The influence of the built environment on outcomes after breast cancer

建筑环境对乳腺癌术后预后的影响

• 批准号: 7739114
• 负责人: Theresa H M Keegan
• 金额: $ 15.95万
• 依托单位: CANCER PREVENTION INSTIT OF CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7739114
• 关键词: Advocate; African American; Area; Asian Americans; Automobile Driving; Behavior; Body Size; Body mass index; Breast Cancer Prognostic Factor; California; Cancer Etiology; Cancer Patient; Cancer Survivor; Cardiovascular Diseases; Cessation of life; Characteristics; Communities; Cox Proportional Hazards Models; Data; Destinations; Diabetes Mellitus; Diagnosis; Environment; Epidemiologic Studies; Food; Geographic Information Systems; Goals; Health; Health Professional; Health behavior; Hispanics; Individual; Interview; Joints; Knowledge; Life; Malignant Neoplasms; Measures; Modeling; Neighborhoods; Not Hispanic or Latino; Obesity; Osteoporosis; Outcome; Overweight; Patients; Physical activity; Pilot Projects; Population; Public Health; Recommendation; Recreation; Recurrence; Relative (related person); Risk; Risk Factors; San Francisco; Second Primary Cancers; Supermarket; Survival Analysis; Survivors; Technology; Time; United States; United States National Institutes of Health; Walking; Weight Gain; Woman; behavior influence; breast cancer diagnosis; cancer diagnosis; design; ethnic minority population; follow-up; improved; interest; malignant breast neoplasm; mortality; neoplasm registry; population based; premature; prognostic; public health relevance; racial and ethnic; racial and ethnic disparities; success; treatment program; urban public health

DESCRIPTION (provided by applicant): For breast cancer (BC), the most common cancer of US women, the 5-year relative survival after diagnosis is now nearing 90%, resulting in an estimated 2.3 million US BC survivors in 2005. Yet, because BC is the 2nd leading cause of cancer death, and survivors have increased risks of recurrence, second cancers, adverse outcomes, and premature death, it is critical to identify modifiable factors that can reduce the risk for these conditions and improve survival, particularly in racial/ethnic minority populations who have less favorable outcomes. Some epidemiologic evidence suggests that body size and physical activity may be such modifiable factors and, moreover, that they are associated with community "built environment" characteristics such as the number of walkable destinations and the availability of recreation facilities and supermarkets. Given the limited success of public health efforts to reduce overweight/obesity and increase physical activity, two prominent goals of the NIH, it is important to consider alternative influences on physical activity behavior. This goal is particularly important for BC survivors, who are at greater risk of weight gain and decreased physical activity. To date, no studies have directly assessed the relationship between the built environment and BC outcomes; therefore, this study aims to consider the combined effects of physical activity, body size, and a comprehensive set of measures of the built environment on overall survival, BC-specific survival and second primary cancer after BC diagnosis. In doing so, this study will assess the independent associations between each of these variables and outcomes, and the relationships of these variables to each other. Utilizing Geographic Information Systems technology, this study efficiently combines data that objectively characterizes the built environments of the Greater San Francisco Bay Area of northern California, data on cancer diagnosis and follow-up from the population-based Greater Bay Area Cancer Registry, and interview data on individual level risk factors from over 4,000 multiethnic (African-American, Hispanic, Asian-American and non-Hispanic white) BC patients who participated in two population-based studies. Regression models will be used to assess the association between variables of interest and multivariate adjusted Cox proportional hazards modeling will be used in the survival analyses. PUBLIC HEALTH RELEVANCE: This study has the potential to identify how community environments may be changed to improve physical activity that, in turn, may improve outcomes in BC survivors. If the built environment proves to influence behaviors and outcomes, then this knowledge can be used by urban and public health planners to advocate changes to the built environment, and by health care professionals to design post-diagnosis treatment programs and/or recommendations for taking greater advantage of the existing built environment to improve health behaviors among BC survivors.

描述(申请人提供)：乳腺癌(BC)是美国女性最常见的癌症，确诊后5年的相对存活率接近90%，2005年估计有230万美国BC幸存者。然而，由于BC是癌症死亡的第二大原因，而幸存者复发、第二次癌症、不良结局和过早死亡的风险增加，确定可以降低这些情况的风险并提高生存率的可改变因素至关重要，特别是在预后不太有利的种族/少数民族人群中。一些流行病学证据表明，体型和体力活动可能是这种可改变的因素，而且，它们与社区的“建筑环境”特征有关，例如可步行目的地的数量以及娱乐设施和超市的可用性。鉴于减少超重/肥胖和增加体力活动的公共卫生努力成效有限，这是美国国立卫生研究院的两个突出目标，重要的是考虑对体力活动行为的替代影响。这一目标对BC幸存者尤其重要，他们体重增加和体力活动减少的风险更大。到目前为止，还没有研究直接评估建筑环境和BC结局之间的关系；因此，这项研究旨在考虑体力活动、身体尺寸和一套全面的建筑环境指标对总体生存率、BC特异性生存率和BC确诊后第二原发癌的影响。在此过程中，本研究将评估这些变量和结果之间的独立关联，以及这些变量之间的相互关系。利用地理信息系统技术，这项研究有效地结合了客观描述加州北部大旧金山湾区建成环境的数据、来自基于人口的大湾区癌症登记中心的癌症诊断和随访数据，以及参与两项基于人口的研究的4000多名多种族(非洲裔美国人、西班牙裔、亚裔美国人和非西班牙裔白人)BC患者的个体水平风险因素的访谈数据。回归模型将被用来评估感兴趣变量之间的关联，多变量调整后的Cox比例风险模型将被用于生存分析。公共卫生相关性：这项研究有可能确定如何改变社区环境以改善体力活动，进而可能改善BC幸存者的结局。如果建成环境被证明影响行为和结果，那么城市和公共卫生规划者可以利用这些知识来倡导对建成环境的改变，卫生保健专业人员可以利用这些知识来设计诊断后治疗计划和/或建议，以便更好地利用现有建成环境来改善不列颠哥伦比亚省幸存者的健康行为。