Understanding Racial and Ethnic Differences in Survival from Colorectal Cancer

描述(申请人提供)：结直肠癌是美国男性和女性中第三种最常见的浸润性癌症。自1980年代以来，预防、筛查和治疗方面的改进降低了结直肠癌的病死率。矛盾的是，这种癌症的存活率差距随着时间的推移而扩大，特别是在黑人和白人之间。尽管在现有文献中没有达成共识，但目前的证据表明，与获得卫生保健有关的因素，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存活率差异的潜在可改变原因，长期目标是减少或消除某些患者群体中不成比例的结直肠癌负担。该项目的具体目标是：1)比较1993至2004年间按种族/民族划分的结直肠癌存活率；2)按种族/民族比较结直肠癌确诊时肿瘤分期的分布；3)研究结直肠癌患者存活率与种族/民族关系的潜在中介因素；4)研究结直肠癌幸存者的护理模式；以及5)探讨社会经济地位对人种/民族与结直肠癌患者存活率关系的影响。该项目将在一个种族多元化的大型队列中进行，其中包括20岁及以上被诊断为结直肠癌的患者(1993年至2004年)，他们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保健系统之一。这项研究计划是职业发展计划的一部分，旨在为杜贝尼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医生兼调查员，专注于癌症存活率的差异。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。拟议的研究计划中包含的研究将对我们理解癌症存活率的种族/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，即设计以系统为基础的干预措施，旨在消除癌症护理和生存方面的差异，这是HealthPeople 2010年的主要目标。

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.