Social Genomics As a Framework for Understanding Health Disparities Among Adolescent and Young Adult Cancer Survivors

Background/Purpose. Adolescent and Young Adult (AYA) cancer survivors (aged 15-39 years at diagnosis) experience complex psychosocial stressors and life disruptions affecting their health and their life. Health outcomes, and disparities in these outcomes, may be partially a function of social determinants of health, including socioeconomic gradients, exposures to childhood traumas or adversity, and accumulated experiences of discrimination. Yet, little is known about if and how these social environmental conditions influence morbidity, mortality, and quality of life (QOL) among AYAs. The purpose of this study is to identify and define functional genomic pathways through which current and past psychosocial and social environmental risk and resilience factors influence gene regulation and subsequent health outcomes in AYAs, and thus contribute to a greater understanding of health disparities in post-treatment survivorship. Methodology. In collaboration with a nationwide federally-funded clinical trials network (the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network and the National Cancer Institute Community Oncology Research Program), we have initiated a 5-year longitudinal prospective cohort study of 2000 AYA Hodgkin and non-Hodgkin lymphoma survivors recruited within one year following completion of treatment. Using a “social genomics” framework, which hypothesizes a biological basis for psychological and social influences on outcomes, we aim to identify neural and molecular pathways (i.e., CTRA gene regulation by the sympathetic nervous system) through which psychological and social factors mechanistically influence disease development and progression. Using Patient Reported Outcomes measures of social isolation, exposures to trauma and discrimination, geographic area deprivation, and behavioral self-efficacy, along with blood assays, we will evaluate (1) the extent to which biological, psychological, and social indicators are associated with, and potentially predict, mortality, morbidity, and QOL in AYA survivors over two years following completion of therapy; and (2) variations by race, ethnicity, sexual orientation, and gender identity. Recruitment and retention strategies include a comprehensive social media strategy specifically tailored in its appeal to a diverse sample in terms of race, ethnicity, sexual orientation, and gender identity. These strategies are intended to create a sense of community among study participants and thus increase likelihood of achieving a diverse and representative sample. Results. Results are pending a four-year data collection period. As we are currently in the first year of data collection, we propose to focus our presentation on (1) social genomics as the conceptual framework for the study; (2) our innovative and purposeful recruitment strategies for obtaining a socio-demographically representative sample of AYA cancer survivors; and (3) our efforts to re-center and democratize an evidence base truly represents the AYA population in terms of multiple and intersecting positionalities. Conclusion. This work is critical for an age-defined population, most of whom will survive cancer and look forward to decades of life. Yet, every AYA survivor has significantly increased risks for deleterious physical and mental health challenges. This study will be significant in that it will inform the conceptualization and development of targeted medical and supportive care interventions that reduce risks for morbidity and mortality and improve QOL for AYAs.