and IA (0.22, 3 × 10−03-0.64). Among non-HL, they were: AFR (0.03; 1 × 10−05-0.83), ASN (0.10; 0.01-0.70), EUR (0.85, 0.13-0.93) and IA (0.02, 2 × 10−03-0.65). Genetic ancestry was associated with the presence of any mutation in MSH3 (P=0.014), ACVR1B (P=0.016) or BRAF (P=0.016); or specifically, with the presence of any truncating mutation in TGFBR2 (P=0.018) or ACVR1B (P=0.024). Relative to EUR ancestry, individuals with higher IA ancestry had a lower probability of any BRAF mutation (OR (95% CI)=0.72 (0.55-0.94); P=0.015) and a higher probability of an APC truncating mutation (1.17 (1.00-1.36); P=0.053). In contrast, higher AFR ancestry (relative to EUR) was associated with increased odds of ACVR1B (OR (95% CI)=1.27 (1.02-1.58); P=0.033) or NRAS mutations (1.22 (1.00-1.47); P=0.047) and decreased odds of an FBXW7 mutation (0.87 (0.77-0.98); P=0.023). Our findings from the largest study of CRC somatic landscapes in HL provide early evidence of mutation frequency differences in driver genes associated with genetic ancestry. Our ongoing efforts to expand LC3 will inform the development of ancestry-tailored treatment strategies to benefit diverse populations. Citation Format: Marco Matejcic, Jamie K. Teer, Hannah J. Hoehn, Zhihua Chen, Diana B. Diaz, Nathalie Nguyen, Douglas Cress, Estrella Carballido, Jason Fleming, Domenico Coppola, Mariana C. Stern, Brooke L. Fridley, Jane C. Figueiredo, Stephanie L. Schmit. Genetic ancestry and somatic mutational frequencies in colorectal cancer: Findings from the Latino Colorectal Cancer Consortium [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1192.

There is a dearth of evidence-based smoking-cessation interventions for Hispanic/Latino smokers, especially for individuals with limited or no English proficiency. Hispanics/Latinos make up 17% of the national population, and in some Hispanic sub-ethnic groups, such as Puerto Ricans and Cubans, smoking prevalence rates are over 30% (greatly exceeding rates of non-Hispanic Whites at 18.1%). Thus, we sought to transcreate our existing validated English-language “Stop Smoking for Good” self-help smoking cessation intervention for Spanish-speaking smokers. The transcreation process involves a series of steps involving translating the text into another language, as well as infusing culturally relevant context, photos, and themes. To begin, focus groups were conducted to assess reactions to the existing English-language materials (10 booklets and 9 pamphlets), and to gather suggestions to adapt content for the intended audience. Specifically, we aimed to identify culturally relevant smoking cessation barriers as well as elements that would increase acceptability in this population. Focus group participants (N=23) were bilingual Hispanic/Latino smokers representing diverse sub-ethnic groups. A key theme that emerged was familism, defined by the sense of attachment, loyalty and collective well-being among the nuclear as well as extended family. This finding prompted us to develop an additional booklet aimed at providing family and friends with the tools necessary to support their loved one's quit attempt. Other findings included: religion and spirituality as a coping mechanism; the role of coffee as a trigger for smoking; and difficulties for immigrants that serve as stressors for smoking, such as language barriers, being separated from one's family, and financial problems. Format change suggestions were also reported by participants and included a desire for color images, preference for a bright color palette, and interactive activities. Focus group findings then informed the development of a Spanish-language version of the booklets entitled, “Libre del cigarrillo, por mi familia y por mí.” Subsequently, learner verification interviews (N=10) were conducted with Spanish-speaking Hispanic/Latino smokers who preferred their health education materials in Spanish to assess the appeal and acceptability of the revised content and visual modifications. Overall, participants responded favorably to the revised content. The learner verification process also revealed a need to: expand the explanation of quitting aids, include additional culturally salient daily stressors, and further emphasize the financial benefits of quitting smoking. We will present additional qualitative results from the focus groups and learner verification interviews as well as the finalized Spanish-language version of the booklets. The final version of the Spanish-language materials will be tested in a randomized controlled trial. Citation Format: Diana B. Díaz, Luis M. Monsalve, Thomas H. Brandon, Bárbara Piñeiro, Lauren R. Meltzer, Cathy D. Meade, Karen O. Brandon, Marina Unrod, Vani N. Simmons. Transcreating self-help smoking cessation intervention materials for Hispanic/Latino smokers: Focus group and learner verification findings. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A09.