Social Determinants of Breast Cancer Survivorship

描述（由申请人提供）：虽然社会和环境因素与乳腺癌筛查和结果的差异有关，但没有研究调查这些因素对癌症生存差异的影响。上半身乳腺癌相关淋巴水肿（BCRL）是癌症治疗的持续不良后果，在美国290万乳腺癌幸存者中，影响身体健康和生活质量的比例高达三分之一。观察性研究发现，黑人女性比白人女性更有可能患上BCRL，而且患病率存在地域差异。对于那些患有BCRL的人，已知的进展预测因素包括体重指数、手术类型和放射治疗，所有这些都与社会因素有关。然而，没有研究探讨种族/民族、地理或其他社会和环境因素与BCRL进展的关系。本研究的目的是探讨宏观（社区）和微观（个体）社会和环境风险因素对癌症治疗持续不良反应的影响及其成本之间的关系，并以乳腺癌手术后接受BCRL的乳腺癌幸存者为例。该项目将使用正在进行的女性稳定运动研究（WISER）幸存者研究的所有350名参与者的BCRL臂体积和成本数据，这些参与者都患有BCRL并且超重或肥胖。为了比较接受BCRL的患者与未接受BCRL的患者的成本，该项目将从PAL试验的参与者（n=295）中收集额外的成本数据，其中包括接受和不接受BCRL的乳腺癌幸存者。它将通过(1)量化黑人和白人在BCRL进展中的差异来扩展WISER Survivor；(2)收集前PAL参与者的额外数据，以评估患有或未患有BCRL的幸存者的费用负担差异；(3)探讨与BCRL相关的宏观和微观社会和环境因素的贡献，以确定其与医疗保健成本的关系。这个K01将通过指导和教学研究活动，为癌症幸存者和经济分析的培训提供保护时间。

DESCRIPTION (provided by applicant): While social and environmental factors are associated with disparities in breast cancer screening and outcomes, no studies have examined the impact of these factors on cancer survivorship disparities. Upper body breast-cancer related lymphedema (BCRL) is a persistent adverse outcome of cancer treatment that affects the physical health and quality of life of up to 1 in 3 of the 2.9 million breast cancer survivors in te US. Observational studies have found that Black women are more likely than Whites to develop BCRL, and that there are geographic differences in prevalence rates. For those with BCRL, known predictors of progression include BMI, type of surgery and radiation treatment, all of which are associated with social factors. However, no studies have explored the association of race/ethnicity, geography or other social and environmental factors with BCRL progression. The purpose of this study is to explore the relationship between macro- (neighborhood) and micro-level (individual) social and environmental risk factors for the persistent adverse effects of cancer treatment, and the costs they pose, using the example of breast cancer survivors who have BCRL as a persistent adverse effect of breast cancer surgery. This project will use BCRL arm volume and cost data from all 350 participants in the ongoing Women in Steady Exercise Research (WISER) Survivor Study, who all have BCRL and are overweight or obese. To compare costs of those with BCRL to those who do not, this project will collect additional cost data from participants in the PAL trial (n=295) which includes breast cancer survivors with and without BCRL. It will expand on WISER Survivor by (1) quantifying Black-White differences in BCRL progression; (2) collecting additional data from former PAL participants to assess differences in cost burden for survivors with or without BCRL; and (3) exploring the contributions of macro- and micro-level social and environmental factors associated with BCRL to determine their association with health care costs. This K01 will provide protected time for training in cancer survivorship and economic analysis through mentorship, and didactic research activities.