Identifying modifiable factors that reduce the burden of late stage melanoma in Hispanics

确定减少西班牙裔晚期黑色素瘤负担的可改变因素

• 批准号: 10612918
• 负责人: MYLES G COCKBURN
• 金额: $ 50.71万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-18 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10612918
• 关键词: Accounting; Acculturation; Acral Lentiginous Malignant Melanoma; Adherence; Awareness; Clinic; Complex; County; Data; Data Sources; Diagnosis; Disease; Disparity; Early Diagnosis; Ensure; Ethnic Origin; Ethnic Population; Etiology; Health Services Accessibility; Health education; Hispanic; Hispanic Populations; Histologic; Histology; Incidence; Intervention; Knowledge; Lesion; Los Angeles; Low income; Neoplasm Metastasis; Not Hispanic or Latino; Outcome; Patients; Pattern; Perception; Phase; Physicians; Population; Predisposition; Primary Care; Prognosis; Reporting; Risk; Role; Rural Population; Self Efficacy; Stage at Diagnosis; Stress; System; Telemedicine; Testing; Time; United States; cancer prevention; cultural competence; cultural values; design; effective intervention; experience; follow-up; health care availability; improved; melanoma; mortality risk; multiple data sources; neoplasm registry; patient-clinician communication; patient-level barriers; population based; primary care setting; response; screening; screening guidelines; skin lesion; therapy design; treatment response; tumor

Project Summary Hispanics are diagnosed with melanoma at later stages than their non-Hispanic white (NHW) counterparts, leading to increased likelihood of metastasis and worse survival. Hispanics are the largest ethnic group in the United States and have rising rates of melanoma, and in particular, increases in tumors with the worst prognosis. Hispanics represent an underserved and understudied population when it comes to melanoma occurrence and outcome. In our recent analysis, while the risk of presenting with a late stage melanoma was higher for Hispanics (OR:1.65 [95% CI:1.52-1.79]) than NHW, the overall risk of death from melanoma after accounting for stage at diagnosis was similar for Hispanics and NHW (HR: 0.99 [95% CI: 0.94-1.04]), implying that the overall poorer prognosis for Hispanics is due almost entirely to their later stage of disease at diagnosis, rather than response to treatment or other factors (e.g. ability to access treatment) once they are diagnosed. A later stage of diagnosis among Hispanics could be due to a multitude of factors all of which are modifiable: a lack of access to appropriate screening, lack of adherence to screening recommendations, lack of understanding of appropriate screening approaches in the primary care setting (among both patients and physicians), or a combination of these factors. The key question remaining to be answered is WHY Hispanics are diagnosed at a later stage: without answering that question, we cannot begin to design, test and implement effective interventions to improve earlier detection and reduce melanoma-related disparities for Hispanics. We will investigate modifiable factors related to diagnosis at later stage in Hispanics compared to NHW. Aim 1: Determine the roles of patient-perceived risk and knowledge of melanoma, perceived barriers to melanoma screening and diagnosis, patient access to screening and diagnosis, and cultural factors in determining the later stage at diagnosis of melanoma in Hispanic compared to NHW melanoma patients. Aim 2: Determine how, when and by whom melanomas are diagnosed (among Hispanics and NHW) and what factors are related to time delays in the diagnosis of melanoma. Aim 3: Develop, deliver and test a clinic-based health education telenovela intervention designed to achieve earlier diagnosis of melanoma among Hispanics. We will obtain data from multiple sources for this study in order to minimize the potential impact of selection, response and survival biases all of which would compromise the scientific rigor of our Approach. We will identify the key factors resulting in late diagnosis of melanoma among Hispanics to provide truly population- based data on HOW to develop targeted patient-and-systems level interventions to reduce the melanoma burden among Hispanics. We will then test targeted patient-and-physician level interventions carried out in low income primary care setting ensuring that we intervene at the earliest possible stage.

项目概要 西班牙裔人被诊断出黑色素瘤的时间比非西班牙裔白人 (NHW) 晚， 导致转移的可能性增加和生存更差。西班牙裔是世界上最大的民族 美国的黑色素瘤发病率不断上升，尤其是最严重的肿瘤的增加 预后。在黑色素瘤方面，西班牙裔代表了服务不足和研究不足的人群 发生和结果。在我们最近的分析中，虽然出现晚期黑色素瘤的风险是 西班牙裔美国人 (OR:1.65 [95% CI:1.52-1.79]) 高于 NHW，术后死于黑色素瘤的总体风险 西班牙裔和 NHW 诊断时的分期情况相似（HR：0.99 [95% CI：0.94-1.04]），这意味着 西班牙裔人的整体预后较差几乎完全是由于他们在诊断时处于疾病晚期， 而不是诊断后对治疗或其他因素（例如获得治疗的能力）的反应。一个 西班牙裔人的诊断后期可能是由于多种因素造成的，所有这些因素都是可以改变的： 缺乏获得适当筛查的机会、不遵守筛查建议、缺乏 了解初级保健机构中适当的筛查方法（患者和患者） 医生），或这些因素的组合。仍有待回答的关键问题是为什么西班牙裔 在稍后阶段进行诊断：如果不回答这个问题，我们就无法开始设计、测试和实施 有效的干预措施可以改善西班牙裔的早期发现并减少与黑色素瘤相关的差异。我们 与 NHW 相比，将调查与西班牙裔后期诊断相关的可修改因素。 目标 1：确定患者感知的黑色素瘤风险和知识的作用、感知的障碍 黑色素瘤筛查和诊断、患者获得筛查和诊断的机会以及文化因素 与 NHW 黑色素瘤患者相比，确定西班牙裔黑色素瘤诊断的后期阶段。 目标 2：确定黑色素瘤的诊断方式、时间和诊断对象（西班牙裔和 NHW）以及诊断内容 因素与黑色素瘤诊断的时间延迟有关。 目标 3：开发、提供和测试基于临床的健康教育电视干预措施，旨在实现 西班牙裔黑色素瘤的早期诊断。 我们将从多个来源获取本研究的数据，以尽量减少选择的潜在影响， 反应和生存偏差所有这些都会损害我们方法的科学严谨性。我们将 确定导致西班牙裔黑色素瘤晚期诊断的关键因素，以提供真正的人口- 基于如何开发有针对性的患者和系统级别干预措施以减少黑色素瘤的数据 西班牙裔的负担。然后，我们将测试在低水平条件下进行的有针对性的患者和医生水平干预措施 收入初级保健环境确保我们尽早进行干预。