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: 10737847
• 负责人: Elisa V Bandera
• 金额: $ 10.08万
• 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/10737847
• 关键词: Accounting; Address; Adherence; African American; Age; Annual Reports; Area; Asian; Asian population; Attenuated; Biological; Biological Factors; Body mass index; California; Cancer Etiology; Caring; Cells; Cessation of life; Characteristics; Classification; Clinical; Clinical Data; Clinical Management; Clinical Pathology; Cohort Studies; Complex; Comprehensive Health Care; Crime; Data; Diagnosis; Diagnostic; Disease; Disparity; Dose; Electronics; Epithelial ovarian cancer; Ethnic Origin; Ethnic Population; Evaluation; Exclusion; Gene Expression; Genetic; Geographic Factor; Geography; Goals; Guidelines; Health Insurance; Health Services Accessibility; Healthcare; Healthcare Systems; Hispanic; Hispanic Populations; Inequity; Insurance Coverage; Integrated Health Care Systems; Malignant Neoplasms; Malignant neoplasm of ovary; Managed Care; Medical; Medical Geography; Minority Groups; Molecular; Morphology; Nature; Neighborhoods; Not Hispanic or Latino; Outcome; Pacific Islander; Participant; Pathology; Patient Self-Report; Patients; Physicians; Policies; Population Heterogeneity; Prospective, cohort study; Race; Recommendation; Recurrence; Reporting; Research; Residual Neoplasm; Resources; Sample Size; Serous; Social support; Societies; Socioeconomic Status; Specimen; Stress; Structural Racism; Time; Toxic effect; Treatment outcome; Underserved Population; United States; Woman; Work; World Health Organization; cancer diagnosis; cancer subtypes; cancer survival; cancer therapy; chemotherapy; clinical database; cohort; comorbidity; contextual factors; disparity reduction; ethnic difference; ethnic disparity; experience; health care availability; health care service; improved; insight; member; molecular subtypes; mortality; mortality disparity; mortality risk; multi-ethnic; novel; prognostic; protein expression; racial determinant; racial difference; racial disparity; residence; segregation; social; social factors; 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）妇女，非裔美国人（AA）妇女的生存率较差 正如我们发现的那样，诊断可能部分是由于AA妇女不太可能接受标准标准 护理疗法，甚至在同等访问的医疗保健中，更有可能降低化学疗法剂量 系统。但是，这些因素不能完全解释AAS之间的生存差异，此外， 对于其他群体（例如，西班牙裔和亚洲人/太平洋岛民（API））知之甚少，尽管有些 西班牙裔妇女也经历更糟糕的生存的证据。此外，新兴的证据表明种族 分子亚型分布的差异。我们建议进行第一个综合性，细胞与社会 评估EOC治疗和生存结果中多层因素之间的相互作用。 我们将组装约4,600个EOC案件，包括〜280 AA，〜520西班牙裔，〜730 API和 2000年至2023年之间，〜2,980名NHW妇女在北加利福尼亚州的Kaiser Permanente（KPNC）中被诊断出。 KPNC具有长期的电子临床数据库，完整的病理标本存储，长期 保持成员的保留，社会人口统计学，临床和社区的实质性差异 种族/种族之间的特征。我们将进行集中病理审查，以通过 最近的金标准Who标准，并将进行图表审查以捕获不可用的数据 电子方式。我们将研究获得种族/种族差异在接受，复发和 生存（整体和EOC特定的），包括通过与数据联系的邻里社会压力源 种族隔离，结构性种族主义，族裔飞地和地理医学可及性，医疗保健系统和 患者级因素。在800名女性中（NHW，AA，西班牙裔和API的200名女性），具有高级浆液EOC， 我们还将表征基因表达亚型（迄今为止，几乎完全在NHW女性中研究） 确定侵袭性亚型的相对分布是否有助于观察到的生存差异。 我们将在自我报告的种族/种族和遗传血统的背景下检查这些因素。 我们全面检查患者，医疗保健，社会的相互作用的全面综合方法 上下文和生物学因素将为EOC持续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，同时最大程度地减少了混淆 保险状况的已知贡献，利用丰富的临床数据库进行调查和控制 详细的预后变量，避免生存偏见。对于EOC，这项拟议的研究在其中是前所未有的 跨学科的性质，样本量和多种族人口，将作为独特的资源 与多层次因素有关的未来研究，以减少EOC生存差异。