Administrative Core

行政核心

• 批准号: 10252803
• 负责人: JOHN D. CARPTEN
• 金额: $ 16.48万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-19 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10252803
• 关键词: 2019-nCoV; Adherence; Affect; African American; Aftercare; American Cancer Society; Antineoplastic Protocols; Behavior; Breast; COVID-19; COVID-19 pandemic; California; Cancer Patient; Caring; Catchment Area; Clinic; Community Outreach; Comprehensive Cancer Center; Coronavirus; Disease Outbreaks; Florida; Fright; Goals; Healthcare; Hispanics; Home environment; Hospitals; Immunocompromised Host; Infrastructure; Learning; Malignant Neoplasms; Malignant neoplasm of lung; Methods; Minority; Oncologist; Outcome; Patient Care; Patients; Pattern; Population; Population Heterogeneity; Positioning Attribute; Protocols documentation; Recommendation; Reporting; Resources; Surgeon; Time; Treatment outcome; active method; anticancer research; cancer care; cancer health disparity; cancer therapy; care delivery; community center; comorbidity; compliance behavior; education research; experience; follow-up; health equity; infection rate; infection risk; older patient; pandemic disease; patient population; risk minimization; side effect; standard of care; survivorship; treatment adherence

The COVID-19 pandemic and concomitant lockdown across the US has forced sudden and unplanned changes in cancer patient care. A majority of cancer patients are older and immunocompromised while undergoing treatment, which presents a difficult challenge for oncologists and surgeons trying to decide how to continue the best care for their patients while minimizing the risk of infection with SARS-CoV-2. Simultaneously, the ability of patients to adhere to treatment recommendations, and to deal with cancer treatment induced side effects and various co-morbidities, has also been severely affected by the consequences of the COVID-19 pandemic. Many patients lost their usual infrastructure to handle their care, and many may have altered their behaviors towards treatment due to fear, lack of resources, or financial instability. The overall impact of ongoing changes in cancer treatment patterns, and changes in patient adherence to ongoing treatment due to COVID19 is yet to be defined. Early numbers from the American Cancer Society Cancer Action Network show that close to 80% of patients in active treatment for cancer experienced a delay in their healthcare, including 17% that reported to their cancer therapy. We propose to evaluate the impact of the COVID-19 pandemic on cancer care delivery among diverse populations, particularly those mostly affected by this outbreak, which include Blacks and Hispanics. We propose to identify and evaluate the impact of ongoing changes in cancer treatment, and changes in patient adherence to treatment among diverse populations, with the long-term goal of learning from this experience to better serve cancer patients moving forward as this pandemic continues its course. The pandemic imposed changes in cancer treatment protocols and survivorship follow-up to accommodate stay-at-home requirements, new hospital protocols to reduce infection rates, and for the protection of vulnerable cancer patients. Many of these changes may prove to be as effective as the standard of care, some may not. We propose to conduct a mixed-methods study within the Norris Comprehensive Cancer Center (NCCC) clinics, focusing on two of the priority cancers for our catchment area with high volume in our clinics: breast (BrCa) and lung cancer (LCa), focusing on identifying changes in cancer treatment for these two cancers from the start of the COVID-19 pandemic in March 2020 until September 2020, in comparison with the same time period in 2019 (Aim 1). We propose to identify treatment changes and evaluate their impact on short-term outcomes 12 months post-treatment. Given the diversity of our patient population, we are uniquely positioned to identify disparities in cancer treatment outcomes and adherence to treatment among minority populations, particularly Hispanics who constitute ~40% of our patient population. To enhance our reach and understanding of the impact of COVID-19 among Black cancer patients, we are leveraging the Florida-California Cancer Research Education and Engagement (CaRE2) Health Equity Center Community Outreach Core, which is focused on community outreach and engagement among Blacks and Hispanics in Florida and California, and will allow us to include a large Black patient population.

整个美国的Covid-19-19大流行和伴随锁定迫使癌症患者护理的突然和计划外的变化。大多数癌症患者在接受治疗时年龄较大且免疫功能低下，这给肿瘤学家和外科医生带来了艰巨的挑战，试图决定如何继续为患者提供最佳护理，同时最大程度地减少SARS-COV-2感染的风险。同时，患者遵守治疗建议的能力以及处理癌症治疗引起的副作用和各种合并症的能力也受到了COVID-19-19大流行的后果的严重影响。许多患者失去了通常的基础设施来处理他们的护理，许多患者可能因恐惧，资源缺乏或金融不稳定而改变了他们对治疗的行为。癌症治疗模式持续变化的总体影响以及患者对Covid19持续治疗的依从性的变化尚待定义。美国癌症协会癌症作用网络的早期数字显示，接近80％的活跃治疗患者的医疗保健延迟了，其中包括报告其癌症治疗的17％。我们建议评估COVID-19-19的影响对不同人群的癌症护理分娩的影响，尤其是那些主要受这次爆发影响的人群，包括黑人和西班牙裔。我们建议识别和评估癌症治疗中持续变化的影响以及患者遵守不同人群治疗的影响，从这种经验中学习的长期目标可以更好地为癌症患者提供服务，因为这种大流行的过程继续前进。大流行施加了癌症治疗方案和生存期随访的变化，以适应全职需求，降低感染率的新医院方案以及保护脆弱的癌症患者。这些更改中的许多可能与护理标准一样有效，有些变化可能不会。我们建议在诺里斯综合癌症中心（NCCC）诊所内进行一项混合方法研究，重点介绍我们诊所中大量集水区的两种优先级癌症：乳腺癌（BRCA）和肺癌（LCA），专注于聚焦从2020年3月至2020年9月，与2019年同一时期相比，从20020年3月至1920年9月的Covid-19大流行开始，确定这两种癌症的癌症治疗变化（AIM 1）。我们建议确定治疗变化并评估其对治疗后12个月的短期结局的影响。鉴于我们的患者人群的多样性，我们的位置是确定癌症治疗结果的差异和遵守少数族裔人口的治疗，尤其是占我们患者群体约40％的西班牙裔。为了增强我们对Covid-19对黑人癌症患者的影响的影响和理解，我们利用佛罗里达 - 加利福尼亚癌症研究教育和参与（CARE2）健康权益中心社区外展核心，该核心专注于社区外展和黑人之间的参与以及佛罗里达州和加利福尼亚州的西班牙裔，将使我们能够包括大量的黑人患者人群。