Identifying modifiable factors that reduce the burden of late stage melanoma in Hispanics

确定减少西班牙裔晚期黑色素瘤负担的可改变因素

• 批准号: 10210925
• 负责人: MYLES G COCKBURN
• 金额: $ 67.52万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-18 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10210925
• 关键词: Accounting; Acral Lentiginous Malignant Melanoma; Adherence; Awareness; Clinic; Complex; County; Data; Data Sources; Diagnosis; Disease; Early Diagnosis; Ensure; Ethnic Origin; Ethnic group; Etiology; Health Services Accessibility; Health education; Hispanics; Histologic; Histology; Incidence; Intervention; Knowledge; Lesion; Los Angeles; Low income; Neoplasm Metastasis; Not Hispanic or Latino; Outcome; Patients; Pattern; Perception; Phase; Physicians; Population; Predisposition; Primary Health Care; Prognosis; Reporting; Risk; Role; Rural Population; Self Efficacy; Stage at Diagnosis; Stress; System; Telemedicine; Testing; Time; United States; base; cancer prevention; cultural competence; cultural values; design; effective intervention; experience; follow-up; health care availability; improved; melanoma; mortality risk; multiple data sources; neoplasm registry; patient-clinician communication; patient-level barriers; population based; primary care setting; response; screening; screening guidelines; skin lesion; therapy design; treatment response; tumor

Project Summary Hispanics are diagnosed with melanoma at later stages than their non-Hispanic white (NHW) counterparts, leading to increased likelihood of metastasis and worse survival. Hispanics are the largest ethnic group in the United States and have rising rates of melanoma, and in particular, increases in tumors with the worst prognosis. Hispanics represent an underserved and understudied population when it comes to melanoma occurrence and outcome. In our recent analysis, while the risk of presenting with a late stage melanoma was higher for Hispanics (OR:1.65 [95% CI:1.52-1.79]) than NHW, the overall risk of death from melanoma after accounting for stage at diagnosis was similar for Hispanics and NHW (HR: 0.99 [95% CI: 0.94-1.04]), implying that the overall poorer prognosis for Hispanics is due almost entirely to their later stage of disease at diagnosis, rather than response to treatment or other factors (e.g. ability to access treatment) once they are diagnosed. A later stage of diagnosis among Hispanics could be due to a multitude of factors all of which are modifiable: a lack of access to appropriate screening, lack of adherence to screening recommendations, lack of understanding of appropriate screening approaches in the primary care setting (among both patients and physicians), or a combination of these factors. The key question remaining to be answered is WHY Hispanics are diagnosed at a later stage: without answering that question, we cannot begin to design, test and implement effective interventions to improve earlier detection and reduce melanoma-related disparities for Hispanics. We will investigate modifiable factors related to diagnosis at later stage in Hispanics compared to NHW. Aim 1: Determine the roles of patient-perceived risk and knowledge of melanoma, perceived barriers to melanoma screening and diagnosis, patient access to screening and diagnosis, and cultural factors in determining the later stage at diagnosis of melanoma in Hispanic compared to NHW melanoma patients. Aim 2: Determine how, when and by whom melanomas are diagnosed (among Hispanics and NHW) and what factors are related to time delays in the diagnosis of melanoma. Aim 3: Develop, deliver and test a clinic-based health education telenovela intervention designed to achieve earlier diagnosis of melanoma among Hispanics. We will obtain data from multiple sources for this study in order to minimize the potential impact of selection, response and survival biases all of which would compromise the scientific rigor of our Approach. We will identify the key factors resulting in late diagnosis of melanoma among Hispanics to provide truly population- based data on HOW to develop targeted patient-and-systems level interventions to reduce the melanoma burden among Hispanics. We will then test targeted patient-and-physician level interventions carried out in low income primary care setting ensuring that we intervene at the earliest possible stage.

项目摘要 与非西班牙裔白人(NHW)相比，西班牙裔美国人被诊断为黑色素瘤的时间较晚， 导致转移的可能性增加，存活率变差。拉美裔是美国最大的种族群体 在美国，黑色素瘤的发病率不断上升，特别是在病情最严重的肿瘤中 预后。当涉及到黑色素瘤时，西班牙裔代表着服务不足和研究不足的人群 发生和结果。在我们最近的分析中，虽然出现晚期黑色素瘤的风险是 西班牙裔(OR：1.65[95%CI：1.52-1.79])高于NHW，死于黑色素瘤的总体风险 拉美裔和nhw的诊断分期相似(HR：0.99[95%CI：0.94-1.04])，这意味着 拉美裔美国人的整体预后较差几乎完全是由于他们在确诊时的晚期疾病， 而不是在确诊后对治疗或其他因素(例如获得治疗的能力)做出反应。一个 拉美裔美国人的后期诊断可能是由于许多因素，所有这些因素都是可以修改的：a 缺乏获得适当筛查的机会，不遵守筛查建议，缺乏 了解初级保健环境中的适当筛查方法(在患者和 医生)，或这些因素的组合。有待回答的关键问题是为什么拉美裔美国人 如果不回答这个问题，我们就不能开始设计、测试和实现 有效的干预措施，以改善早期发现和减少西班牙裔黑色素瘤相关差异。我们 将调查与西班牙裔后期诊断相关的可修改因素，并与NHW相比。 目标1：确定患者感知的风险和对黑色素瘤的了解、感知的障碍 黑色素瘤筛查和诊断，患者获得筛查和诊断的途径，以及文化因素 与nhw黑色素瘤患者比较，确定西班牙裔黑色素瘤诊断的晚期。 目标2：确定如何、何时和由谁诊断黑色素瘤(在西班牙裔和NHW中)以及诊断内容 黑色素瘤诊断的时间延迟与这些因素有关。 目标3：开发、提供和测试以诊所为基础的健康教育Telenovela干预，旨在实现 西班牙裔美国人黑色素瘤的早期诊断。 我们将从多个来源获取这项研究的数据，以最大限度地减少选择的潜在影响， 回应和生存偏见，所有这些都会损害我们方法的科学严谨性。我们会 确定导致拉美裔美国人黑色素瘤诊断延迟的关键因素，以提供真正的人群- 基于如何开发有针对性的患者和系统水平的干预措施以减少黑色素瘤的数据 拉美裔美国人的负担。然后，我们将测试在Low中执行的有针对性的患者和医生级别的干预 收入初级保健环境确保我们在尽可能早的阶段干预。