Stress-related inflammation and racial disparities in ovarian cancer

卵巢癌中与压力相关的炎症和种族差异

• 批准号: 10064445
• 负责人: Tomi F Akinyemiju
• 金额: $ 14.63万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-01 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10064445
• 关键词: Address; Adjuvant; Aftercare; American; Area; Attitude; Cancer Patient; Cancer Survivor; Caring; Community Surveys; Complex; Cost Sharing; Data; Data Set; Databases; Development; Dimensions; Equation; Fatigue; Financial Hardship; Guidelines; Health Personnel; Health Services Accessibility; Healthcare; Hospitals; Inflammation; Knowledge; Link; Location; Malignant Neoplasms; Malignant neoplasm of ovary; Mediating; Medicare; Mental Depression; Modeling; National Cancer Institute; Nature; Neighborhoods; Operative Surgical Procedures; Outcome; Pain; Patient Outcomes Assessments; Patients; Patterns of Care; Perception; Pharmaceutical Preparations; Platinum; Population; Poverty; Provider; Quality of Care; Quality of life; Race; Reporting; Research Personnel; Resources; Rural; SEER Program; Sampling; Social support; Source; Specialist; Stress; Structure; Subgroup; Supportive care; Surveys; Survival Rate; Survivors; Symptoms; Time; Travel; Trust; Tumor Debulking; Woman; barrier to care; base; cancer care; cancer survival; cancer therapy; chemotherapy; cohort; disparity reduction; health care availability; health care service; health care service organization; health literacy; healthcare acceptability; improved; insight; neoplasm registry; novel; patient-clinician communication; population based; preference; racial difference; racial disparity; recruit; socioeconomics; surveillance data; symptom management; theories; treatment strategy; trend

Less than 40% of ovarian cancer (OC) patients in the US receive stage-appropriate guideline- adherent surgery and chemotherapy; Black OC patients are even less likely to receive such treatment. While 5-year relative survival for White OC patients improved by 47% between 1975 and 2009, it declined by 27% for Black patients during this same period. Among cancer survivors, Black patients are also observed to have significantly higher depression, pain, and fatigue than White survivors. These racial disparities are likely due largely to differences in healthcare access – specifically, access to high quality initial treatment and post- treatment supportive care. Healthcare access is a complex subject; however, the Penchansky healthcare access framework proposed that it comprises of five specific dimensions: availability, affordability, accessibility, accommodation and acceptability of health care services. Our study will comprehensively evaluate all five dimensions of healthcare access (HCA) among Black and White patients to identify and quantify the specific factors contributing to the striking racial differences in OC care and survival. More specifically, we will utilize data from SEER-Medicare (8,060 OC patients) along with primary survey data from a population-based sample of 1,010 OC patients, linked with several existing datasets (e.g., American Community Survey, Area Healthcare Resource File), to characterize racial differences in associations between each HCA dimension and three outcomes: quality of initial treatment and supportive care, quality of life based on patient-reported outcomes in prevalent yet manageable symptoms, and survival. We will evaluate HCA dimensions across patient, neighborhood, provider and hospital levels, and utilize hierarchical regression models with random effects to account for clustering, and multilevel structural equation models to estimate the total, direct and indirect effect of race on treatment mediated through HCA dimensions. Our preliminary studies suggest that certain under-studied dimensions (e.g., acceptability) may outweigh other dimensions (e.g., availability) in determining quality of care. Moreover, the impact of the various HCA dimensions may vary by race. By analyzing high-quality multilevel datasets with Black and White patients, we can fully characterize the nature of racial disparities, assess the relative importance of race-specific barriers to care, and identify race-specific modifiable factors. Our study will provide novel, empirical, and generalizable insights regarding the distinct and collective influence of HCA dimensions on OC outcomes. These insights will help identify and prioritize specific modifiable factors that can then be targeted to reduce disparities and improve care for all patients.

在美国，只有不到40%的卵巢癌(OC)患者接受了符合分期的指南 手术和化疗；黑人OC患者接受此类治疗的可能性更小。而5年期 1975至2009年间，白人OC患者的相对存活率提高了47%，而2005年则下降了27% 黑人患者在同一时期。在癌症幸存者中，黑人患者也被观察到有 与白人幸存者相比，白人幸存者的抑郁、疼痛和疲劳程度要高得多。这些种族差异很可能是由于 这在很大程度上是由于医疗保健获得方面的差异--具体地说，获得高质量的初始治疗和后治疗的机会 治疗支持性护理。医疗保健获取是一个复杂的主题；然而，Penchansky医疗保健 准入框架提出，它包括五个具体方面：可获得性、可负担性、 卫生保健服务的可及性、住宿性和可接受性。我们的研究将全面 评估黑人和白人患者的医疗保健准入(HCA)的所有五个维度，以确定和 量化导致OC护理和存活率显著种族差异的具体因素。更多 具体地说，我们将利用SEER-Medicare(8,060名OC患者)的数据以及初步调查数据 来自1010名OC患者的基于人群的样本，与几个现有的数据集(例如，American 社区调查，地区医疗资源文件)，以表征关联中的种族差异 在每个HCA维度和三个结果之间：初始治疗和支持性护理的质量， 生活基于患者报告的普遍但可控症状的结果和存活率。我们会 跨患者、邻居、提供者和医院级别评估HCA维度，并利用分层 具有随机效应的回归模型用于解释聚类，多层结构方程模型用于 通过HCA维度估计种族对治疗的总体、直接和间接影响。我们的 初步研究表明，某些研究不足的方面(例如，可接受性)可能会超过其他方面 在决定护理质量时的维度(例如，可用性)。此外，各种HCA的影响 尺寸可能因种族而异。通过分析黑人和白人患者的高质量多级数据集， 我们可以充分描述种族差异的性质，评估特定种族的相对重要性 护理障碍，并确定特定于种族的可修改因素。我们的研究将提供新颖的、实证的和 关于HCA维度对OC结果的不同和集体影响的概括性见解。 这些见解将有助于确定特定的可修改因素并确定其优先顺序，然后可以有针对性地减少这些因素 并改善对所有患者的护理。