Racial/Ethnic Disparities in Ovarian Cancer Treatment and Survival: An Integrative Approach

卵巢癌治疗和生存的种族/民族差异：综合方法

• 批准号: 10450747
• 负责人: Elisa V Bandera
• 金额: $ 144.52万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10450747
• 关键词: Accounting; Address; Adherence; African American; Age; Annual Reports; Area; Asian; Asian Pacific Islander; Attenuated; Biological; Biological Factors; Body mass index; California; Cancer Etiology; Caring; Cells; Cessation of life; Characteristics; Clinical; Clinical Data; Clinical Management; Clinical Pathology; Cohort Studies; Complex; Comprehensive Health Care; Crime; Data; Diagnosis; Diagnostic; Disease; Dose; Epithelial ovarian cancer; Ethnic Origin; Ethnic group; Evaluation; Gene Expression; Genetic; Geographic Factor; Geography; Goals; Gold; Guidelines; Health Insurance; Health Services Accessibility; Healthcare; Healthcare Systems; Hispanic; Hispanic Populations; Insurance Coverage; Integrated Health Care Systems; Malignant Neoplasms; Malignant neoplasm of ovary; Medical; Medical Geography; Minority Groups; Molecular; Morphology; Nature; Neighborhoods; Not Hispanic or Latino; Outcome; Participant; Pathology; Patient Self-Report; Patients; Physicians; Policies; Population Heterogeneity; Prospective cohort study; Race; Recurrence; Reporting; Research; Residual Tumors; Resources; Sample Size; Serous; Social support; Societies; Socioeconomic Status; Specimen; Stress; Structural Racism; Suggestion; Time; Toxic effect; Treatment outcome; Underserved Population; United States; Woman; Work; World Health Organization; base; cancer diagnosis; cancer subtypes; cancer survival; cancer therapy; chemotherapy; clinical database; cohort; comorbidity; contextual factors; disparity reduction; ethnic difference; experience; health care availability; health care service; improved; insight; member; molecular subtypes; mortality; mortality disparity; mortality risk; multi-ethnic; novel; prognostic; protein expression; racial and ethnic; racial and ethnic disparities; racial determinant; racial difference; racial disparity; residence; segregation; social; social stressor; sociodemographics; standard of care; survival disparity; survival outcome; treatment guidelines; treatment response; tumor

ABSTRACT Epithelial ovarian cancer (EOC) is the fifth leading cause of cancer deaths in women. Compared to non- Hispanic white (NHW) women, African American (AA) women have much poorer survival after an EOC diagnosis, which, as we have found, may be in part due to AA women being less likely to receive standard-of- care therapy, and more likely to have chemotherapy dose reduction, even within an equal-access healthcare system. However, these factors do not completely explain survival disparities among AAs, and furthermore, little is known about other groups (e.g., Hispanics and Asians/Pacific Islanders (API)), although there is some evidence that Hispanic women also experience worse survival. Moreover, emerging evidence suggests racial differences in molecular subtype distribution. We propose to conduct the first integrative, cells-to-society evaluation of the interplay among multilevel factors on disparities in EOC treatment and survival outcomes. We will assemble a cohort of ~4,600 EOC cases, including ~280 AA, ~520 Hispanic, ~730 API, and ~2,980 NHW women diagnosed at Kaiser Permanente Northern California (KPNC) between 2000 and 2023. KPNC has longstanding electronic clinical databases, complete pathology specimen storage, long-term retention of members, and substantial variability in sociodemographic, clinical, and neighborhood characteristics among races/ethnicities. We will perform centralized pathology review to classify histotypes by the recent gold standard WHO criteria, and will conduct chart review to capture data that are not available electronically. We will examine determinants of racial/ethnic differences in treatment received, recurrence, and survival (overall and EOC-specific), including neighborhood social stressors through linkage to data on segregation, structural racism, ethnic enclaves, and geographic medical accessibility, health care system and patient-level factors. In 800 women (200 each of NHW, AA, Hispanic, and API) with high grade serous EOC, we will also characterize gene expression subtypes (to date studied almost exclusively in NHW women), to identify whether the relative distribution of aggressive subtypes contributes to the observed survival disparities. We will examine these factors in the context of both self-reported race/ethnicity and genetic ancestry. Our comprehensive integrative approach to examine the interplay among patient, health care, social contextual, and biological factors will provide unique insights into the persistent racial disparities in EOC survival. The KPNC setting provides the opportunity to examine these factors while minimizing confounding by the known contribution of insurance status, leveraging rich clinical databases to investigate and control for detailed prognostic variables, and avoiding survival bias. For EOC, this proposed study is unprecedented in its transdisciplinary nature, sample size, and multi-ethnic population, and will serve as a unique resource for future research related to multilevel factors to reduce EOC survival disparities.

抽象的 上皮性卵巢癌（EOC）是女性癌症死亡的第五大原因。与非 西班牙裔白人 (NHW) 女性和非洲裔美国 (AA) 女性在 EOC 后的生存率要低得多 正如我们所发现的，诊断结果可能部分是由于 AA 女性接受标准治疗的可能性较小 护理治疗，并且更有可能减少化疗剂量，即使在平等的医疗保健范围内 系统。然而，这些因素并不能完全解释 AA 之间的生存差异，而且， 对于其他群体（例如西班牙裔和亚裔/太平洋岛民 (API)）知之甚少，尽管有一些 有证据表明西班牙裔女性的生存率也较差。此外，新出现的证据表明种族 分子亚型分布的差异。我们建议进行第一次综合性的、细胞到社会的研究 评估多层次因素之间的相互作用对 EOC 治疗和生存结果差异的影响。 我们将收集约 4,600 个 EOC 病例，其中包括约 280 个 AA、约 520 个西班牙裔、约 730 个 API 和 2000 年至 2023 年间，北加州凯撒医疗机构 (KPNC) 约有 2,980 名 NHW 女性被确诊。 KPNC拥有长期的电子临床数据库，完整的病理标本存储，长期 成员的保留，以及社会人口、临床和邻里的巨大变化 种族/民族之间的特征。我们将进行集中病理学审查，通过以下方式对组织型进行分类： 最近的黄金标准世界卫生组织标准，并将进行图表审查以获取无法获得的数据 电子方式。我们将研究接受治疗、复发和治疗方面种族/民族差异的决定因素。 生存（总体和 EOC 特定），包括通过与相关数据联系的邻里社会压力源 种族隔离、结构性种族主义、种族飞地、地理医疗可及性、医疗保健系统和 患者层面的因素。在 800 名患有高级别浆液性 EOC 的女性（NHW、AA、西班牙裔和 API 各 200 名）中， 我们还将描述基因表达亚型的特征（迄今为止几乎只在 NHW 女性中进行研究），以 确定攻击性亚型的相对分布是否会导致观察到的生存差异。 我们将在自我报告的种族/民族和遗传血统的背景下研究这些因素。 我们采用全面的综合方法来检查患者、医疗保健、社会之间的相互作用 背景和生物因素将为 EOC 中持续存在的种族差异提供独特的见解 生存。 KPNC 设置提供了检查这些因素的机会，同时通过以下方式最大限度地减少混杂因素： 保险状况的已知贡献，利用丰富的临床数据库来调查和控制 详细的预后变量，并避免生存偏差。对于 EOC 来说，这项拟议的研究是前所未有的 跨学科性质、样本量和多种族人口，并将作为独特的资源 未来的研究涉及多层次因素，以减少 EOC 生存差异。