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

低收入乳腺癌女性的居住流动性、治疗质量和生存率

• 批准号: 9791160
• 负责人: Min Lian
• 金额: $ 34.85万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9791160
• 关键词: Address; Adherence; Adjuvant Therapy; Affect; African American; Agriculture; American; Appointment; Area; Behavior; Black race; Breast; Breast Cancer therapy; Cancer Patient; Cancer Prognosis; Caring; Censuses; Characteristics; Code; Collaborations; Communication; Community Surveys; Commuting; County; Data; Data Sources; Databases; Diagnosis; Enrollment; Environment; Environmental Exposure; Equilibrium; Ethnic Origin; Face; Failure; Financial Hardship; Geography; Guidelines; Health; Health Insurance; Housing; Incidence; Individual; Intervention; Link; Location; Logistic Regressions; Low Income Population; Low income; Malignant Neoplasms; Mediating; Medicaid; Medical Care Costs; Mental Health; Missouri; Modeling; Neighborhoods; Odds Ratio; Oncologist; Outcome; Outpatients; Patients; Pattern; Physicians; Population; Probability; Provider; Quality of Care; Race; Radiation therapy; Research; Residential Mobility; Risk; Role; Rural; Socioeconomic Status; Specialist; Structural Models; Testing; Time; Treatment outcome; Uncertainty; Uninsured; Validity of Results; Woman; base; behavioral health; breast cancer diagnosis; cancer care; cancer diagnosis; cancer health disparity; cancer therapy; chemotherapy; cohort; compliance behavior; deprivation; experience; follow-up; health care availability; hormone therapy; improved; malignant breast neoplasm; medically underserved population; mortality; neighborhood disadvantage; neoplasm registry; novel; older patient; outcome forecast; physical conditioning; population based; prognostic; programs; racial disparity; residence; rurality; socioeconomics; therapy outcome; treatment disparity

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.

项目摘要/摘要 在种族和社会经济地位之间，乳腺癌结局的差异持续存在。医疗补助保险的妇女 不要获得与参加其他类型的健康保险的人相同程度的生存收益，而是 与未保险妇女一样，预后也类似。年轻的低收入患者面临更多的障碍 作为癌症的医疗费用，访问和遵守高质量的癌症护理构成了更严重的财务 与老年患者相比，年轻人的负担。医疗补助保险的高质量癌症护理的障碍 妇女尚未完全理解。我们的初步数据表明，医疗补助保险的妇女很高 乳腺癌诊断后移动。尽管住宅搬迁对 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，患者遵守治疗和结局。医疗补助注册人不足 获得专业护理。乳腺癌的大部分辅助治疗都在门诊环境中进行。作为 结果，多个提供者的任命和治疗的协调是居住的重大挑战 移动患者。癌症诊断后的住宅搬迁可能是延续和 为低收入患者完成癌症治疗，从而影响其预后。利用我们的 与密苏里州癌症注册表和密苏里医疗补助计划建立了合作，我们将 通过联系 医疗补助要求密苏里州癌症注册中心。其他五个有价值的数据源将用于定义 社区，提供者和设施的特征。我们将研究住宅搬迁的影响 低收入乳腺癌妇女的诊断前12个月遵守治疗（AIM） 1）。将定义住宅搬迁及其地理模式，这使我们能够捕获动态 邻里暴露。我们还将评估住宅搬迁与乳房之间的关联 低收入妇女的癌症结果（AIM 2）。它将控制住宅流动性 - 引发空间不确定性 并准确估计邻里对癌症结局的影响。此外，我们将研究 住宅搬迁解释了遵守治疗和预后结果的种族差异 低收入乳腺癌妇女（AIM 3）。这将是评估住宅作用的第一项研究 低收入患者遵守乳腺癌疗法和预后的迁移。它将加深我们的 了解医学上服务不足的乳腺癌预后不良的原因。这 研究将有助于指导乳腺癌的差异干预措施，这些干预措施可能针对可生活的低收入 患者并减轻住宅搬迁对癌症治疗和结局的不利影响。