Do barriers to transplantation impact liver cancer survival in Asians?

描述(申请人提供)：肝细胞癌是全球第三大癌症死亡原因。尽管肝癌的治疗总体上取得了进展，但少数族裔的存活率仍然比高加索人差。这种差异背后的机制仍然知之甚少。肝移植是治疗肝癌的唯一最好的方法，然而，即使是分期相似的肿瘤，少数族裔接受移植的频率也低于高加索人。这可能是因为器官分配的要求不成比例地排除了少数群体，可能是一个潜在的歧视点。具体目的1.为了评估少数族裔与高加索人相比的低移植率与肝癌存活率差异之间的关系，我们的第一个目标是研究包括偏见在内的哪些因素导致移植成功率较低，以及这些较低的移植比率是否是少数族裔预后不良的主要决定因素。我们将使用倾向得分匹配来解决这一目标，这是一种用于比较具有复杂背景信息的群体的统计方法。我们假设(1)少数族裔和高加索人群有统计学上不同的倾向评分，但(2)这种差异不会与移植比率的差异成比例，这表明存在治疗偏倚； (3)与倾向评分匹配的个体将具有相似的存活率--从而确定缺乏移植是少数人肝癌存活率较低的主要决定因素。我们将进行专门针对亚洲少数民族的亚群分析，因为这一群体的肝癌发病率特别高。具体目的2.为了了解纽约华人社区对肝细胞癌治疗的态度，并调查他们接受肝移植的频率低于高加索人的感知原因，我们的目标是探索中国少数民族群体接受肝移植的频率低于高加索人的感知原因。通过直接沟通，我们将能够探索定性问题，如对提供者治疗偏见的感知，以及社会支持网络的存在。为此，我们将使用焦点小组和社会认知理论来研究少数人肝癌社区对肝癌和肝移植的态度和知识。虽然现有的许多文献都集中在注意到癌症预后中存在差异，但这种应用在试图阐明这些差异的潜在机制方面是创新的。当基本机制被充分理解时，缩小差距的干预措施本身就更成功。确定移植障碍是否是少数族裔患者预后不良的主要原因，以及这种障碍是如何发生的，将使我们能够解决这种差异，并提高肝癌患者的存活率。 公共卫生相关性：项目叙述种族/少数民族患肝癌的预后更差，尽管其确切原因仍不清楚。肝移植是治疗肝癌的最佳方法，我们的工作将研究移植政策是否将少数族裔排除在外，从而影响其结果。从这个项目中获得的信息将被用来理解和尝试解决肝癌存活率的差异。

DESCRIPTION (provided by applicant): Hepatocellular carcinoma (HCC) is the third leading cause of death from cancer worldwide. Despite overall advances in the treatment of HCC, racial/ethnic minorities continue to exhibit worse survival than Caucasians. The mechanisms behind this discrepancy remain poorly understood. Liver transplantation is the single best treatment for HCC, however minorities undergo transplantation less often than Caucasians, even with similarly staged tumors. This may be because requirements for organ allocation disproportionately exclude minority groups, and may represent a potential point of discrimination. Specific Aim 1. To assess the relationship between low transplantation rates and HCC survival disparity in racial/ethnic minorities compared to Caucasians Our first aim is to examine what factors, including bias, contribute to the lower rates of transplantation and whether these lower rates are the main determinant of poor prognosis in minorities. We will address this aim using Propensity Score Matching, a statistical method used to compare groups with complex background information. We hypothesize that (1) minority and Caucasian groups will have statistically different Propensity Scores, but that (2) this difference will not be proportionate to the disparity in transplantation rates, suggesting the presence of treatment bias; and that (3) individuals matched by Propensity Scores will have similar survival - thereby establishing lack of transplantation as the major determinant of poor HCC survival in minorities. We will conduct a subgroup analysis specifically examining Asian minorities, since this group has especially high rates of HCC. Specific Aim 2. To explore attitudes on HCC treatment in the New York City Chinese community, and investigate perceived reasons why they undergo liver transplantation less frequently than Caucasians Second, we aim to explore perceived reasons Chinese minority groups undergo liver transplantation less frequently than Caucasians. By communicating directly, we will be able explore qualitative issues such as perception of provider treatment bias, and presence of social support networks. For this aim we will employ focus groups and Social Cognitive Theory to study the attitudes and knowledge about HCC and liver transplantation in a minority HCC community. While much of the existing literature has focused on noting the presence of disparities in cancer outcomes, this application is innovative in its attempt to elucidate the underlying mechanism for these disparities. Interventions to reduce disparities are inherently more successful when the underlying mechanism is well understood. Determining whether transplantation barriers are largely responsible for poor outcomes in minority patients, and how this occurs, will allow us to address this disparity and lead to improvements in survival for patients with HCC. PUBLIC HEALTH RELEVANCE: Project Narrative Racial/ethnic minorities have a worse prognosis from liver cancer, although the exact reasons for this remain poorly understood. Liver transplantation is the best treatment for liver cancer, and our work will examine whether transplantation policies exclude minorities, thus affecting their outcome. Information gained from this project will be used to understand and attempt to resolve disparities in liver cancer survival