The paper of the year

This year's undisputed winner would be a report published by researchers from Stanford University explaining the so-called “Hispanic Paradox” in lung cancer.

By
December 9, 2014 21:34
4 minute read.
A DOCTOR at a conference in Paris describes new research on lung cancer

A DOCTOR at a conference in Paris describes new research on lung cancer. (photo credit: REUTERS)

For the past two decades, each year in December, various dictionaries and websites have selected their candidates for Word of the Year (WotY). In 2013, the consensus winner was “selfie,” that fashionable photograph that we take of ourselves with our smartphones.

If there were a “PotY” or “Paper of the Year,” reflecting the most important article published by members of a discipline, then in my field, oncology, 2014’s undisputed winner would be a report published by researchers from Stanford University explaining the so-called “Hispanic Paradox” in lung cancer.

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Some may not have heard of the “Hispanic Paradox,” but it has been known to cancer physicians for more than three decades. To prove that the concept is not new, one editor recently remarked that, if the phenomenon had been described in the past decade rather than three decades ago, it would surely have been called the “Latino Paradox.” But irrespective of political correctness, the concept is, in the words of Gilbert and Sullivan, “a paradox, a paradox, a most ingenious paradox.”

It turns out that lung cancer patients of Hispanic origin who have moved to the USA have better survival rates than do “non-Hispanic white Americans.” Paradoxically, the improved outcome occurs despite the fact that Hispanic Americans are, on average, socioeconomically disadvantaged in comparison to their non-Hispanic counterparts.

No one could explain the Hispanic Paradox until the research team led by Dr. Manali Patel analyzed a large registry of Latino individuals – mostly of Mexican descent – living in southern California.

First, the researchers confirmed that the Hispanic patients had, in fact, fared better than the non-Hispanic whites. Then, the researchers drilled down into their database and unearthed yet another paradox: foreign-born Hispanics had fared better than US-born Hispanics even though the latter had higher levels of “health literacy,” a term reflecting the ability to understand the subtleties of the complex American healthcare system.

The investigators wondered whether the foreign-born Hispanics had better nutritional status since they may not yet have been corrupted by the diet of the “fast-food nation.” They then checked to see whether the foreign-born patients may have been an “enriched population,” with earlier-stage lung tumors.

Other factors were also incorporated into a statistical blender to determine whether something was confounding the data. But in the end, only one parameter was prognostic: foreign-born Hispanics tended to coalesce into what the investigators called “ethnic enclaves.” In other words, the immigrants lived closer to each other in their neighborhoods and buoyed each other during times of hardship, including employment layoffs and illness.

The bonds formed by the process of caregiving overwhelmed even the improved and more frequently administered chemotherapy and radiation treatments that the US-born Hispanic patients received. Although the difference amounted to only a few percentage points, the findings reached significance when sophisticated mathematical tests were applied.

That indicates, to me, that the data were real, robust and reproducible.

I love these data because they demonstrate how valuable it is for us to pull together, to help each other during times of ordeal. A few months ago, my sister found a 1937 journal published by the Greenberg Family Circle, the social network (pre-Facebook!) formed by my maternal grandparents and great-uncles upon arrival in New York City. I have no idea whether anyone in my family was diagnosed with lung cancer several generations ago, and if so, what kind of oncologic outcome they had, but my guess is that the Greenbergs regularly reassured each other and that similar organizations made the American absorption process more palatable for families of many Jerusalem Post readers.

Currently, from Rosh Pina in the north to Ashdod in the south, Israelis have begun to establish “communities of caring” with support from the UJA Federation New York. Bolstered by physicians, nurses, social workers, chaplains, and an array of volunteers, those communities of caring serve to fortify patients and families who contend with serious disease.

This is a noteworthy sociological development in a country that has not been oriented toward the religious institutions (e.g., synagogues) or community centers (e.g., JCC) around which many of us grew up before making aliya from our native lands.

In the case of cancer patients, the challenge is to provide not only access to cutting-edge therapy but also access to that type of time-honored spiritual support practiced by the foreign-born Hispanics on which the aforementioned study focused. For healthy individuals as well, communities of caring will probably have a positive impact on many aspects of life quality.

Surely the article by Patel and colleagues will never reach the celebrity status of the “selfie”; however I confess that something bothers me about the selfie. It’s not that I find the digital pictures to reflect outright solipsism or egocentricity. They are fun, and we all enjoy sharing them. But the notion that we can reach out beyond the self – that we may even re-discover the self within “communities of caring” – encourages me as we begin our new calendar year.

The author is a professor of oncology at Tel Aviv University, chairman of the Institute of Radiotherapy at Tel Aviv Medical Center, and co-founder of the NGO Life’s Door. The latter organization is funded, in part, by the UJA.


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