Abramson Cancer Center Support Grant

项目摘要 本申请是为了响应被标识为NOT-CA的特别利益通知（NOSI）而提交的- 21-058.生活在低收入和中等收入国家（LMIC）的癌症幸存者人数预计将增加 在未来十年中，部分由于全球在早期发现和治疗方面的进步， 了解癌症幸存者的长期需求或在中低收入国家提供生存护理。这种补充剂 应用程序将有助于通过定量和定性评估护理结果来填补这一关键的研究空白 博茨瓦纳被诊断为宫颈癌的妇女中生存护理的背景决定因素。 宫颈癌是全球女性中最主要的癌症之一，每年有60万新发病例， 2020年每年死亡人数估计数。宫颈癌是一种获得性免疫缺陷综合征（艾滋病）的定义 人类免疫缺陷病毒（HIV）感染率高的国家， 宫颈癌由于高艾滋病毒感染率和次优的筛查吸收，宫颈癌的大部分负担 低收入国家的癌症发病率、发病率和死亡率福尔斯下降，特别是在撒哈拉以南非洲，许多妇女 出现了晚期疾病博茨瓦纳是撒哈拉以南的非洲国家，宫颈癌发病率很高 （发病率为每10万人34.4例）和艾滋病毒（患病率为18.5%），宫颈癌死亡率很高 妇女中的癌症（每100 000人中有20.1人）。迄今为止，博茨瓦纳和其他中低收入国家的大多数癌症研究 一直专注于早期发现或治疗，评估长期身体或 生存的心理社会结果或生存护理如何影响这些结果。而且就算 关于哪种方法可能最有效和可持续地提供生存护理， 在中低收入国家。因此，迫切需要了解中低收入国家的生存现状， 制定有效战略，确保所有妇女获得最佳生存护理。本项目的目标是 目的：1）定量描述a）治疗后生存护理模式和B）长期身体和 使用Princess Marina医院现有患者队列研究宫颈癌的心理社会后遗症 哈博罗内，博茨瓦纳;和2）定性评估上下文的决定因素（例如，生活质量，获得 资源，护理提供策略）塑造患者的经验和坚持生存护理。在 结合使用，这些数据将用于制定和/或调整生存护理干预措施，以针对特定的 博茨瓦纳和其他中低收入国家的背景决定因素。该项目的成果将推动科学 了解中低收入国家的生存护理和后遗症，以及这些经验可能会或可能不会有所不同 从高收入国家癌症幸存者的经历和需求中。该项目还将产生 改善全球癌症幸存者的生存和生活质量所需的基本证据。长期 该项目的目标是通过开发和 实施生存护理干预措施，在资源较低的情况下可以持续。

PROJECT SUMMARY This application is being submitted in response to the Notice of Special Interest (NOSI) identified as NOT-CA- 21-058. The number of cancer survivors living in low- and middle-income countries (LMICs) is expected to grow rapidly over the next decade driven in part by global advances in early detection and treatment, yet very little is known about the long-term needs of cancer survivors or delivery of survivorship care in LMICs. This supplement application will help to fill this critical research gap by quantitatively and qualitatively evaluating care outcomes and contextual determinants of survivorship care among women diagnosed with cervical cancer in Botswana. Cervical cancer is one of the leading cancers among women globally with 600,000 new cases and 340,000 deaths annually per 2020 estimates. Cervical cancer is an acquired immunodeficiency syndrome (AIDS)-defining malignancy, and countries with high rates of human immunodeficiency virus (HIV) have higher incidence of cervical cancer. Due to high HIV-infection rates and suboptimal screening uptake, most of the burden of cervical cancer incidence, morbidity, and mortality falls on LMICs particularly in sub-Saharan Africa, with many women presenting with advanced disease. Botswana, a sub-Saharan African country, has high rates of cervical cancer (incidence rate of 34.4 per 100,000) and HIV (18.5% prevalence), and a high rate of mortality due to cervical cancer (20.1 per 100,000) among women. To date, the majority of cancer research in Botswana and other LMICs has focused on early detection or treatment, with limited research evaluating the long-term physical or psychosocial outcomes in survivorship or how survivorship care may impact these outcomes. Furthermore, even less is known regarding which approaches may be most impactful and sustainable to deliver survivorship care in LMICs. As such, there is a critical need to understand the current state of survivorship in LMICs and to identify effective strategies to ensure that all women receive optimal survivorship care. The objectives of this project are to: 1) quantitatively describe a) patterns in post-treatment survivorship care and b) long-term physical and psychosocial sequelae of cervical cancer using an existing cohort of patients at Princess Marina Hospital in Gaborone, Botswana; and 2) qualitatively assess contextual determinants (e.g., quality of life, access to resources, care delivery strategies) shaping patient experiences and adherence to survivorship care. In combination, these data will be used to develop and/or adapt survivorship care interventions to target the specific contextual determinants in Botswana and other LMICs. The results of this project will advance scientific understanding of survivorship care and sequelae in LMICs and how these experiences may or may not differ from the experiences and needs of cancer survivors in high-income countries. This project will also generate fundamental evidence needed to improve survival and quality of life of cancer survivors globally. The long-term goal of this project is to decrease cervical cancer mortality in Botswana and other LMICs by developing and implementing survivorship care interventions that can be sustained in lower resource settings.