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.

这项研究将调查激素受体阳性 (HR+) 乳房的黑人和白人患者是否 癌症报告的不良症状不同，导致不同的治疗决策，并最终 健康结果的差异。尽管过去两年乳腺癌死亡率显着下降 几十年来，黑人与白人（B-W）的死亡率差距持续扩大。 70%的乳腺癌患者中 患有 HR+ 肿瘤的黑人女性的死亡率是具有相同诊断的白人女性的两倍。 辅助内分泌治疗（AET），通常使用选择性雌激素受体拮抗剂他莫昔芬和/或 口服芳香酶抑制剂至少五年，可显着提高存活率 患有 HR+ 乳腺癌的女性。不幸的是，AET 的使用率明显不足且依从性较低 黑人女性与白人女性相比。所有患者的 AET 依从率都很低 HR+ 乳腺癌，最常见的是由于不良副作用。我们将调查患者之间的关键联系 HR+ 乳腺癌的症状、后续治疗过程和健康结果。 AET 的副作用 明确限制药物依从率，并经常引发临床医生和患者改变或停止用药 治疗。据我们所知，没有人研究过 AET 相关的副作用和依从性如何 提供者的治疗决策可能会导致男女健康结果和死亡率的差异。我们的研究是 以症状管理模型为指导，强调三个症状的相互关联性 管理维度（症状经历、管理策略和健康结果） 纳入不同领域和层次的分析，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改变因素的 B-W 差异如何导致 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 观察患者报告的统计和临床显着的 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治疗的反应是否不同 与白人患者相比，AET 依从性和处方治疗变化方面症状相同； 3) 检查患者报告的症状、药物依从性和治疗是否以及如何改变 影响乳腺癌结果的男女差异，包括死亡率、复发和住院治疗。我们将 对西癌症中心 (West Cancer Center) 照顾的患者进行检查，该中心是利用技术收集数据的行业领导者 并利用实时临床环境中患者报告的结果以及全球最大的癌症护理提供商 田纳西州西部地区。该地区的男女乳腺癌死亡率差异是美国 50 个最大地区中最高的 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 医疗保险和医疗补助受益人的数据和索赔记录。我们的结果将提供可操作的 减少乳腺癌性别差异的有针对性的干预机制。