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This study will learn more about the beliefs of family members of African American patients with lung cancer and whether these beliefs are associated with their interest in genetic testing for disease risk and willingness to participate in genetics research. Lung cancer is the second most common form of cancer and the leading cause of cancer deaths for men and women in the United States. Like most cancers, there are racial and ethnic disparities (gaps) in lung cancer cases and deaths. The age-adjusted rates for blacks and whites (years 2000 to 2003) was 76.9 per 100,000 and 66.0 per 100,000, respectively. Mortality rates were 62.5 per 100,000 for blacks and 55.3 per 100,000 for whites. Cigarette smoking is the most preventable cause of lung cancer. Findings are that African Americans begin smoking at older ages and smoke fewer cigarettes per day than Caucasian Americans do. Yet the severity of lung cancer is greater for African Americans. Behavioral, social, environmental, and genetic factors may explain the differences.

Participants (subjects) ages 18 to 55 who are family of patients with lung cancer who self-identify as African Americans may be eligible for this study. Washington, D.C., researchers plan to recruit 115 lung cancer patients and 200 family members-100 current smokers and 100 who never smoked. Lung cancer patients, who must have been born in the United States, will be recruited from those who are receiving care at the Washington Cancer Institute at the Washington Hospital Center. They will be asked to list relatives and friends they consider to be as close as family. Patients will be asked permission for researchers to contact those people. Family members will receive a letter telling them that unless they decline to participate, they will be contacted by a telephone interviewer.

The survey will feature questions to evaluate family members' explanations for the causes of lung cancer, as well as their reactions to possible reasons for the disparity in lung cancer between African Americans and Caucasian Americans. Subjects will be asked about perceived personal risk, worry about developing lung cancer, smoking history, motivation to quit smoking, feelings about the lung cancer patient's diagnosis, racial identify, experience with racial discrimination, pros and cons of genetic testing, and interest in genetic testing. The survey will take up to 20 minutes to complete.

This study may or may not have a direct benefit for those who participate. However, lung cancer patients and their families will be offered a free self-help guide to stop smoking. They will be referred to local smoking cessation programs. Knowledge gained from the study may be used to design smoking cessation methods and research studies related to genetics for minority populations.

The purpose of the African American (AA) Families and Lung Cancer Study is to learn more about (1) the beliefs of family members of AA patients with lung cancer about why AA get lung cancer and (2) whether these beliefs are associated with their interest in genetic testing for lung cancer risk and willingness to participate in clinical genetics research. We plan to recruit 200 AAs (n = 100 current smokers and n = 100 never smokers) who are considered to be as close as family (both biological and non-biological kin) to patients with lung cancer who self-identify as AA (n = 115). Patients will be recruited from Washington Cancer Institute at the Washington Hospital Center in Washington, DC. Family members who self-identify as AA and are between the ages 18 and 55 will be eligible for the study. A Washington Hospital Center recruiter will approach patients and ask their willingness to be contacted for a telephone survey about their general well-being. As part of the survey, patients will be asked to enumerate family and friends who they consider to be as close as family, and asked to specifically focus on those who are current cigarette smokers and those who have never smoked. Patients will be asked to give permission to contact some or all of those enumerated. These family members will be mailed a letter to inform them that unless they call to decline they will be contacted by a telephone interviewer. The survey will include questions to assess family members' explanations for the causes of lung cancer and reactions to possible explanations for disparities in lung cancer between AA and Caucasian Americans (CA), perceived personal risk and worry about developing lung cancer, smoking history, motivation to quit smoking, emotional responses to the patient's diagnosis, racial identity, experience with racial discrimination, pros and cons of genetic testing, and interest in genetic testing (the primary outcome variable). Data analysis using hierarchical linear modeling will assess whether patient characteristics and family members' endorsement of genetics as the cause of lung cancer are associated with their interest in genetic testing and participation in clinical genetics research.

African American Families and Lung Cancer Study

National Human Genome Research Institute (NHGRI)

This study will explore beliefs and knowledge about genetics and smoking among smokers who have a first or second degree relative with advanced lung cancer, and whether their understanding of genetic risk influences their desire to quit smoking.

Healthy adult smokers between 18 and 55 years of age who are first or second degree relatives (e.g., siblings, children, grandchildren, nieces, nephews, grandnieces or grandnephews) of a patient with advanced lung cancer who is receiving care at the Moffitt Cancer Center and Research Institute in Tampa, Fla. and the GUMC/LCCC, may be eligible for this study. Participants must be able to complete computer online surveys.

Participants log on to a password-protected website to complete online educational sessions and surveys. The educational sessions include information on: 1) the role of smoking and genetics in the development of lung cancer; 2) glutathione S transferase (GSTM1), an enzyme made by the GSTM1 gene that "cleans up" toxins such as cigarette smoke and that may play a role in preventing lung cancer from developing; 3) pros and cons of being tested for GSTM1; and 5) a series of questions and answers about genetic testing. Participants are offered free genetic testing for GSTM1, and those who wish to be tested are sent materials to collect a sample from inside the cheek using a mouth rinse and return it to a laboratory at Duke University Medical Center. They later receive their results online.

Participants also complete online surveys that ask about their risk perceptions, beliefs and attitudes related to lung cancer, emotional responses to their relative's diagnosis, smoking history and motivation to quit, reactions to information about smoking and genetic risk, and interest in receiving smoking cessation services. They are asked to review depictions and descriptions of smoking cessation materials offered through a quit smoking program at Duke University Medical Center and to evaluate the extent to which the various materials might be helpful. They are offered additional information among categories they can choose from.

Participants are surveyed again by telephone 6 months after completing the online surveys.

The overarching objective of this observational prospective "Genetic Risk \& Lung Cancer Study" is to evaluate the impact of a loved one's lung cancer diagnosis on relative's seeking and processing of information related to risks of smoking, genetic susceptibility, and their receptivity to smoking cessation services. We plan to recruit 150 relatives of lung cancer patients who are receiving care at H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida and the Lombardi Comprehensive Cancer Center at the Georgetown University Medical Center (GUMC/LCCC). First- or second-degree blood relatives who are current smokers between the ages of 18 to 55 will be eligible for the study. Because these relatives will be living throughout the United Sates, a web-based research protocol will be employed. A nurse recruiter will approach patients at Moffitt and assess their willingness to do a telephone survey The overarching objective of this observational prospective "Genetic Risk \& Lung Cancer Study" is to evaluate the impact of a loved one's lung cancer diagnosis on relative's seeking and processing of information related to risk of smoking, genetic susceptibility, and their receptivity to smoking cessation services. We plan to recruit 150 relatives of lung cancer patients who are receiving care at H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida. First-or second-degree relatives who are current smokers between the ages 18 to 55 will be eligible for the study. Because these relatives will be living throughout the United States, a web-based research protocol wil be employed. A nurse recruiter will approach patients at Moffitt and assess their willingness to do a telephone survey to enumerate their relatives who smoke and be asked to give permission to contact none, some or all of these relatives. These survey contacts with patients and contacts with relatives for screening and recruitment will be conducted in partnership with an ongoing recruitment activities for a five-year, NCI-funded randomized controlled intervention trial (RCT) at Duke University Medical Center (Quit Smoking Program for Lung Cancer Patient's Families or "Family Ties", Duke IRB# 4620, Bastian, PI). Relatives who agree to participate will be asked to log on to a password protected website and view two online educational sessions and complete three online surveys. As part of the educational session, participants will be offered free geneticsusceptibility testing for glutathione S transferase (GSTM1). Participants who accept testing will receive their result online. Participants who decline testing will be retained in the the study and offered all the same smoking cessation services provided to those who accept testing. Participants will be sent instructions to collect their own buccal samples and postage-paid mailing envelopes to return the sample to a CLIA-approved laboratory at Duke. Survey assessments will include questions about risk perceptions, beliefs and attitudes related to lung cancer, emotional responses to the patient's diagnosis, smoking history, motivation to quit, reactions to information about smoking and genetic risk, interest in genetic testing, comprehension of susceptibility feedback, and interest in receiving smoking cessation services. The primary outcome variable will be seeking of free quit smoking services. Participating relatives will be surveyed by telephone via the Duke RCT infrastructure 6-months after completing the online protocol.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
African American Families and Lung Cancer Study	NCT00487760	Lung Cancer		18 Years -	National Institutes of Health Clinical Center (CC)
Impact of Lung Cancer Diagnosis on Relatives' Understanding of Genetic Risk and Receptivity to Quit Smoking	NCT00341341	Lung Cancer		18 Years - 55 Years	National Institutes of Health Clinical Center (CC)

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