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：
9245568
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/9245568
关键词：
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 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 Population Study 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 Care Self Efficacy Surveys Survivors Symptoms Time Visit Work base cancer therapy childhood cancer mortality childhood cancer survivor cohort comparative emerging adult emerging adulthood ethnic difference experience follow-up health care availability health care service utilization health disparity high risk improved mortality population based prevent public health relevance 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）：尽管生存率提高，但儿童癌症幸存者（CCS）仍受到疾病和严格治疗的晚期和长期影响的高风险。与非西班牙裔人相比，在生存研究方面人数不足的西班牙裔CCS在生存研究领域的人数不足。尽管建议对CCS进行终身，基于风险的后续护理，但随着CCS进入新兴成年，该护理的使用迅速下降。我们在两家医院接受治疗的CC（接受调查时年龄为14-26岁）中的初步工作表明，与癌症相关的随访护理在西班牙裔（相对于非西班牙裔）CC中的CC在成年后的早期（21-26岁）。我们建议招募和调查新兴的成年人（18-39岁）西班牙裔（54％）和非西班牙裔CC的基于人群的队列（n = 1,232），以了解获得建议的后续护理中的潜在不平等，以及可能会差异化的因素，这些因素可能会差异地影响Hispanic和non-Hispanic CCS的健康状况。我们的目的是确定：1）接受癌症相关的随访护理的风险和保护因素； 2）如果收到的随访护理（基于医疗记录审查）与已发表的长期随访指南（对于患者特定的癌症和临床病史）一致/遵守； 3）新兴成年的里程碑（例如，全职工作，婚姻，生孩子）与癌症相关的随访护理之间的关系。遵守指南护理将由医师小组评估。比较分析将用于确定种族和治疗地点（癌症生存诊所和AT）的差异初级保健/社区诊所）。这项基于人群的研究的结果将提供指导，以识别和减少西班牙裔和非西班牙裔CC之间在医疗保健利用，后期效果以及最终长期生存中观察到的健康不平等。结果可以指导教育/政策工作，重点是治疗西班牙裔CC的临床医生，并支持专门的过渡诊所和健康促进工作，重点是进入新兴成年的CC。