Reducing racial/ethnic inequities in childhood cancer survivorship

描述（由申请人提供）：尽管生存率有所提高，但儿童癌症幸存者（CCS）因其疾病和严格的治疗而处于晚期和长期影响的高风险中。西班牙裔CCS在生存研究中代表性不足，与非西班牙裔相比，在死亡率方面存在显着的健康不平等。虽然建议对CCS进行终身的、基于风险的随访治疗，但随着CCS进入初成年期，这种治疗的使用迅速下降。我们在两家医院接受CCS治疗的初步研究（调查年龄为14-26岁）表明，在成年早期（21-26岁），西班牙裔CCS患者的癌症相关随访护理明显低于非西班牙裔CCS患者。我们建议招募和调查一个以人群为基础的队列（n=1,232），包括18-39岁的新生成人西班牙裔（54%）和非西班牙裔CCS，以了解在接受推荐的随访护理方面的潜在不公平，以及可能不同地影响西班牙裔和非西班牙裔CCS健康结局的因素。我们的目的是确定：1)接受癌症相关随访治疗的风险和保护因素；2)如果接受的随访治疗（基于医疗记录审查）与已发表的长期随访指南（针对患者特定的癌症和临床病史）一致/符合；3)成年初期的里程碑（如全职工作、结婚、生孩子）与接受癌症相关的后续护理之间的关系。医师小组将评估对指南护理的依从性。比较分析将用于确定种族和治疗地点（癌症生存诊所和医院）的差异

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.