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

项目概要/摘要 作为癌症死亡的主要原因，肺癌代表了与癌症相关的最重要的公共卫生 在美国的挑战。尽管低剂量CT筛查有望实现早期检测， 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 21%或更低。与黑人-白人生存差异相反，西班牙裔患者的生存率明显低于白人。 年龄调整后的死亡率比非西班牙裔白色（NHW）同行，尽管后期诊断， 更广泛的社会经济地位和医疗保健差异;这些发现是公认的，并与“西班牙裔”一致。 健康伙伴关系”，一种以西班牙裔在客观健康结果方面的优势为特征的现象（例如， 尽管存在重大的健康和社会经济风险因素，主要的解释性假设 关注文化因素促进社会融合的作用。社会融合是最有力的 一系列客观健康结果的社会心理预测因素，包括癌症生存率。但没有 已发表的研究直接验证了这一社会文化假设与西班牙裔弹性的关系。一致 随着复原力科学的兴起，我们提出了一个多地点、两项研究、混合方法的调查， 评估这个社会文化假设。研究1是一项对672名西班牙裔美国人进行的多中心纵向观察性研究。 来自美国三个地区的晚期肺癌患者和NHW患者。 使用黄金标准和文化知情的调查措施（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以英语和西班牙语进行， 为期一周的后续行动，以审查所感知的支助提供/需求方面的变化。生存率的主要结果， 次要结果（例如，治疗依从性），将从平均 随访时间为33个月。研究2是一项单中心、为期7天的密集测量研究， 社会融合的单位，调解结果。研究2整合了两种新的体内采样方法 （电子激活记录仪[ESTA]和生态瞬时评估[EMA]）使用移动的电话 平台目前的目的是（1）调查观察到的西班牙裔生存优势是否是介导的 最近诊断的晚期肺癌患者在社会融合方面的种族差异，以及（2） 研究在日常生活中这些关系的基础上的过程/机制，包括 个人、家庭、网络和邻里因素。经验丰富的研究团队包括 领导者在所有相关的内容领域，包括西班牙裔健康悖论，肺癌生存，社会 整合和生态取样方法。研究结果将有助于更好地了解社会 在癌症患者中，为基于社会融合的心理社会干预提供信息， 有助于健康弹性以及健康中的种族/民族和文化差异的新兴科学 成果。

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.