Improving the Timeliness and Equity of Adjuvant Therapy Following Surgery for Head and Neck Cancer

提高头颈癌术后辅助治疗的及时性和公平性

基本信息

批准号：
10449344
负责人：
Evan Michael Graboyes
金额：
$ 26.65万
依托单位：
MEDICAL UNIVERSITY OF SOUTH CAROLINA
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-11 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10449344
关键词：
Address Adjuvant Therapy Advanced Malignant Neoplasm Affect African American population Caring Cessation of life Clinical Clinical Trials Design Continuity of Patient Care Data Development Disease Division of Cancer Control and Population Sciences Enrollment Excess Mortality Goals Head and Neck Cancer Head and Neck Surgery Health system Interpersonal Relations Intervention Intervention Studies Interview Knowledge Lead Logistics Mentors Modeling Operative Surgical Procedures Outcome Outcome Measure Patients Patterns of Care Pilot Projects Population Positioning Attribute Postoperative Period Process Provider Qualitative Research Racial Equity Radiation Radiation therapy Randomized Randomized Controlled Trials Research Scientist Self Efficacy Site Surgeon Testing Time Training Treatment-related toxicity Work acceptability and feasibility arm base cancer care cancer health disparity cancer surgery cancer type care coordination care delivery caucasian American chemotherapy clinical care effective intervention efficacy evaluation head and neck cancer patient health disparity implementation research improved informant mortality mortality disparity multimodality novel patient population pilot test prevent primary outcome programs racial difference racial disparity satisfaction screening social health determinants systems research theories therapeutic target treatment as usual

项目摘要

PROJECT SUMMARY/ABSTRACT The goal of this K08 proposal is to provide the candidate with a framework to develop a comprehensive research program as a surgeon scientist investigating multi-level, theory-based interventions to improve the timeliness, equity, and quality of head and neck cancer (HNC) care delivery. HNC is a disease with poor survival despite intense therapy with surgery, radiation, and chemotherapy. HNC is also a disease with significant racial disparities in mortality; African Americans (AAs) have a 51% relative decrease in survival compared to whites. Delays starting postoperative radiation therapy (PORT) after HNC surgery are a key driver of high mortality and racial disparities in survival and thus an appealing therapeutic target to address both issues. Delayed, non- guideline-adherent PORT initiation affects 56% of HNC patients, is 31% more common in AAs, associated with an 11% absolute decrease in 5-year survival, and a key contributor to racial differences in mortality. Although delivering timely PORT is of critical importance to prevent excess mortality and racial disparities in survival, effective interventions to improve the rate of timely, equitable PORT are lacking, in part due to the gap in our understanding of the relevant barriers in this population. In this proposal, the candidate will develop, pilot-test, and evaluate the preliminary clinical impact of NDURE (Navigation for Disparities and Untimely Radiation thErapy), a novel theory-based PN intervention to improve timely, equitable PORT in HNC patients. The research objective is to evaluate the preliminary clinical impact of NDURE on delays and racial disparities starting PORT among HNC patients. The central hypothesis is that NDURE will decrease PORT delays and racial disparities in delay by improving care coordination, self-efficacy, interpersonal support, and knowledge. Specific Aim 1 will identify the multi-level barriers that contribute to delays starting PORT after HNC surgery through key informant interviews with HNC patients and providers. Specific Aim 2 will assess the feasibility and acceptability of NDURE in a single-arm pilot study. Specific Aim 3 will test NDURE in a pilot randomized controlled trial (RCT) to evaluate its preliminary clinical impact on delays starting PORT among white and AA HNC patients. Ultimately, this research will have a large scientific impact by enhancing our conceptual understanding of timely, equitable multimodal HNC care delivery. It will have a significant clinical impact through the development of a scalable and practical intervention to decrease delays and racial disparities starting PORT, thereby improving survival for HNC patients and decreasing racial disparities in mortality. The training objective is to address the candidate’s scientific gaps in cancer health disparities, qualitative research, health systems and interventions research, and clinical trial design and analysis through mentored scientific training integrated and aligned with his research. Completion of the research and scientific training will position the candidate well to lead research investigating multi-level, theory-based interventions to improve the timeliness, equity, and quality of HNC care delivery.

项目概要/摘要 K08 提案的目标是为候选人提供一个框架来开展全面的研究作为外科医生调查多层次、基于理论的干预措施以提高及时性的计划，头颈癌 (HNC) 护理服务的公平性和质量尽管 HNC 是一种生存率较低的疾病。手术、放疗和化疗等强化治疗 HNC 也是一种具有显着种族差异的疾病。死亡率差异；与白人相比，非洲裔美国人 (AA) 的生存率相对下降 51%。 HNC 手术后延迟开始术后放射治疗 (PORT) 是导致高死亡率和高死亡率的关键因素生存方面的种族差异，因此是解决这两个问题的一个有吸引力的目标。遵守指南的 PORT 启动影响 56% 的 HNC 患者，在 AA 中更常见 31%，与 5 年生存率绝对下降 11%，也是死亡率种族差异的一个关键因素。及时提供 PORT 对于防止死亡率过高和生存方面的种族差异至关重要，缺乏有效的干预措施来提高及时、公平的 PORT 率，部分原因是我们的差距了解该人群的相关障碍在本提案中，候选人将开发、试点测试、评估 NDURE（差异导航和不及时辐射）的初步临床影响 thErapy），一种基于理论的新型 PN 干预措施，旨在改善 HNC 患者及时、公平的 PORT。研究目的是评估 NDURE 对开始延误和种族差异的初步临床影响 HNC 患者中的 PORT 中心假设是 NDURE 将减少 PORT 延误和种族问题。通过提高护理协调、自我效能、人际支持和具体知识来减少延误的差异。目标 1 将通过关键因素识别导致 HNC 手术后延迟开始 PORT 的多层次障碍与 HNC 患者和提供者进行知情访谈将评估可行性和可接受性。具体目标 3 将在一项随机对照试验 (RCT) 中测试 NDURE。最终评估其对白人和 AA HNC 患者延迟开始 PORT 的初步临床影响。这项研究将通过增强我们对及时、公平的概念的理解而产生巨大的科学影响。通过开发可扩展的、多模式的 HNC 护理服务，它将产生重大的临床影响。采取实际干预措施，减少 PORT 启动的延误和种族差异，从而提高 HNC 的生存率培训目标是解决候选人的问题。癌症健康差异、定性研究、卫生系统和干预研究方面的科学差距，以及通过与他的研究相结合和一致的指导科学培训进行临床试验设计和分析。完成研究和科学培训将使候选人能够很好地领导研究调查多层次、基于理论的干预措施，以提高 HNC 护理服务的及时性、公平性和质量。