Endometrial Cancer Survival and Survivorship among Latinas in California: A Mixed Methods Study

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PROJECT SUMMARY/ABSTRACT The goal of this F31 fellowship is to prepare me to become an independent researcher who can effectively contribute to addressing cancer disparities for Latina women with endometrial cancer (EC). EC is the third most prevalent cancer among Latina women, representing 8% of all new cancer diagnoses among Latinas in the United States. Higher than any other racial/ethnic group, Latinas have had a 30.2% increase in EC incidence between 2010 and 2017. EC is the second most common cancer survivor site among women of all race/ethnicities. While Latinas with EC have relatively high 5-year survival rates, they also are more likely to be diagnosed with later stage and more aggressive disease, have lower quality of and barriers to equitable cancer treatment and follow-up care, and have lower levels of income, education, and health insurance compared to white women. Further, their interactions with the healthcare system and socio-ecological contexts in which they live can directly shape opportunities for and barriers to optimal health impacting their survival and survivorship. Under the guidance of my mentorship team and enhanced by the training from this fellowship, I will conduct an explanatory sequential mixed methods study to examine how macro/systemic level contexts shape the EC survival outcomes and survivorship experiences of Latinas. The Specific Aims of this study are to: 1) Examine the association between treatment facility and endometrial cancer survival and to explore whether race/ethnicity moderates this association; 2) Investigate the association between neighborhood socioeconomic status and EC survival and to examine whether race/ethnicity moderates this association; and 3) Qualitatively explore and characterize Latina EC survivors’ lived experiences and the impact of healthcare system and socio-ecological contexts on survivorship. To accomplish the proposed research, I will implement a comprehensive training and mentorship plan that will build upon my prior cancer health disparities knowledge, research experience, and doctoral training. Specifically, my Training Goals will focus on expanding my knowledge and skills in: 1) cancer epidemiology for gynecologic cancers and gynecologic oncology treatment and survivorship practices; 2) cancer disparities across the cancer continuum; 3) intersections of race/ethnicity, socioeconomic position, and gender with inequities in health, with a focus on Latino and immigrant communities; 4) mixed-methods research approaches and interpretation; 4a) quantitative methodology including epidemiologic methods, survival analysis, and multilevel modeling; 4b) qualitative methodology; and 5) grant writing. These goals will be accomplished through a range of coursework, seminars/workshops, clinical exposure, conferences, journal readings, and tailored mentoring from a committed team of interdisciplinary researchers. Complemented by support from a dedicated research and training environment at the University of California, Irvine Program in Public Health, this fellowship will accelerate my trajectory in becoming an independent researcher focused on reducing cancer disparities in gynecologic cancer.