RESIDENTIAL MOBILITY, TREATMENT QUALITY AND SURVIVAL IN LOW-INCOME WOMEN WITH BREAST CANCER

低收入乳腺癌女性的居住流动性、治疗质量和生存率

• 批准号: 10005893
• 负责人: Min Lian
• 金额: $ 36.03万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10005893
• 关键词: Address; Adherence; Adjuvant Therapy; Affect; African American; Agriculture; American; Appointment; Area; Behavior; Black race; Breast; Breast Cancer therapy; Cancer Patient; Cancer Prognosis; Caring; Censuses; Characteristics; Chemotherapy and/or radiation; Code; Collaborations; Communication; Community Surveys; Commuting; County; Data; Data Sources; Databases; Diagnosis; Enrollment; Environment; Environmental Exposure; Equilibrium; Ethnic Origin; Face; Failure; Financial Hardship; Geography; Guidelines; Health; Health Insurance; Housing; Incidence; Individual; Intervention; Link; Location; Logistic Regressions; Low Income Population; Low income; Malignant Neoplasms; Mediating; Medicaid; Medical Care Costs; Mental Health; Missouri; Modeling; Neighborhoods; Odds Ratio; Oncologist; Outcome; Outpatients; Patients; Pattern; Physicians; Population; Probability; Provider; Quality of Care; Race; Radiation therapy; Research; Residential Mobility; Risk; Role; Rural; Socioeconomic Status; Specialist; Structural Models; Testing; Time; Treatment outcome; Uncertainty; Uninsured; Validity of Results; Woman; base; behavioral health; breast cancer diagnosis; cancer care; cancer diagnosis; cancer health disparity; cancer therapy; cohort; compliance behavior; deprivation; experience; follow-up; health care availability; hormone therapy; improved; malignant breast neoplasm; medically underserved population; mortality; neighborhood disadvantage; neoplasm registry; novel; older patient; outcome forecast; physical conditioning; population based; prognostic; programs; racial disparity; residence; rurality; socioeconomics; therapy outcome; treatment disparity

PROJECT SUMMARY/ABSTRACT Disparities in breast cancer outcomes persist across race and socioeconomic status. Medicaid-insured women do not gain the same degree of survival benefit as those enrolled in other types of health insurance, but experience similarly poor prognosis as uninsured women. Younger, low-income patients face more barriers to access and adherence to high-quality cancer care as medical costs for cancer pose a more severe financial burden to younger compared to older patients. The barriers to high-quality cancer care for Medicaid-insured women have not been fully understood. Our preliminary data showed that Medicaid-insured women are highly mobile after breast cancer diagnosis. Despite the well documented effects of residential relocation on behaviors and health outcomes, there is lack of research that assesses the impacts of residential relocation after cancer diagnosis on patient's adherence to therapy and outcomes. Medicaid enrollees have inadequate access to specialist care. Much of adjuvant therapy for breast cancer is delivered in outpatient settings. As a result, coordination of multiple provider appointments and treatments is a significant challenge for residentially mobile patients. Residential relocation following cancer diagnosis may act as a key barrier to continuation and completion of cancer treatment for low-income patients and thus influences their prognosis. Drawing on our established collaborations with the Missouri Cancer Registry and the Missouri Medicaid Program, we will develop a contemporary population-based cohort of low-income women with breast cancer by linking the Medicaid claims to the Missouri Cancer Registry. Five other valuable data sources will be used to define characteristics of neighborhoods, providers and facilities. We will examine the impact of residential relocation on adherence to therapy in the first 12 months of diagnosis among low-income women with breast cancer (Aim 1). Residential relocation and its geographic patterns will be defined, which allows us to capture the dynamics of neighborhood exposures. We will also assess the associations between residential relocation and breast cancer outcomes in low-income women (Aim 2). It will control for residential mobility-induce spatial uncertainty and accurately estimate neighborhood impacts on cancer outcomes. Furthermore, we will examine the extent to which residential relocation explains racial disparities in adherence to therapy and prognostic outcomes in low-income women with breast cancer (Aim 3). This will be the first study to assess the role of residential relocation in adherence to breast cancer therapy and prognosis among low-income patients. It will deepen our understanding of the reasons for poor prognosis in medically underserved populations with breast cancer. The study will help guide breast cancer disparity interventions that could target residentially mobile, low-income patients and mitigate the adverse impacts of residential relocation on cancer treatment and outcomes.

项目概要/摘要 不同种族和社会经济地位的乳腺癌结果仍然存在差异。医疗补助保险女性 无法获得与参加其他类型健康保险的人相同程度的生存福利，但是 与未投保的女性一样，预后也很差。年轻、低收入患者面临更多障碍 获得并坚持高质量的癌症护理，因为癌症的医疗费用构成了更严重的财务负担 与老年患者相比，年轻患者的负担更大。医疗补助投保人获得高质量癌症护理的障碍 女性还没有被充分理解。我们的初步数据显示，参加医疗补助保险的女性比例很高 乳腺癌诊断后可移动。尽管住宅搬迁的影响已有充分记录 行为和健康结果，缺乏评估住宅搬迁影响的研究 癌症诊断后，患者对治疗的依从性和结果。医疗补助参与者没有足够的 获得专家护理。乳腺癌的大部分辅助治疗都是在门诊进行的。作为一个 因此，协调多个提供者的预约和治疗对于住宅来说是一个重大挑战 移动患者。癌症诊断后的居住搬迁可能是继续治疗的主要障碍 低收入患者完成癌症治疗，从而影响他们的预后。借鉴我们的 与密苏里州癌症登记处和密苏里州医疗补助计划建立合作，我们将 通过将以下人群联系起来，建立一个基于当代人群的低收入乳腺癌女性队列 医疗补助向密苏里州癌症登记处索赔。其他五个有价值的数据源将用于定义 社区、服务提供者和设施的特征。我们将研究住宅搬迁的影响 低收入乳腺癌女性在诊断后前 12 个月内坚持治疗的情况（Aim 1）。住宅搬迁及其地理模式将被定义，这使我们能够捕捉动态 邻里曝光。我们还将评估居住搬迁与乳腺癌之间的关联 低收入女性的癌症结局（目标 2）。它将控制住宅流动性——引起空间不确定性 并准确估计邻里对癌症结果的影响。此外，我们将检查范围 居住搬迁解释了治疗依从性和预后结果的种族差异 患有乳腺癌的低收入妇女（目标 3）。这将是第一项评估住宅作用的研究 低收入患者乳腺癌治疗依从性和预后的重新定位。它将加深我们的 了解医疗服务不足的乳腺癌人群预后不良的原因。这 研究将有助于指导针对居住流动、低收入人群的乳腺癌差异干预措施 患者并减轻居住搬迁对癌症治疗和结果的不利影响。