Project 3: Chronic Medical Conditions and Late Effects in the AYA Cancer Population

项目 3：AYA 癌症人群的慢性疾病和后期影响

• 批准号: 10477012
• 负责人: Theresa H M Keegan
• 金额: $ 28.38万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10477012
• 关键词: Accident and Emergency department; Address; Adolescent; Adolescent and Young Adult; Adult; Affect; Aftercare; Age; Ambulatory Surgical Procedures; Area; Asthma; Biological; California; Cancer Patient; Cancer Survivor; Cancer Survivorship; Cardiovascular Diseases; Cardiovascular system; Caring; Childhood; Childhood Cancer Survivor Study; Chronic; Chronic Kidney Failure; Clinical; Complement; Comprehensive Health Care; Country; County; Data; Diabetes Mellitus; Diagnosis; Drug Kinetics; Early Diagnosis; Electronic Health Record; Employment; Endocrine; Endocrine System Diseases; Ethnic Origin; Face; Fertility; Financial Hardship; Goals; Guidelines; Health; Health Insurance; Health Personnel; Health system; Healthcare; High Prevalence; Hospitalization; Hospitals; Incidence; Individual; Inpatients; Insurance; Insurance Coverage; Integrated Health Care Systems; Intervention; Investigation; Kidney Failure; Late Effects; Lead; Life; Link; Liver Cirrhosis; Liver diseases; Long-Term Care; Lung diseases; Malignant Childhood Neoplasm; Malignant Neoplasms; Medical; Monitor; Necrosis; Neighborhoods; North Carolina; Oncology; Outcome; Outpatients; Patients; Phase; Population; Population Intervention; Prevention; Primary Health Care; Provider; Race; Registries; Reporting; Research; Research Infrastructure; Research Personnel; Research Priority; Resources; Risk; Second Primary Cancers; Socioeconomic Status; Source; Specialist; Stroke; Surveys; Survivors; System; Utah; Visit; age group; barrier to care; body system; cancer survival; cancer therapy; cancer type; care coordination; care seeking; care systems; clinical care; clinical examination; clinical infrastructure; cohort; cost; data resource; disparity reduction; diverse data; evidence based guidelines; experience; follow-up; health care service; health care service utilization; health disparity; high risk; improved; medical specialties; medically underserved; neoplasm registry; population based; preventive intervention; programs; respiratory; rural dwellers; rural underserved; social factors; survivorship

ABSTRACT – Project 3, Late Effects in the AYA Cancer Population Few studies have evaluated long-term medical outcomes in US survivors of adolescent and young (AYA) cancers, a population with among the greatest number of life-years affected by cancer. Studies on AYA survivors find elevated risks of medical conditions such as asthma, diabetes, and second cancers, but typically do not consider treatment in detail or examine results by clinical or patient factors to identify those at higher risk for late effects and poorer survival. This limited research hinders creating long-term care guidelines and interventions to improve health outcomes in this population. To address these evidence gaps, we propose a detailed examination of clinical care factors and their association with late effects in AYA cancer survivors using integrated P01 data resources: the clinical and research infrastructure of Kaiser Permanente (KP); the population-based California Cancer Registry (CCR) and Utah Cancer Registry (UCR), both linked to statewide healthcare data; and survey data from ~5,000 AYAs with cancer, including from North Carolina. The KP Northern California (KPNC) and Southern California (KPSC) integrated healthcare systems provide comprehensive healthcare services and use electronic health records that facilitate investigating late effects of cancer and its treatment. The CCR-hospitalization are from linking one of the largest, most diverse U.S. cancer registries with statewide hospitalization, emergency department, and ambulatory surgery data. The UCR-hospitalization are from similar sources for many rural and medically underserved residents. With these diverse resources, this study will assess chronic medical conditions and late effects (collectively called late effects) in AYA cancer survivors and will: 1) determine the incidence of late effects, examining how risks vary by primary cancer type, specific treatment approaches, race/ethnicity, neighborhood socioeconomic status, and health insurance coverage; 2) examine how guideline-concordant survivorship care and inpatient and outpatient visits to multiple provider types are associated with the risk of late effects; and 3) evaluate the influence of patient-reported barriers to care on late effects. We will use a cohort of ~53,000 AYAs diagnosed with cancer from 2006 through 2019 in California; ~13,000 will have been diagnosed and treated at KPNC or KPSC. Data from KPNC, KPSC and California hospitals allows medical outcome follow-up of AYA cancer survivors who leave or seek coverage outside the KP system and facilitates comparisons between those seeking care within and outside an integrated care system for late effects requiring hospitalization. Our analyses will be enhanced by approximately 8,400 AYAs from Utah, of whom ~1,700 are rural residents. We hypothesize a higher burden of late effects among AYAs with care barriers such as insurance and financial concerns that impact both initial and survivorship care. Results from this project will inform evidence-based guidelines on prevention and surveillance of late effects among AYAs with cancer by characterizing disparities and unique barriers to receipt of necessary care and lead to strategies to mitigate the impact of late effects.

摘要 - 项目3，AYA癌症种群的后期影响 很少有研究评估了美国青少年和Young的长期医学结果 （AYA）癌症，是受癌症影响最多的人群中的人群。研究AYA 幸存者发现医疗状况的风险升高，例如哮喘，糖尿病和第二癌，但通常是 不要考虑详细治疗或通过临床或患者因素检查结果以识别较高的患者 延迟影响和生存较差的风险。这项有限的研究阻碍了创建长期护理准则的 改善该人群健康状况的干预措施。为了解决这些证据差距，我们提出了一个 详细检查临床护理因素及其与AYA癌症幸存者的迟来影响的关联 使用综合P01数据资源：Kaiser Permanente（KP）的临床和研究基础设施；这 基于人群的加利福尼亚癌症注册中心（CCR）和犹他州癌症注册表（UCR）都与全州有关 医疗保健数据；以及来自约5,000名AYA癌症的调查数据，包括来自北卡罗来纳州的癌症。 KP 北加州（KPNC）和南加州（KPSC）综合医疗系统提供 全面的医疗保健服务并使用电子健康记录，以促进调查的后期影响 癌症及其治疗。 CCR院份是通过将美国最大的，大多数潜水员之一联系起来 全州住院，急诊科和门诊手术数据的癌症登记处。 对于许多粗糙和医疗服务不足的居民而言，UCR住院来自类似的来源。与这些 多种资源，这项研究将评估慢性医疗状况和后期影响（统称为迟到 效果）在AYA癌症的存活中，将：1）确定后期影响的事件，检查风险如何变化 根据原发性癌症类型，特定的治疗方法，种族/种族，邻里社会经济地位， 和健康保险范围； 2）检查指导方向的表面护理和住院医师如何 对多种提供商类型的门诊就诊与迟到的风险有关； 3）评估 患者报告的障碍的影响，以照顾晚期影响。我们将使用约53,000个AYA诊断的队列 从2006年到2019年在加利福尼亚州患癌症； 〜13,000将在KPNC或 kpsc。 KPNC，KPSC和加利福尼亚医院的数据允许对AYA癌症进行医学结果随访 在KP系统之外离开或寻求承保范围并促进与之比较的幸存者 在综合护理系统内部和外部寻求护理，以便需要住院治疗。我们的 来自犹他州的大约8,400个AYA将增强分析，其中约有1,700个大约是居民。我们 假设在AYA中具有较高的伯恩（AYA），并具有保险和财务等护理障碍 担心会影响初始和生存护理。该项目的结果将为循证提供信息 通过表征差异来预防和监视与癌症的AYA的后期作用指南 以及获得必要的护理的独特障碍，并导致减轻晚期影响影响的策略。