The Impact of COVID-19 Pandemic on Cancer Care and Health-Related Quality of Life of Racial and Ethnic Minority Women Diagnosed with Breast Cancer

COVID-19大流行带来的前所未有的负担对癌症护理的提供产生了严重影响：患者对疾病的脆弱性更大，新实施的治疗途径和方案可能会因护理不佳或延迟而影响长期生存。对于接受乳腺癌治疗的少数种族和族裔妇女而言，为规范患者就医而实施的体制措施以及治疗顺序的修改可能会加剧该疾病目前不成比例的负担。因此，了解COVID-19对少数群体接受的癌症护理的影响，并确定潜在的可改变因素，为未来的护理提供模式提供信息至关重要。U-HAND（休斯顿/MD安德森大学）减少癌症差异计划（P20 CA 221697; 9/22/17-8/31/21）是休斯顿大学和德克萨斯大学MD安德森癌症中心之间的合作伙伴关系，支持卓越的教育规划和研究创新，影响受癌症差异影响不成比例的种族/族裔群体的健康公平。拟议的行政补充申请是UHAND伙伴关系目标的自然延伸，反映了其总体使命，即执行旨在减轻黑人和西班牙裔群体癌症不平等的创新社会/行为科学。具体而言，拟议补充协议将是此目标的延伸，调查COVID-19大流行对来自受疾病及其心理社会后遗症影响不成比例的种族和族裔社区的妇女接受最佳乳腺癌护理的影响。该建议是基于行政申请人对癌症相关结果的中间决定因素的专业知识的合理下一步。收集的试点数据将评估诊断为早期乳腺癌的黑人和西班牙裔妇女（与非西班牙裔白色妇女相比）的癌症护理中断和健康相关生活质量的差异率，并研究差异的近端，中间和远端决定因素如何促成这些结果。据设想，这项研究将产生有关“高危”患者的信息，以及利用现有社会资源的方法。最后，这些发现将用于为未来的多层次干预提供信息，这些干预能够在急性COVID-19后环境中维持有效的护理模式。在为期一年的行政补充补助金期间，研究和指导培训活动将帮助申请人完成拟议项目的研究目标，并培养技能，以支持她理解导致不同群体之间医疗保健利用率和结果差异的机制，以促进减少和消除癌症差异的成功职业生涯。

The unprecedented burden of the COVID-19 pandemic has critical consequences for the delivery of cancer care: patients present greater vulnerability to the disease and newly implemented treatment pathways and protocols may affect long-term survival because of suboptimal or delayed care. For racial and ethnic minority women receiving treatment for breast cancer, institutional measures implemented to regulate access of patients to medical settings and modifications in therapy sequence may exacerbate the existing disproportionate burden of the disease. Therefore, understanding the impact of COVID-19 on the cancer care received by minority groups and identifying potentially modifiable factors to inform future models of care delivery is critical. The U-HAND (University of Houston/MD Anderson) Program to Reduce Cancer Disparities (P20CA221697; 9/22/17-8/31/21) is a collaborative partnership between the University of Houston and The University of Texas MD Anderson Cancer Center that supports excellence in educational programming and innovation in research that affects health equity among racial/ethnic groups disproportionately affected by cancer disparities. The proposed Administrative Supplement application is a natural extension of the aims of the UHAND partnership and it is reflective of its overarching mission to execute innovative social/behavioral science aimed at mitigating cancer inequities for Black and Hispanic groups. Specifically, the proposed Supplement will be an extension of this goal by investigating the impact that the COVID-19 pandemic has on the receipt of optimal breast cancer care among women from racial and ethnic communities disproportionately affected by the illness and its psychosocial sequelae. This proposal is a logical next step building upon the Administrative Applicant’s expertise on the intermediate determinants of cancer-related outcomes. Pilot data collected will assess differential rates of cancer care disruption and health-related quality of life among Black and Hispanic women diagnosed with early-stage breast cancer (as compared with non-Hispanic white women), and examine how proximal, intermediate, and distal determinants of disparities contribute to these outcomes. It is envisioned that the study will yield information about “at-risk” patients and ways to leverage existing social resources. Finally, these findings will be used to inform future multilevel interventions able to sustain effective models of care delivery in a post-acute COVID-19 environment. During the one-year Administrative Supplement grant period, research and mentored training activities will help the applicant complete the research aims of the proposed project, and develop skills that will support her understanding of mechanisms that contribute to disparities in both health care utilization and outcomes among diverse groups to foster a successful career in reducing and eliminating cancer disparities.