Do barriers to transplantation impact liver cancer survival in Asians?

描述（由申请人提供）：肝细胞癌（HCC）是全球第三大癌症死亡原因。尽管肝癌治疗取得了总体进展，但少数种族/族裔的生存率仍然低于白人。这种差异背后的机制仍然知之甚少。肝移植是HCC的最佳治疗方法，然而少数民族接受移植的频率低于白人，即使肿瘤分期相似。这可能是因为器官分配的要求不成比例地将少数群体排除在外，可能是一个潜在的歧视点。具体目标1。为了评估低移植率和肝癌生存率差异之间的关系，在种族/少数民族相比，高加索人我们的第一个目的是检查哪些因素，包括偏见，有助于移植率较低，以及这些较低的利率是否是少数民族预后不良的主要决定因素。我们将使用倾向分数匹配来实现这一目标，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）少数民族和高加索人群的倾向评分在统计学上有差异，但（2）这种差异与移植率的差异不成比例，表明存在治疗偏倚; （3）通过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HCC存活率差的主要决定因素。我们将进行一项亚组分析，专门研究亚洲少数民族，因为这一群体的HCC发病率特别高。具体目标2。探讨纽约市华人社区对肝癌治疗的态度，并调查他们接受肝移植的频率低于白人的感知原因。其次，我们的目的是探索中国少数民族接受肝移植的频率低于白人的感知原因。通过直接沟通，我们将能够探索定性问题，如供应商治疗偏见的看法，以及社会支持网络的存在。为此，我们将采用焦点小组和社会认知理论，研究在少数肝癌社区的态度和知识，肝癌和肝移植。虽然现有的许多文献都集中在注意到癌症结果的差异的存在，这个应用程序是创新的，试图阐明这些差异的潜在机制。如果对基本机制有充分的了解，减少差距的干预措施必然会更成功。确定移植障碍是否是少数患者预后不良的主要原因，以及这种情况是如何发生的，将使我们能够解决这种差异，并改善HCC患者的生存率。 公共卫生相关性：少数种族/族裔肝癌预后较差，尽管确切原因仍知之甚少。肝移植是肝癌的最佳治疗方法，我们的工作将研究移植政策是否排斥少数群体，从而影响其结果。从这个项目中获得的信息将用于了解和试图解决肝癌生存率的差异

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