Reducing racial/ethnic inequities in childhood cancer survivorship

描述(由申请人提供)：尽管存活率有所提高，但儿童癌症幸存者(CCS)因其疾病和严格的治疗而面临远期和远期影响的高风险。西班牙裔CCS在生存研究中的代表性不足，与非西班牙裔相比，他们在死亡率方面显示出显著的健康不平等。尽管建议对CCS患者进行终生的、基于风险的后续护理，但随着CCS进入成年阶段，这种护理的使用率迅速下降。我们在两家医院(接受调查的年龄为14-26岁)接受治疗的CC中的初步工作表明，在成年初期(21-26岁)，西班牙裔(与非西班牙裔)CC中与癌症相关的后续护理显著较低。我们建议招募和调查一个基于人群的队列(n=1,232)，其中包括新发成人(18-39岁)、西班牙裔(54%)和非西班牙裔CC，以了解在接受推荐的后续护理方面的潜在不平等，以及可能对西班牙裔和非西班牙裔CC的健康结果产生不同影响的因素。我们的目标是确定：1)接受癌症相关后续护理的风险和保护因素；2)接受的后续护理(基于病历回顾)是否与已公布的长期随访指南一致/遵守(针对特定癌症患者和临床病史)；3)成年阶段里程碑(如全职工作、婚姻、有孩子)与接受癌症相关后续护理之间的关系。对指南护理的遵守将由医生小组进行评估。将使用比较分析来确定种族和治疗地点的差异(癌症存活期诊所和 初级保健/社区诊所)。这项以人群为基础的研究结果将为识别和减少西班牙裔和非西班牙裔CCS在卫生保健利用、晚期效应和最终长期生存方面观察到的健康不平等提供指导。结果可以指导侧重于治疗拉美裔CCS的临床医生的教育/政策努力，以及支持专门的过渡诊所和侧重于CCS进入新兴成年期的健康促进努力。

DESCRIPTION (provided by applicant): Despite improved survival, childhood cancer survivors (CCS) are at high risk of late and long term effects from their disease and rigorous treatment. Hispanic CCS, who are underrepresented in survivorship research, show significant health inequities in mortality compared to non-Hispanics. Although life-long, risk based follow-up care is recommended for CCS, use of this care drops rapidly as CCS enter emerging adulthood. Our preliminary work among CCS treated at two hospitals (ages 14-26 when surveyed) indicates that cancer related follow-up care is significantly lower among Hispanic (vs. non-Hispanic) CCS during the early years of emerging adulthood (ages 21-26). We propose to recruit and survey a population-based cohort (n=1,232) of emerging adult (ages 18-39) Hispanic (54%) and non-Hispanic CCS to understand potential inequities in the receipt of recommended follow-up care, as well as factors that may differentially affect health outcomes of Hispanic and non-Hispanic CCS. Our aims are to determine: 1) risk and protective factors of receiving cancer related follow-up care; 2) if the follow-up care received (based on medical records review) is consistent/adherent with published Long- Term Follow-up Guidelines (for patient specific cancer and clinical history); and, 3) the relationship between milestones of emerging adulthood (e.g., full-time employment, marriage, having children) and receipt of cancer related follow-up care. Adherence to guideline care will be assessed by a physician panel. Comparative analyses will be used to identify differences by ethnicity and treatment site (cancer survivorship clinics and at primary care/community clinics). Results from this population-based study will provide guidance to identify and reduce health inequities observed between Hispanic and non-Hispanic CCS in health care utilization, late effects, and ultimately, long term survival. Results can guide education/policy efforts focused on clinicians who treat Hispanic CCS as well as support specialized transition clinics and health promotion efforts focused on CCS entering emerging adulthood.