Who Cares For Older Breast Cancer Surivors And How Does It Affect Quality?

描述（由申请人提供）：尽管美国老年人口快速增长，预期寿命增加，癌症发病率随着年龄的增长而上升，但缺乏对老年（65岁以上）幸存者的研究。该项目利用NCI对现有老年乳腺癌妇女队列的投资来解决有关生存护理的新科学问题。在这项研究中，我们使用医学研究所（IOM）的框架，基于Donadebian的结构、过程和结果模型，来确定在积极治疗结束后谁来照顾这群老年幸存者，以及提供者的类型如何影响护理质量。该队列包括1100名老年英语和西班牙语乳腺癌患者，他们有详细的基线数据。2005年末至2007年间，106家癌症和白血病B组（CALGB）机构对女性进行了诊断；90%的站点都在社区环境中。该队列在种族/民族、保险覆盖范围和护理社区环境方面代表了美国乳腺癌患者人口；根据教育程度，其中一半被认为是低社会经济地位，三分之一生活在高度贫困地区。我们的多学科团队将在积极治疗后的五年内进行年度电话随访访谈，以检查护理选择和经历、症状、生活质量和满意度。这些数据将与积极治疗前18个月至5年的医疗保险索赔联系起来，以确定基线模式和治疗后提供者和服务。我们还将使用AMA文件来获取医生特征（专业、性别和种族）和幸存者地址，以包括地区特征的人口普查数据。我们的主要结果将是索赔的服务率（例如，幸存者中乳房x光检查的累积使用）和患者评价的满意度和生活质量。关键预测因素是生存护理模式（由肿瘤学家和初级保健提供者共享或仅由初级保健提供者共享）；我们将评估沟通和/或协调是否会促成结果。最后，我们将每年对少数族裔和非少数族裔妇女进行深入的开放式访谈，以提高我们了解在护理方面是否存在种族/民族差异的能力。使用已建立的队列使我们能够以具有成本效益的方式收集新数据；这项研究还解决了IOM所阐述的幸存者研究的一个关键优先事项。最大限度地提高生活质量和功能的护理模式在老年妇女中尤为突出，因为老年妇女的衰退可能加剧她们的虚弱和独立生活的能力。我们将使用项目数据来指导未来的干预措施，以改善结果，并为临床实践和政策决策提供信息，以最大限度地提高对日益增长的老年乳腺癌幸存者的护理模式的质量。尽管美国老年人口迅速增长是人口统计学的必然趋势，但对老年（65岁以上）幸存者的研究却很缺乏。该项目将研究在积极治疗结束后的前五年，由肿瘤学家和初级保健医生共同护理是否比单独由初级保健医生提供的护理更能提高老年幸存者的护理质量、满意度和生活质量。结果将用于指导未来的干预措施，以改善结果，并为临床实践和政策决策提供信息，以最大限度地提高对日益增长的老年乳腺癌幸存者的护理模式的质量。最大限度地提高生活质量和功能的护理模式在老年妇女中尤为突出，因为老年妇女的衰退可能加剧她们的虚弱和独立生活的能力。

DESCRIPTION (provided by applicant): Despite the demographic imperative of a rapidly growing older US population, increasing life expectancy, and rising cancer rates with advancing age, there is a paucity of research on older (65+ years) survivors. This project leverages NCI's investment in an extant cohort of older women with breast cancer to address new scientific questions about survivorship care. In this study, we use the Institute of Medicine's (IOM) framework based on Donadebian's model of structure, process and outcomes to determine who cares for this cohort of older survivors after active treatment ends and how the type of provider affects quality of care. The cohort includes 1100 older English and Spanish speaking breast cancer patients with detailed baseline data. Women were diagnosed between late 2005 and 2007 in 106 Cancer and Leukemia Group B (CALGB) institutions; 90% of the sites are in community settings. The cohort is representative of the US population of breast cancer patients in terms of race/ethnicity, insurance coverage and community settings of care; half would be considered low SES based on education and one-third live in areas of high poverty. Our multidisciplinary team will conduct annual telephone follow-up interviews over five years post active-treatment to examine care choices and experiences, symptoms, quality of life and satisfaction. These data will be linked to Medicare claims from the 18 months prior to five years post-active treatment to define baseline patterns and post- treatment providers and services. We will also use AMA files to obtain physician characteristics (specialty, gender, and race) and survivor's addresses to include census data on area characteristics. Our primary outcomes will be rates of services from claims (e.g., cumulative use of mammography among survivors) and patient-rated satisfaction and quality of life. The key predictor is model of survivorship care (shared by an oncologist and primary care provider or a primary care provider alone); we will assess whether communication and/or coordination mediate outcomes. Finally, we will conduct in-depth, open ended interviews among a sub- set of minority and non-minority women each year to enhance our ability to understand whether there are race/ethnicity differences in care. The use of an established cohort allows us to collect new data in a cost- efficient manner; this research also addresses a key priority for survivorship research as articulated by the IOM. Patterns of care that maximize quality of life and functioning are particularly salient in older women, where declines may exacerbate frailty and ability to live independently. We will use project data to guide future interventions to improve outcomes and inform clinical practice and policy decisions about care models that maximize quality for the growing older population of breast cancer survivors. Despite the demographic imperative of a rapidly growing older US population there is a paucity of research on older (65+ years) survivors. This project will examine whether care in the first five years after active treatment ends that is shared by an oncologist and primary care physician results in better quality care, satisfaction and quality of life for older survivors than care provided by a primary care physician alone. Results will be used to guide future interventions to improve outcomes and inform clinical practice and policy decisions about care models that maximize quality for the growing older population of breast cancer survivors. Patterns of care that maximize quality of life and functioning are particularly salient in older women, where declines may exacerbate frailty and ability to live independently.