The Role of Adverse Symptoms and Clinical Response on Racial Disparity Outcomes in Breast Cancer

不良症状和临床反应对乳腺癌种族差异结果的作用

• 批准号: 9314164
• 负责人: Ilana Graetz
• 金额: $ 23.14万
• 依托单位: UNIVERSITY OF TENNESSEE HEALTH SCI CTR
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-23 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9314164
• 关键词: Adherence; Adjuvant; Adverse effects; Aromatase Inhibitors; Automobile Driving; Breast Cancer Patient; Cancer Center; Cities; Clinical; Clinical Data; Communities; Data; Data Reporting; Death Rate; Diagnosis; Dimensions; Disease; Electronic Health Record; Emergency department visit; Environment; Estrogen Receptors; Frequencies; Goals; Health; Health Personnel; Health Sciences; Health Status; Hormone Receptor; Hospitalization; Industry; Intervention; Link; Malignant Neoplasms; Measures; Medicare/Medicaid; Mental Health; Modeling; Oral; Outcome; Pathway interactions; Patient Care; Patient Outcomes Assessments; Patients; Persons; Play; Provider; Recording of previous events; Records; Recurrence; Reporting; Research; Role; Severities; Source; Survival Rate; Symptoms; System; Tablets; Tamoxifen; Technology; Tennessee; Time; Universities; Visit; Woman; base; beneficiary; black/white disparity; cancer care; cancer health disparity; cancer recurrence; clinically significant; disparity reduction; experience; health care service utilization; health disparity; hormone therapy; improved; improved outcome; malignant breast neoplasm; medication compliance; mortality; mortality disparity; point of care; racial disparity; response; social; symptom management; therapy adherence; tumor

This study will investigate whether black and white patients with hormone receptor-positive (HR+) breast cancer report adverse symptoms differently, contributing to diverse treatment decisions and ultimately disparities in health outcomes. Despite significant reductions in breast cancer mortality over the past two decades, black-white (B-W) mortality disparities continue to widen. Among the 70% of breast cancer patients that have HR+ tumors, black women have double the death rate of white women with the same diagnosis. Adjuvant endocrine therapy (AET), typically using the selective estrogen receptor antagonist tamoxifen and/or an aromatase inhibitor given orally for at least five years, significantly and substantially improves survival rates in women with HR+ breast cancer. Unfortunately, there is significant underuse and lower adherence to AET among black women compared to their white counterparts. AET adherence rates are low for all patients with HR+ breast cancer, most often due to adverse side effects. We will investigate the crucial link between patient symptoms and subsequent treatment course and health outcomes in HR+ breast cancer. Side effects of AET clearly limit medication adherence rates and often trigger clinicians and patients to change or discontinue treatment. To our knowledge, no one has investigated how AET-related side effects and adherence and provider treatment decisions may be driving disparities in B-W health outcomes and mortality. Our study is guided by the Symptom Management Model, which emphasizes the interrelatedness of three symptom management dimensions (symptom experience, management strategies, and health outcomes) while incorporating distinct domains and levels of analyses, including person/health and environment. Our main goal is to understand how B-W differences in potentially modifiable factors in the treatment pathway contribute to B- W mortality disparities. To accomplish this goal, we will pursue the following aims: 1) To determine whether we observe statistically and clinically significant B-W differences (frequency, severity, type) in patient-reported adverse symptoms; 2) To investigate whether black patients and their providers respond differently to the same symptoms in terms of AET adherence and prescribed treatment changes compared to white patients; and 3) To examine if and how patient-reported symptoms, medication adherence, and treatment changes impact B-W disparities in breast cancer outcomes, including mortality, recurrence, and hospitalizations. We will examine patients cared for by the West Cancer Center, an industry leader in leveraging technology to collect and utilize patient-reported outcomes in real-time clinical settings and the largest cancer care provider in the West Tennessee region. This region has the highest B-W breast cancer mortality disparity of the 50 largest US cities. We will leverage nine years of data from multiple sources, including patient-reported measures, clinical data, and claims records for Medicare and Medicaid beneficiaries. Our results will provide actionable mechanisms for targeted interventions to reduce B-W disparities in breast cancer.

这项研究将研究黑人和白色的激素受体阳性（HR+）乳房是否 癌症报告不良症状的情况有所不同，有助于各种治疗决策，最终导致 健康结果的差异。尽管过去两个乳腺癌死亡率大幅降低 几十年来，黑白（B-W）死亡率差异继续扩大。在70％的乳腺癌患者中 患有HR+肿瘤的黑人妇女的死亡率是具有相同诊断的白人妇女的两倍。 辅助内分泌疗法（AET）通常使用选择性雌激素受体拮抗剂他莫昔芬和/或 口服至少五年的芳香酶抑制剂，显着提高了生存率 在HR+乳腺癌的女性中。不幸的是，对AET的依从性很大，并且较低 在黑人妇女中，与白人同行相比。所有患者的AET依从率较低 HR+乳腺癌，通常是由于不良副作用。我们将研究患者之间的关键联系 HR+乳腺癌的症状和随后的治疗过程和健康结果。 AET的副作用 显然限制了药物依从性率，并经常触发临床医生和患者改变或停止 治疗。据我们所知，没有人调查过AET相关的副作用和依从性和 提供者的治疗决策可能是在B-W健康成果和死亡率方面的差异。我们的研究是 在症状管理模型的指导下，该模型强调了三种症状的相互关系 管理维度（症状经验，管理策略和健康成果），而 结合不同的域和分析水平，包括人/健康和环境。我们的主要目标 是了解治疗途径中潜在可修改因素的B-W差异如何有助于B- W死亡率差异。为了实现这一目标，我们将追求以下目标：1）确定我们是否是否 在患者报告中观察统计和临床上显着的B-W差异（频率，严重程度，类型） 不良症状； 2）调查黑人患者及其提供者对 与白人患者相比，就AET依从性和规定的治疗变化而言，相同的症状； 3）检查患者报告的症状，药物依从性和治疗的变化是否以及如何变化 影响乳腺癌结果的B-W差异，包括死亡率，复发和住院。我们将 检查由利用技术收集的行业领导者西癌中心照顾的患者 并在实时临床环境中利用患者报告的结果，并且是最大的癌症护理提供者 西田纳西州。该地区的B-W乳腺癌死亡率差异最高 城市。我们将利用来自多个来源的九年数据，包括患者报告的措施，临床 数据，并索赔医疗保险和医疗补助受益人的记录。我们的结果将提供可行的 有针对性干预措施的机制减少乳腺癌的B-W差异。