Uterine cancer survival disparities, Hispanic ethnicity, and comorbidities.

子宫癌生存差异、西班牙裔和合并症。

• 批准号: 7941753
• 负责人: Linda S Cook
• 金额: $ 7.53万
• 依托单位: UNIVERSITY OF NEW MEXICO
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7941753
• 关键词: Affect; Age; American; Area; Breast; California; Cancer Patient; Characteristics; Comorbidity; Comorbidity Index; DNA Fingerprinting; Data; Databases; Diabetes Mellitus; Diagnosis; Diagnostic Neoplasm Staging; Discipline of obstetrics; Disease; Employee Strikes; Endometrial; Endometrial Carcinoma; Ethnic Origin; Future; Gynecology; Health; High Prevalence; Hispanics; Histology; Hypertension; Incidence; International; Investigation; Investments; Latino; Life Style; Link; Los Angeles; Malignant Female Reproductive System Neoplasm; Malignant Neoplasms; Medicare; New Mexico; Not Hispanic or Latino; Patients; Population; Prognostic Factor; Prostate; Relative (related person); Research; Risk Factors; SEER Program; San Francisco; Stable Populations; Staging; Therapeutic Intervention; United States; Uterine Cancer; Woman; aged; base; burden of illness; cancer diagnosis; cancer health disparity; cancer therapy; cancer type; cohort; experience; falls; improved; mortality; outcome forecast; public health relevance; racial and ethnic disparities; receptor expression; tumor

DESCRIPTION (provided by applicant): Overall relative survival for women with uterine cancer is worse now than in 1975. Once thought to be the "curable cancer", the five-year survival for endometrial cancer is now lower than 10 other types of cancer, including breast and prostate. And the burden of this disease is substantial; approximately 1 in 12 American women will be diagnosed with endometrial cancer in their lifetime. Furthermore, there are striking racial/ethnic disparities. Disparities in uterine cancer survival between whites and blacks have been noted and studied, but little is known about disparities between non-Hispanic whites (NHWs) and Hispanic whites (HWs). Based upon our own preliminary examination of Surveillance, Epidemiology and End Results program (SEER) data, we found that HWs experience consistently worse observed survival than NHWs in New Mexico and California. While the reasons for this disparity are unknown, differences in comorbidities between HWs and NHWs is one possible explanation because comorbidities reduce survival following cancer diagnoses. We expect to see a higher prevalence of comorbidities in HWs relative to NHWs at cancer diagnosis because both hypertension and diabetes are established risk factors for endometrial cancer and there is a higher prevalence of comorbidities such as diabetes and hypertension in HWs relative to NHWs. We hypothesize that comorbidities, in particular diabetes and hypertension, may explain part or all of the survival disparities between HWs and NHWs. We propose to explore this question using the SEER-Medicare linked database in New Mexico and three areas in California (Los Angeles, San Francisco-Oakland, San Jose-Monterey). We will compare tumor characteristics, patient characteristcs, and cancer therapy between HW and NHW cases. We will also determine if adjustment for comorbidites reduces or eliminates the difference in survival between HWs and NHWs. If we find that tumor characteristics (e.g., histology, stage) are different between HWs and NHWs, this finding will be the basis for a future line of research exploring the etiologic basis for these differences as well as a further investigation of tumor receptor expression and DNA profiling. If we find that one or more comorbidities explain, at least in part, the survival disparity, this finding will be the basis for a future line of research to investigate interventions (therapeutic or lifestyle) to specifically reduce uterine cancer mortality. By 2050 it is estimated that 103 million Americans will be of Latino/Hispanic ethnicity, representing 24% of the United States (US) population. A research investment to better understand the reasons for uterine cancer disparities will help us develop strategies for improving prognosis and survival for this common gynecologic cancer in this large and growing segment of our population. PUBLIC HEALTH RELEVANCE: Project Narrative This project is directly aimed at understanding the factors that affect differential uterine cancer survival between Hispanic white women and non-Hispanic white women. The results of our study will provide needed clarity about factors that drive this disparity so that further research can be done to establish ways to reduce the survival disparity. In this manner, the results could have a direct impact on improving the long-term health of uterine cancer patients across the nation.

描述（由申请人提供）：子宫癌妇女的总体相对生存率比1975年更差。曾经被认为是“可治愈的癌症”，子宫内膜癌的五年生存率现在低于其他10种癌症，包括乳腺癌和前列腺癌。这种疾病的负担是巨大的;大约每12名美国妇女中就有1名在其一生中被诊断出患有子宫内膜癌。此外，种族/民族差异也很明显。白人和黑人之间子宫癌生存率的差异已经被注意到并研究过，但对非西班牙裔白人（NHWs）和西班牙裔白人（HWs）之间的差异知之甚少。根据我们自己对监测、流行病学和最终结果计划（SEER）数据的初步检查，我们发现在新墨西哥州和加州，HWs的观察生存率始终低于NHWs。虽然这种差异的原因尚不清楚，但HWs和NHWs之间合并症的差异是一种可能的解释，因为合并症降低了癌症诊断后的生存率。我们预计在癌症诊断时，HWs的合并症患病率高于NHWs，因为高血压和糖尿病都是子宫内膜癌的既定风险因素，并且HWs的合并症（如糖尿病和高血压）患病率高于NHWs。我们推测，合并症，特别是糖尿病和高血压，可以解释部分或全部的生存差距之间的HWs和NHWs。我们建议探索这个问题，使用SEER医疗保险链接数据库在新墨西哥州和三个地区在加州（洛杉矶，旧金山-奥克兰，圣何塞-蒙特雷）。我们将比较HW和NHW病例之间的肿瘤特征、患者特征和癌症治疗。我们还将确定合并症的调整是否减少或消除了HWs和NHWs之间的生存差异。如果我们发现肿瘤特征（例如，组织学、分期）在HWs和NHWs之间是不同的，这一发现将成为未来研究的基础，探索这些差异的病因学基础，以及进一步研究肿瘤受体表达和DNA谱。如果我们发现一种或多种合并症至少部分解释了生存差异，这一发现将成为未来研究干预措施（治疗或生活方式）的基础，以专门降低子宫癌死亡率。到2050年，估计将有1.03亿美国人是拉丁裔/西班牙裔，占美国人口的24%。一项研究投资，以更好地了解子宫癌差异的原因，将有助于我们制定策略，改善这种常见的妇科癌症在我们人口的这一大部分和不断增长的部分的预后和生存。 公共卫生关系：项目叙述本项目直接旨在了解影响西班牙裔白色妇女和非西班牙裔白色妇女之间子宫癌生存率差异的因素。我们的研究结果将提供必要的清晰度，推动这种差异的因素，以便进一步研究，以建立减少生存差异的方法。通过这种方式，结果可能对改善全国子宫癌患者的长期健康产生直接影响。