Survivorship and Access to care for Latinos to Understand and address Disparities (SALUD)

拉丁裔的生存和获得护理的机会，以了解和解决差异（SALUD）

• 批准号: 10403641
• 负责人: Maria Monica Gramatges
• 金额: $ 96.92万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-10 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10403641
• 关键词: Acute; Address; Adolescent; Adverse event; Affect; Age; Area; Behavioral; Blood; Cancer Patient; Cancer Relapse; Cancer Survivorship; Caring; Cells; Child; Chronic; Clinical; Clinical Practice Guideline; Data; Databases; Diagnosis; Enrollment; Epidemiology; Ethnic group; Financial Hardship; Foundations; Genetic Status; Genomics; Geography; Guidelines; Health; Health Insurance; Health Services Accessibility; Healthcare; Institution; Insurance Coverage; Intervention; Late Effects; Latino; Latino Population; Link; Long-Term Survivors; Low income; Malignant Childhood Neoplasm; Malignant Neoplasms; Medical; Medical Genetics; Molecular Genetics; Morbidity - disease rate; Native American Ancestry; Neurocognitive; Not Hispanic or Latino; Outcome; Patients; Pediatric Oncology; Pediatric cohort; Phase; Population; Population Heterogeneity; Poverty; Predisposition; Prospective cohort; Quality of life; Race; Recurrence; Relapse; Reporting; Resources; Risk; Risk Assessment; Risk Factors; Saliva; Sampling; Services; Severities; Social Functioning; Socioeconomic Status; Specimen; Survivors; Symptoms; Texas; Time; Toxic effect; Treatment outcome; Treatment-related toxicity; Underrepresented Minority; Unemployment; Uninsured; United States; Urine; Work; adverse outcome; base; behavioral outcome; biobank; cancer diagnosis; cancer epidemiology; cancer risk; cancer therapy; childhood cancer survivor; clinical risk; cohort; data repository; deprivation; ethnic diversity; evidence based guidelines; experience; follow-up; functional outcomes; genetic epidemiology; high risk; indexing; low socioeconomic status; metabolomics; mortality; multidisciplinary; peer; prospective; psychological outcomes; psychosocial; sociodemographics; socioeconomics; success; survivorship; treatment risk; tumor; uptake

ABSTRACT Pediatric cancer survivors (PCS) experience an excess risk of adverse outcomes related to their cancer diagnosis and the treatment they receive. The accumulation and severity of these acute and chronic health conditions broadly impact PCS functioning, quality of life, and health care resource utilization. Consequently, PCS are more likely to live in financial hardship, have lower educational attainment, be unemployed due to poor health, and be under- or uninsured compared with their age-based peers. Latino PCS are at particularly high risk for having a lower socioeconomic status (SES compared with non-Latino PCS. These factors contribute to reduced access to routine medical care, and lower overall survival of Latino children diagnosed with cancer. Existing and well-established patient cohorts of PCS largely include long-term (at least 5 years) survivors and a relatively small proportion of Latino PCS, so that the outcome data that inform our understanding of risk for cancer treatment late effects, and therefore our clinical practice guidelines, are largely derived from the experiences of NHW PCS. The over-arching objective of this proposal is to identify and comprehensively assess adverse outcomes among Latino PCS that will inform clinical guidelines and lay the foundation for early, targeted interventions to mitigate such outcomes in this vulnerable and growing population of PCS. Key to the success of our proposal is the prospective establishment of a Latino PCS cohort in Texas that is linked with genomic and geographic data (UG3 planning phase), which will permit analyses of the interaction between ancestry and SES on risk for adverse cancer treatment outcomes during the UH3 implementation phase. There is a significant unmet need to comprehensively characterize the socioeconomic, psychosocial, genomic, and metabolomic risk determinants of treatment-related toxicities and relapse in Latino PCS in the context of known clinical risk factors. In addition, among under-represented minorities there is a critical need to identify facilitators and barriers to obtaining survivorship care. Therefore, utilizing existing and prospectively collected longitudinal data, we will: (1) Identify demographic, clinical, and genetic/molecular determinants of treatment-related toxicities and their association with chronic health conditions, patient-reported symptoms, and neurocognitive/ psychological and functional outcomes in Latino PCS; (2) Identify demographic, clinical, and genetic/molecular determinants of the excess risk of cancer relapse/recurrence in a cohort of Latino PCS; and (3) Determine Latino PCS understanding of risk for late effects and rationale for survivorship care, and identify perceived facilitators and barriers to obtaining survivorship care. This proposal synergizes multidisciplinary expertise and data collected from clinical and epidemiological resources to establish a prospective, comprehensive biobank and database inclusive of a large population of Latino PCS. Our aims represent the largest assessment to date of genetic and SES contributors to outcomes in Latino PCS, an effort that is imperative to inform risk assessments for adverse outcomes in an ethno-diverse population, as well as potential barriers to obtaining optimal survivorship care.

抽象的 小儿癌症幸存者（PC）经历与癌症相关的不良后果的过多风险 诊断及其接受的治疗。这些急性和慢性健康的积累和严重程度 条件广泛影响PC的功能，生活质量和医疗保健资源利用。最后， PC更有可能生活在经济困难中，受教育程度较低，由于差而失业 与基于年龄的同龄人相比，健康，没有保险。拉丁裔PC的风险特别高 由于具有较低的社会经济地位（与非Latino PC相比，SES。这些因素有助于 降低了常规医疗服务的机会，并降低了被诊断出患有癌症的拉丁裔儿童的总生存期。 现有和建立良好的PC患者队列在很大程度上包括长期（至少5年）幸存者和 拉丁美洲人PC的比例相对较小，因此结果数据能够了解我们对风险的理解 癌症治疗后期影响，因此我们的临床实践指南主要来自 NHW PC的体验。该提案的整个目标是确定和全面评估 拉丁裔PC之间的不良结果，将为临床准则提供信息，并为早期的针对性奠定基础 在这种脆弱且不断增长的PC人群中减轻这种结果的干预措施。成功的关键 我们的建议是在德克萨斯州的一家拉丁裔PCS队列的预期建立，该公司与基因组和 地理数据（UG3计划阶段），该阶段将允许分析祖先与SES之间的相互作用 在UH3实施阶段发生不良癌症治疗结果的风险。有重要的 未满足的需求可以全面地描述社会经济，社会心理，基因组和代谢性风险 在已知的临床危险因素的背景下，拉丁裔PC的治疗相关毒性的决定因素和复发。 此外，在代表性不足的少数群体中，迫切需要确定促进者和障碍 获得生存护理。因此，利用现有和前瞻性收集的纵向数据，我们将：（1） 确定与治疗相关毒性的人口，临床和遗传/分子决定因素及其 与慢性健康状况，患者报告的症状以及神经认知/心理学的关联 拉丁裔PC中的功能结果； （2）确定人口统计学，临床和遗传/分子决定因素 在拉丁裔PC的队列中，癌症复发/复发的风险过多； （3）确定拉丁裔PC的理解 有迟来影响和生存护理理由的风险，并确定感知的促进者和障碍 获得生存护理。该建议协同临床收集的多学科专业知识和数据 和流行病学资源，以建立一个预期，全面的生物库和数据库，包括 大量拉丁裔PC。我们的目标是遗传和SES迄今为止的最大评估 拉丁裔PC中结果的贡献者，这是必须向风险评估提供不利的风险评估的努力 民族多样性人群的结果，以及获得最佳生存护理的潜在障碍。