Ethnicity and Lung Cancer Survival: A Test of the Hispanic Sociocultural Hypothesis

种族与肺癌生存：对西班牙裔社会文化假说的检验

• 批准号: 10440521
• 负责人: Heidi Ann Hamann
• 金额: $ 64.74万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10440521
• 关键词: Acculturation; Adopted; Affective; Age; Area; Behavioral; Black race; Cancer Etiology; Cancer Patient; Cancer Survivorship; Car Phone; Cessation of life; Clinical Treatment; Computerized Medical Record; Data; Death Rate; Diagnosis; Early Diagnosis; Ecological momentary assessment; Ethnic Origin; Ethnic group; Family; Fostering; Frequencies; Gold; Health; Health Sciences; Hispanic; Hispanic Populations; Incidence; Individual; Intervention; Interview; Investigation; Life; Longitudinal observational study; Malignant Neoplasms; Malignant neoplasm of lung; Measurement; Measures; Mediating; Mediator of activation protein; Medical; Methodology; Methods; Morality; Neighborhoods; Non-Small-Cell Lung Carcinoma; Not Hispanic or Latino; Outcome; Patient Self-Report; Patients; Persons; Process; Public Health; Publishing; Reporting; Research; Research Personnel; Risk; Risk Factors; Role; Sampling; Science; Site; Social Environment; Social Interaction; Social Processes; Social support; Surveys; Survival Rate; Testing; Time; Underserved Population; United States; Variant; Work; base; burden of illness; cancer survival; cultural values; demographics; ethnic difference; ethnic minority; experience; follow-up; health care disparity; health related quality of life; in vivo; innovation; low dose computed tomography; mortality; novel; primary outcome; psychosocial; racial and ethnic; recruit; resilience; screening; secondary outcome; social; social culture; social integration; socioeconomic disparity; socioeconomics; survival disparity; survival outcome; treatment adherence

PROJECT SUMMARY/ABSTRACT As the leading cause of cancer death, lung cancer represents the most significant cancer-related public health challenge in the United States. Although low-dose CT-based screening holds promise for earlier detection, currently, most lung cancer cases are not diagnosed until advanced stages (III, IV) and have 5-year survival rates of 21% or less. In contrast to Black-White survival disparities, Hispanic patients have markedly lower age-adjusted death rates than their non-Hispanic White (NHW) counterparts despite later stage diagnoses and broader SES and healthcare disparities; these findings are well established and consistent with the “Hispanic Health Paradox”, a phenomenon characterized by Hispanic advantages in objective health outcomes (e.g., mortality) despite significant health and socioeconomic risk factors. The leading explanatory hypothesis concerns the role of cultural factors facilitating social integration. Social integration is among the most robust psychosocial predictors of a range of objective health outcomes, including cancer survival. However, no published work has directly tested this sociocultural hypothesis in relation to Hispanic resilience. Consistent with the emerging science of resilience, we propose a multisite, two-study, mixed-methods investigation to evaluate this sociocultural hypothesis. Study 1 is a multisite, longitudinal observational study of 672 Hispanic and NHW individuals with advanced stage lung cancer sampled from three regions across the U.S. Interviews using gold-standard and culturally-informed survey measures (demographics, social integration, cultural values, acculturation) will be conducted in English and Spanish from a centralized coordinating center with a 6- week follow-up to examine change in perceived support provision/needs. The primary outcome of survival and secondary outcomes (e.g., treatment adherence), will be gathered from electronic medical records over mean follow-up time of 33-months. Study 2 is a single-site, 7-day, intensive measurement investigation into the daily units of social integration that mediate outcomes. Study 2 integrates two novel in vivo sampling methods (Electronically Activated Recorder [EAR] and ecological momentary assessments [EMA]) using a mobile phone platform. The current aims are to (1) investigate whether the observed Hispanic survival advantage is mediated by ethnic differences in social integration among recently diagnosed late-stage lung cancer patients and (2) to examine the processes/mechanisms that underlie these relationships in daily life including the role of individual, family, network, and neighborhood-level factors. The highly experienced investigator team includes leaders in all relevant content areas, including the Hispanic health paradox, lung cancer survivorship, social integration, and ecological sampling methodologies. The results will contribute to better understanding of social processes among cancer patients, inform psychosocial interventions based on social integration, and contribute to the emerging science of health resilience as well as racial/ethnic and cultural variations in health outcomes.

项目概要/摘要 作为癌症死亡的主要原因，肺癌代表了最重要的癌症相关公共卫生问题 尽管基于低剂量 CT 的筛查有望实现早期检测， 目前，大多数肺癌病例直到晚期（III、IV）才被诊断出来，并且有 5 年生存期 与黑人和白人的生存率差异相比，西班牙裔患者的生存率明显较低。 尽管已进行后期诊断，但年龄调整死亡率仍高于非西班牙裔白人 (NHW) 夫妇 更广泛的社会经济地位和医疗保健差异；这些发现已得到充分证实，并且与“西班牙裔美国人”的观点一致。 健康悖论”，这是一种以西班牙裔在客观健康结果方面具有优势为特征的现象（例如， 尽管存在重大的健康和社会经济风险因素，但死亡率）。 关注文化因素促进社会融合的作用 社会融合是最有力的因素之一。 包括癌症生存率在内的一系列客观健康结果的心理社会预测因素。 已发表的作品测试了这种与西班牙裔韧性直接相关的社会文化假设。 随着复原力科学的兴起，我们提出了一项多地点、两项研究、混合方法的调查，以 研究 1 是一项针对 672 名西班牙裔的多地点纵向观察研究。 和 NHW 从美国三个地区采样的晚期肺癌个体 使用黄金标准和文化背景的调查措施（人口统计、社会融合、文化 价值观、文化适应）将由一个中央协调中心以英语和西班牙语进行，该中心有 6 名员工 每周随访，检查感知的支持提供/需求的变化 生存和生存的主要结果。 次要结果（例如治疗依从性）将从电子病历中收集 研究 2 是一项为期 7 天的单中心日常密集测量调查，随访时间为 33 个月。 研究 2 整合了两种新颖的体内采样方法。 （电子激活记录仪 [EAR] 和生态瞬时评估 [EMA]）使用手机 当前的目标是（1）调查观察到的西班牙裔生存优势是否受到调节。 最近诊断的晚期肺癌患者的社会融合方面存在种族差异；(2) 检查日常生活中这些关系背后的过程/机制，包括 经验丰富的调查团队包括个人、家庭、网络和社区层面的因素。 所有相关内容领域的领导者，包括西班牙裔健康悖论、肺癌生存率、社会 整合和生态抽样方法的结果将有助于更好地了解社会。 癌症患者的过程，为基于社会融合的心理社会干预提供信息，以及 为新兴的健康复原力科学以及健康方面的种族/民族和文化差异做出贡献 结果。