Reducing racial/ethnic inequities in childhood cancer survivorship

减少儿童癌症幸存者中的种族/民族不平等

基本信息

批准号：
8885884
负责人：
Joel E Milam
金额：
$ 41.21万
依托单位：
UNIVERSITY OF SOUTHERN CALIFORNIA
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-07-03 至 2019-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8885884
关键词：
21 year old Acculturation Acute Lymphocytic Leukemia Adherence Administrator Adult Affect Age Attitude Behavioral Belief Cancer Survivorship Caring Cessation of life Child Childhood Cancer Survivor Study Clinic Clinical Clinical Oncology Communities Comorbidity County Diagnosis Disease Drops Education Employment Ethnic Origin Guidelines Health Health Insurance Health Promotion Health Services Accessibility Health Status Health behavior Healthcare Hispanics Hospitals Insurance Journals Knowledge Late Effects Life Long-Term Effects Los Angeles Malignant Childhood Neoplasm Malignant Neoplasms Marriage Medical Medical Records Not Hispanic or Latino Oncologist Outcome Patients Pediatric Oncology Group Physicians Policies Posttraumatic growth Primary Care Physician Primary Health Care Provider Psychological Factors Publishing Recommendation Recording of previous events Recruitment Activity Reporting Research Risk Risk Factors Self Efficacy Surveys Survivors Symptoms Time Visit Work base cancer therapy childhood cancer survivor cohort comparative emerging adult emerging adulthood experience follow-up health care service utilization health disparity high risk improved mortality population based prevent racial and ethnic sex social socioeconomics survivorship treatment site

项目摘要

DESCRIPTION (provided by applicant): Despite improved survival, childhood cancer survivors (CCS) are at high risk of late and long term effects from their disease and rigorous treatment. Hispanic CCS, who are underrepresented in survivorship research, show significant health inequities in mortality compared to non-Hispanics. Although life-long, risk based follow-up care is recommended for CCS, use of this care drops rapidly as CCS enter emerging adulthood. Our preliminary work among CCS treated at two hospitals (ages 14-26 when surveyed) indicates that cancer related follow-up care is significantly lower among Hispanic (vs. non-Hispanic) CCS during the early years of emerging adulthood (ages 21-26). We propose to recruit and survey a population-based cohort (n=1,232) of emerging adult (ages 18-39) Hispanic (54%) and non-Hispanic CCS to understand potential inequities in the receipt of recommended follow-up care, as well as factors that may differentially affect health outcomes of Hispanic and non-Hispanic CCS. Our aims are to determine: 1) risk and protective factors of receiving cancer related follow-up care; 2) if the follow-up care received (based on medical records review) is consistent/adherent with published Long- Term Follow-up Guidelines (for patient specific cancer and clinical history); and, 3) the relationship between milestones of emerging adulthood (e.g., full-time employment, marriage, having children) and receipt of cancer related follow-up care. Adherence to guideline care will be assessed by a physician panel. Comparative analyses will be used to identify differences by ethnicity and treatment site (cancer survivorship clinics and at primary care/community clinics). Results from this population-based study will provide guidance to identify and reduce health inequities observed between Hispanic and non-Hispanic CCS in health care utilization, late effects, and ultimately, long term survival. Results can guide education/policy efforts focused on clinicians who treat Hispanic CCS as well as support specialized transition clinics and health promotion efforts focused on CCS entering emerging adulthood.

描述（由申请人提供）：尽管儿童癌症幸存者（CCS）的生存率有所提高，但他们的疾病和严格的治疗仍面临着晚期和长期影响的高风险。西班牙裔 CCS 在生存研究中代表性不足，与非西班牙裔相比，死亡率方面存在显着的健康不平等。尽管建议对 CCS 进行终生、基于风险的后续护理，但随着 CCS 进入成年期，这种护理的使用迅速下降。我们对两家医院治疗的 CCS（调查时年龄为 14-26 岁）的初步研究表明，西班牙裔（与非西班牙裔）CCS 在成年早期（21-26 岁）的癌症相关后续护理显着较低）。我们建议招募和调查一个基于人口的队列（n = 1,232），其中包括新兴成年人（18-39岁）西班牙裔（54％）和非西班牙裔CCS，以了解在接受建议的后续护理方面潜在的不平等，因为以及可能对西班牙裔和非西班牙裔 CCS 健康结果产生不同影响的因素。我们的目标是确定：1）接受癌症相关后续护理的风险和保护因素； 2) 接受的后续护理（基于病历审查）是否与已发布的长期随访指南（针对患者特定癌症和临床病史）一致/遵守； 3) 成年初期的里程碑（例如全职工作、结婚、生孩子）与接受癌症相关后续护理之间的关系。对指南护理的遵守情况将由医生小组进行评估。将使用比较分析来确定种族和治疗地点（癌症生存诊所和治疗地点）的差异。初级保健/社区诊所）。这项基于人群的研究结果将为识别和减少西班牙裔和非西班牙裔 CCS 在医疗保健利用、后期影响以及最终长期生存方面观察到的健康不平等提供指导。结果可以指导针对治疗西班牙裔 CCS 的临床医生的教育/政策工作，以及支持针对 CCS 进入成年初期的专门过渡诊所和健康促进工作。