Christina Williams

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

University of North Carolina at Chapel Hill

Grants:

Publications:

Aging

MLA Citation
Zullig, L. L., et al. “Aging.” Handbook of Cancer Survivorship: Second Edition, 2018, pp. 91–109. Scopus, doi:10.1007/978-3-319-77432-9_6.
URI
https://scholars.duke.edu/individual/pub1421455
Source
scopus
Published Date
Start Page
91
End Page
109
DOI
10.1007/978-3-319-77432-9_6

Cardiovascular disease-related chronic conditions among Veterans Affairs nonmetastatic colorectal cancer survivors: a matched case-control analysis.

Purpose: The growing number of colorectal cancer (CRC) survivors often have multiple chronic conditions. Comparing nonmetastatic CRC survivors and matched noncancer controls, our objectives were to determine the odds of CRC survivors being diagnosed with cardiovascular disease (CVD)-related chronic conditions and their likelihood of control during the year after CRC diagnosis. Patients and methods: We retrospectively identified patients diagnosed with nonmetastatic CRC in the Veterans Affairs health care system from fiscal years 2009 to 2012 and matched each with up to 3 noncancer control patients. We used logistic regression to assess differences in the likelihood of being diagnosed with CVD-related chronic conditions and control between nonmetastatic CRC survivors and noncancer controls. Results: We identified 9,758 nonmetastatic CRC patients and matched them to 29,066 noncancer controls. At baseline, 69.4% of CRC survivors and their matched controls were diagnosed with hypertension, 52.4% with hyperlipidemia, and 36.7% with diabetes. Compared to matched noncancer controls, CRC survivors had 57% higher odds of being diagnosed with hypertension (OR=1.57, 95% CI=1.49-1.64) and 7% higher odds of controlled blood pressure (OR=1.07, 95% CI 1.02, 1.13) in the subsequent year. Compared to matched noncancer control patients, CRC survivors had half the odds of being diagnosed with hyperlipidemia (OR=0.50, 95% CI=0.48-0.52) and lower odds of low-density lipoprotein (LDL) control (OR 0.88, 95% CI 0.81-0.94). There were no significant differences between groups for diabetes diagnoses or control. Conclusion: Compared to noncancer controls, nonmetastatic CRC survivors have 1) greater likelihood of being diagnosed with hypertension and worse blood pressure control in the year following diagnosis; 2) lower likelihood of being diagnosed with hyperlipidemia or LDL control; and 3) comparable diabetes diagnoses and control. There may be a need for hypertension control interventions targeting cancer survivors.
Authors
Zullig, LL; Smith, VA; Lindquist, JH; Williams, CD; Weinberger, M; Provenzale, D; Jackson, GL; Kelley, MJ; Danus, S; Bosworth, HB
MLA Citation
Zullig, Leah L., et al. “Cardiovascular disease-related chronic conditions among Veterans Affairs nonmetastatic colorectal cancer survivors: a matched case-control analysis..” Cancer Manag Res, vol. 11, 2019, pp. 6793–802. Pubmed, doi:10.2147/CMAR.S191040.
URI
https://scholars.duke.edu/individual/pub1404026
PMID
31413631
Source
pubmed
Published In
Cancer Management and Research
Volume
11
Published Date
Start Page
6793
End Page
6802
DOI
10.2147/CMAR.S191040

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

INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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, Christina D., et al. “Impact of Race on Treatment and Survival among U.S. Veterans with Early-Stage Lung Cancer..” J Thorac Oncol, vol. 11, no. 10, Oct. 2016, pp. 1672–81. Pubmed, doi:10.1016/j.jtho.2016.05.030.
URI
https://scholars.duke.edu/individual/pub1134820
PMID
27296104
Source
pubmed
Published In
J Thorac Oncol
Volume
11
Published Date
Start Page
1672
End Page
1681
DOI
10.1016/j.jtho.2016.05.030

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

OBJECTIVE: 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. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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, Christina Dawn, et al. “Antioxidant and DNA methylation-related nutrients and risk of distal colorectal cancer..” Cancer Causes Control, vol. 21, no. 8, Aug. 2010, pp. 1171–81. Pubmed, doi:10.1007/s10552-010-9544-3.
URI
https://scholars.duke.edu/individual/pub1114022
PMID
20352485
Source
pubmed
Published In
Cancer Causes Control
Volume
21
Published Date
Start Page
1171
End Page
1181
DOI
10.1007/s10552-010-9544-3

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

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: Among diabetics with colorectal cancer, metformin use is associated with improved survival, despite adjustments for diabetes severity and other risk factors. IMPACT: 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, Jessica K., et al. “Metformin, Diabetes, and Survival among U.S. Veterans with Colorectal Cancer..” Cancer Epidemiol Biomarkers Prev, vol. 25, no. 10, Oct. 2016, pp. 1418–25. Pubmed, doi:10.1158/1055-9965.EPI-16-0312.
URI
https://scholars.duke.edu/individual/pub1139034
PMID
27496094
Source
pubmed
Published In
Cancer Epidemiol Biomarkers Prev
Volume
25
Published Date
Start Page
1418
End Page
1425
DOI
10.1158/1055-9965.EPI-16-0312