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，但还没有研究检查这些因素对癌症存活率差异的影响。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，影响美国290万乳腺癌幸存者中高达三分之一的身体健康和生活质量。观察性研究发现，黑人女性比白人更容易患上BCRL，而且患病率存在地域差异。对于患有BCRL的患者，已知的进展预测因素包括BMI、手术类型和放射治疗，所有这些都与社会因素有关。然而，还没有研究探讨种族/民族、地理或其他社会和环境因素与BCRL进展的关系。本研究的目的是以患有BCRL的乳腺癌存活者为例，探讨宏观(邻里)和微观(个体)的社会环境风险因素与癌症治疗持续性不良反应的关系及其所带来的成本。该项目将使用BCRL手臂体积和成本数据，这些数据来自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，她们都患有BCRL，并且超重或肥胖。为了比较患有BCRL的患者和不患有BCRL的患者的成本，该项目将从PAL试验(n=295)的参与者那里收集额外的成本数据，其中包括患有和不患有BCRL的乳腺癌幸存者。它将通过(1)量化BCRL进展中的黑白差异；(2)从以前的PAL参与者那里收集额外的数据，以评估有或没有BCRL的幸存者在费用负担方面的差异；以及(3)探索与BCRL相关的宏观和微观社会和环境因素的贡献，以确定它们与医疗费用的关联。这个K01将通过指导和教学研究活动，为癌症生存和经济分析培训提供受保护的时间。

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.