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）因其疾病和严格治疗而面临晚期和长期影响的高风险。西班牙裔CCS，谁是在生存研究中代表性不足，显示出显着的健康不平等的死亡率相比，非西班牙裔。虽然终身，基于风险的后续护理建议CCS，使用这种护理迅速下降，CCS进入成年期。我们在两家医院（调查时年龄为14-26岁）接受治疗的CCS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）CCS中与癌症相关的随访护理显着降低。我们建议招募并调查一个基于人群的队列（n= 1，232），其中包括新出现的成年（18-39岁）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平等，以及可能差异影响西班牙裔和非西班牙裔CCS健康结局的因素。我们的目标是确定：1）接受癌症相关随访护理的风险和保护因素; 2）所接受的随访护理（基于医疗记录审查）是否与已发布的长期随访指南（针对患者特定癌症和临床病史）一致/遵守;以及3）成年期的里程碑之间的关系（例如，全职工作、结婚、生子）和接受癌症相关的后续护理。对指南护理的依从性将由医生小组评估。比较分析将用于确定种族和治疗部位（癌症生存率诊所和 初级保健/社区诊所）。这项基于人群的研究结果将为识别和减少西班牙裔和非西班牙裔CCS在医疗保健利用、晚期效应和最终长期生存方面的健康不平等提供指导。结果可以指导教育/政策的努力，重点是临床医生治疗西班牙裔CCS以及支持专门的过渡诊所和健康促进工作，重点是CCS进入成年期。

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.