Adherence Among Older Women with Breast Cancer

描述(由申请人提供)：该职业发展奖的目标是为莎伦·佐丹诺博士提供必要的经验和知识，使其成为乳腺癌领域的独立卫生服务研究人员。佐丹诺博士是一名内科肿瘤学家和公共卫生硕士候选人，他将通过定向阅读、研讨会、课程作业和有指导的研究相结合的方式来实现这一目标。一支高素质的导师团队将监督她的训练，确保她达到目标。佐丹诺博士将使用两种不同的方法来检查老年女性乳腺癌患者对标准辅助治疗疗程的依从性：使用SEER-Medicare数据库进行的二级数据分析和初级数据收集。这样做的具体目的是 这些建议包括：1)描述老年乳腺癌患者中不坚持化疗和放疗的人群样本；2)确定特定的合并症以及患者、医生和环境特征对坚持化疗和放射治疗的影响；3)前瞻性地确定影响老年乳腺癌患者坚持治疗的因素，包括潜在的未被发现的抑郁症和痴呆症的并存。前两个具体目标将使用基于人口的SEER-Medicare数据库来实现，第三个具体目标将通过前瞻性研究来实现。这项拟议的研究将提供有关老年妇女坚持辅助治疗的模式和预测因素的重要知识。此外，这些研究将为申请人提供使用癌症登记数据和索赔数据、初级数据收集和数据分析方面的专门知识。拟议的学习和职业发展活动将为申请者提供发展成为独立调查员的技能。

DESCRIPTION (provided by applicant): The objective of this career development award is to provide Dr. Sharon Giordano with the experience and knowledge necessary to become an independent health services researcher in the field of breast cancer. Dr. Giordano, who is a medical oncologist and MPH candidate, will accomplish this goal through a combination of directed reading, seminars, coursework, and mentored research. A highly qualified team of mentors will supervise her training and ensure that she meets her goals. Dr. Giordano will be examining adherence to a standard course of adjuvant treatment among older women with breast cancer using two different approaches: secondary data analyses using the SEER-Medicare database and primary data collection. The specific aims of this proposal are: 1 ) to describe lack of adherence to chemotherapy and radiotherapy in a population-based sample of older women with breast cancer; 2) to determine the effect of specific comorbidities as well as patient, physician, and environmental characteristics on adherence to chemotherapy and radiotherapy; and 3) to prospectively identify factors, including the potentially unrecognized comorbidities of depression and dementia, that affect adherence to therapy in older women with breast cancer. The first two specific aims will be accomplished using the population-based SEER-Medicare database, and the third specific aim through a prospective study. The proposed research will provide important knowledge regarding the patterns and predictors of adherence to adjuvant therapy among older women. In addition, these studies will provide the applicant with expertise in the use of cancer registry data and claims data, in primary data collection, and in data analysis. The proposed studies and career development activities will provide the applicant with the skills to develop into an independent investigator.