Understanding Racial and Ethnic Differences in Survival from Colorectal Cancer

描述（由申请人提供）：结直肠癌是美国男性和女性中第三大常见的浸润性癌症。自20世纪80年代以来，预防、筛查和治疗方面的改进导致结直肠癌的病死率下降。奇怪的是，这种癌症的生存差异，特别是黑人和白人之间的差异，随着时间的推移而扩大。虽然在现有文献中没有达成共识，但目前的证据表明，与获得医疗保健有关的因素，包括社会经济差异，导致了这些差异。拟议研究计划的目标是确定癌症生存差异的潜在可改变原因，长期目标是减少或消除某些患者人群中结直肠癌的不成比例负担。该项目的具体目标是：1）比较1993年至2004年期间不同种族/民族的结直肠癌生存率; 2）比较不同种族/民族的结直肠癌诊断时肿瘤分期的分布; 3）研究结直肠癌患者生存率与种族/民族关系的潜在介导因素; 4）检查结直肠癌幸存者的护理模式; 5）探索社会经济地位对结直肠癌患者种族/民族与生存之间关系的影响。该项目将在一个大型种族多样化队列中进行，该队列由20岁及以上诊断为结直肠癌（1993年至2004年）的患者组成，同时参加了隶属于国家癌症研究所资助的癌症研究网络的四个综合医疗保健系统之一。该研究计划是职业发展计划的一部分，旨在为Doubeni博士提供所需的培训和经验，使其成为一名独立资助的临床研究人员，专注于癌症生存率的差异。职业发展计划的目标是获得以下方面的知识和技能：1）癌症生物学，流行病学和治疗; 2）先进的研究方法; 3）科学写作; 4）将研究转化为实践和政策。职业发展计划将通过指导和有针对性的高级课程来完成。拟议的研究计划所包含的研究将为我们理解癌症生存率的种族/民族差异做出重要贡献。拟议的项目将为候选人的长期职业目标奠定基础，即设计旨在消除癌症护理和生存差距的系统性干预措施，这是2010年健康人民的一个主要目标。

DESCRIPTION (provided by applicant): Colorectal cancers are the third most common invasive cancers among men and women in the United States. Improvements in prevention, screening and treatment have resulted in decreasing case-fatality rates from colorectal cancer since the 1980s. Paradoxically, disparities in survival from this cancer especially between Blacks and Whites have widened over time. Although there is no consensus in existing literature, current evidence suggests that factors related to access to health care including socioeconomic differences contribute to these disparities. The goal of the proposed research program is to identify potentially modifiable causes of disparities in cancer survival with a long range goal of reducing or eliminating the disproportionate burden of colorectal cancer among certain patient populations. The specific aims for this project are to: 1) compare colorectal cancer survival rates by race/ethnicity over the period 1993 through 2004; 2) compare the distribution of tumor stage at diagnosis for colorectal cancer by race/ethnicity; 3) examine potential mediators of the relationship of survival and race/ethnicity among colorectal cancer patients; 4) examine the patterns of care of survivors of colorectal cancer; and 5) explore the effect of socioeconomic status on the relationship between race/ethnicity and survival among colorectal cancer patients. This project will be conducted on a large racially diverse cohort comprised of patients 20 years and older diagnosed with colorectal cancer (1993 to 2004) while enrolled in one of four integrated health care systems that are affiliated with the National Cancer Institute-funded Cancer Research Network. This research plan is part of a career development program aimed at providing the training and experience needed for Dr. Doubeni to become an independently funded clinician-investigator focusing on disparities in cancer survival. The objectives of the career development plan are to acquire knowledge and skills in: 1) cancer biology, epidemiology and treatment; 2) advanced research methods; 3) scientific writing; and 4) the translation of research into practice and policy. The career development program will be accomplished through mentoring and targeted advanced courses. The studies encompassed under the proposed research program will make important contributions to our understanding of racial/ethnic differences in cancer survival rates. The proposed project will lay the foundation for the candidate's long-term career goal of designing system-based interventions aimed at eliminating disparities in cancer care and survival, a major objective of HealthyPeople 2010.