RESIDENTIAL MOBILITY, TREATMENT QUALITY AND SURVIVAL IN LOW-INCOME WOMEN WITH BREAST CANCER

项目总结/摘要 乳腺癌结局的差异在种族和社会经济地位之间持续存在。参加医疗保险的妇女 不像参加其他类型健康保险的人那样获得同等程度的生存福利， 与没有保险的妇女一样，预后也很差。年轻、低收入患者面临更多障碍， 获得和坚持高质量的癌症护理，因为癌症的医疗费用构成了更严重的财务问题。 与老年患者相比，年轻患者的负担更重。医疗补助保险人获得高质量癌症护理的障碍 妇女还没有得到充分的理解。我们的初步数据显示，有医疗保险的妇女 乳腺癌诊断后移动的。尽管有充分的证据表明， 行为和健康结果，缺乏评估住宅搬迁影响的研究 癌症诊断后对患者治疗依从性和结果的影响。医疗补助计划的参与者 获得专家护理。乳腺癌的大部分辅助治疗都是在门诊进行的。作为 因此，协调多个提供者的预约和治疗是一个重大的挑战， 移动的患者。癌症诊断后的居住搬迁可能是继续治疗的关键障碍， 低收入患者的癌症治疗完成率很低，从而影响他们的预后。也关注于我们的 与密苏里州癌症登记处和密苏里州医疗补助计划建立了合作关系，我们将 建立一个以当代人口为基础的低收入乳腺癌妇女队列， 医疗补助要求密苏里州癌症登记处。另外五个有价值的数据源将用于定义 社区、供应商和设施的特点。我们将研究住宅搬迁的影响 在低收入乳腺癌妇女中，在诊断的前12个月内坚持治疗（Aim 1）。住宅搬迁及其地理模式将被定义，这使我们能够捕捉动态 邻里接触。我们还将评估住宅搬迁和乳房之间的关联 低收入妇女的癌症结局（目标2）。它将控制居民流动引起的空间不确定性 并准确地估计社区对癌症结果的影响。此外，我们还将研究 居民搬迁解释了在坚持治疗和预后结果方面的种族差异， 患有乳腺癌的低收入妇女（目标3）。这将是第一个评估住宅 搬迁在坚持乳腺癌治疗和低收入患者的预后。它将加深我们的 了解医疗服务不足的乳腺癌患者预后不良的原因。的 一项研究将有助于指导乳腺癌差异干预措施，这些干预措施可能针对居住在移动的低收入人群 患者和减轻住宅搬迁对癌症治疗和结果的不利影响。

PROJECT SUMMARY/ABSTRACT Disparities in breast cancer outcomes persist across race and socioeconomic status. Medicaid-insured women do not gain the same degree of survival benefit as those enrolled in other types of health insurance, but experience similarly poor prognosis as uninsured women. Younger, low-income patients face more barriers to access and adherence to high-quality cancer care as medical costs for cancer pose a more severe financial burden to younger compared to older patients. The barriers to high-quality cancer care for Medicaid-insured women have not been fully understood. Our preliminary data showed that Medicaid-insured women are highly mobile after breast cancer diagnosis. Despite the well documented effects of residential relocation on behaviors and health outcomes, there is lack of research that assesses the impacts of residential relocation after cancer diagnosis on patient's adherence to therapy and outcomes. Medicaid enrollees have inadequate access to specialist care. Much of adjuvant therapy for breast cancer is delivered in outpatient settings. As a result, coordination of multiple provider appointments and treatments is a significant challenge for residentially mobile patients. Residential relocation following cancer diagnosis may act as a key barrier to continuation and completion of cancer treatment for low-income patients and thus influences their prognosis. Drawing on our established collaborations with the Missouri Cancer Registry and the Missouri Medicaid Program, we will develop a contemporary population-based cohort of low-income women with breast cancer by linking the Medicaid claims to the Missouri Cancer Registry. Five other valuable data sources will be used to define characteristics of neighborhoods, providers and facilities. We will examine the impact of residential relocation on adherence to therapy in the first 12 months of diagnosis among low-income women with breast cancer (Aim 1). Residential relocation and its geographic patterns will be defined, which allows us to capture the dynamics of neighborhood exposures. We will also assess the associations between residential relocation and breast cancer outcomes in low-income women (Aim 2). It will control for residential mobility-induce spatial uncertainty and accurately estimate neighborhood impacts on cancer outcomes. Furthermore, we will examine the extent to which residential relocation explains racial disparities in adherence to therapy and prognostic outcomes in low-income women with breast cancer (Aim 3). This will be the first study to assess the role of residential relocation in adherence to breast cancer therapy and prognosis among low-income patients. It will deepen our understanding of the reasons for poor prognosis in medically underserved populations with breast cancer. The study will help guide breast cancer disparity interventions that could target residentially mobile, low-income patients and mitigate the adverse impacts of residential relocation on cancer treatment and outcomes.