Ethnicity and Lung Cancer Survival: A Test of the Hispanic Sociocultural Hypothesis

项目摘要/摘要 作为癌症死亡的主要原因，肺癌是与癌症相关的最重要的公共卫生问题。 在美国的挑战。尽管基于CT的低剂量筛查有望实现更早的检测， 目前，大多数肺癌病例直到晚期(III、IV期)才被诊断出来，并有5年的生存期 税率为21%或更低。与黑人和白人的生存差距相比，西班牙裔患者的生存差距明显较低 年龄调整死亡率高于非西班牙裔白人(NHW)，尽管后期诊断和 更广泛的社会经济地位和医疗保健差距；这些发现得到了很好的证实，并与“西班牙裔”一致 健康悖论“，一种以西班牙裔在客观健康结果中的优势为特征的现象(例如， 死亡率)，尽管存在重大的健康和社会经济风险因素。主要的解释性假说 关注促进社会融合的文化因素的作用。社会融合是最有活力的 包括癌症存活率在内的一系列客观健康结果的心理社会预测者。然而，没有 已发表的研究直接验证了这一社会文化假说与西班牙裔韧性的关系。一致 随着恢复力科学的兴起，我们提出了一种多点、两项研究、混合方法的调查方法 评估这一社会文化假说。研究1是一项对672名西班牙裔美国人的多点纵向观察研究 NHW晚期肺癌患者从美国三个地区抽样采访 使用黄金标准和了解文化的调查措施(人口统计、社会融合、文化 价值观、文化适应)将在一个中央协调中心用英语和西班牙语进行，有6- 一周的跟踪，以检查感知的支持提供/需求的变化。生存和生存的主要结果 次要结果(例如，治疗依从性)将从电子医疗记录中平均收集 随访时间33个月。研究2是一项为期7天的单站点密集测量调查 调解结果的社会融合单位。研究2整合了两种新的活体采样方法 (电子激活记录器[EAR]和生态瞬时评估[EMA])使用移动电话 站台。目前的目标是(1)调查观察到的西班牙裔生存优势是否被中介 新近确诊的晚期肺癌患者在社会融合方面的种族差异和(2) 检查日常生活中这些关系的基础过程/机制，包括 个人、家庭、网络和邻里层面的因素。经验丰富的调查团队包括 所有相关内容领域的领导者，包括西班牙裔健康悖论，肺癌存活率，社会 整合和生态抽样方法。研究结果将有助于更好地理解社会 癌症患者的治疗过程，为基于社会融合的心理社会干预提供信息，以及 促进关于健康复原力以及健康方面的种族/民族和文化差异的新兴科学 结果。

PROJECT SUMMARY/ABSTRACT As the leading cause of cancer death, lung cancer represents the most significant cancer-related public health challenge in the United States. Although low-dose CT-based screening holds promise for earlier detection, currently, most lung cancer cases are not diagnosed until advanced stages (III, IV) and have 5-year survival rates of 21% or less. In contrast to Black-White survival disparities, Hispanic patients have markedly lower age-adjusted death rates than their non-Hispanic White (NHW) counterparts despite later stage diagnoses and broader SES and healthcare disparities; these findings are well established and consistent with the “Hispanic Health Paradox”, a phenomenon characterized by Hispanic advantages in objective health outcomes (e.g., mortality) despite significant health and socioeconomic risk factors. The leading explanatory hypothesis concerns the role of cultural factors facilitating social integration. Social integration is among the most robust psychosocial predictors of a range of objective health outcomes, including cancer survival. However, no published work has directly tested this sociocultural hypothesis in relation to Hispanic resilience. Consistent with the emerging science of resilience, we propose a multisite, two-study, mixed-methods investigation to evaluate this sociocultural hypothesis. Study 1 is a multisite, longitudinal observational study of 672 Hispanic and NHW individuals with advanced stage lung cancer sampled from three regions across the U.S. Interviews using gold-standard and culturally-informed survey measures (demographics, social integration, cultural values, acculturation) will be conducted in English and Spanish from a centralized coordinating center with a 6- week follow-up to examine change in perceived support provision/needs. The primary outcome of survival and secondary outcomes (e.g., treatment adherence), will be gathered from electronic medical records over mean follow-up time of 33-months. Study 2 is a single-site, 7-day, intensive measurement investigation into the daily units of social integration that mediate outcomes. Study 2 integrates two novel in vivo sampling methods (Electronically Activated Recorder [EAR] and ecological momentary assessments [EMA]) using a mobile phone platform. The current aims are to (1) investigate whether the observed Hispanic survival advantage is mediated by ethnic differences in social integration among recently diagnosed late-stage lung cancer patients and (2) to examine the processes/mechanisms that underlie these relationships in daily life including the role of individual, family, network, and neighborhood-level factors. The highly experienced investigator team includes leaders in all relevant content areas, including the Hispanic health paradox, lung cancer survivorship, social integration, and ecological sampling methodologies. The results will contribute to better understanding of social processes among cancer patients, inform psychosocial interventions based on social integration, and contribute to the emerging science of health resilience as well as racial/ethnic and cultural variations in health outcomes.