Project 3: Chronic Medical Conditions and Late Effects in the AYA Cancer Population

项目 3：AYA 癌症人群的慢性疾病和后期影响

• 批准号: 10263882
• 负责人: Theresa H M Keegan
• 金额: $ 35.22万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10263882
• 关键词: Accident and Emergency department; Address; Adolescent; Adolescent and Young Adult; Adult; Affect; Aftercare; Age; Ambulatory Surgical Procedures; Area; Asthma; Biological; California; Cancer Patient; Cancer Survivor; Cancer Survivorship; Cardiovascular Diseases; Cardiovascular system; Caring; Childhood; Childhood Cancer Survivor Study; Chronic; Chronic Kidney Failure; Clinical; Complement; Comprehensive Health Care; Country; County; Data; Diabetes Mellitus; Diagnosis; Drug Kinetics; Early Diagnosis; Electronic Health Record; Employment; Endocrine; Endocrine System Diseases; Ethnic Origin; Face; Fertility; Financial Hardship; Goals; Guidelines; Health; Health Insurance; Health Personnel; Health system; Healthcare; High Prevalence; Hospitalization; Hospitals; Incidence; Individual; Inpatients; Insurance; Insurance Coverage; Integrated Health Care Systems; Intervention; Investigation; Kidney Failure; Late Effects; Lead; Life; Link; Liver Cirrhosis; Liver diseases; Long-Term Care; Lung diseases; Malignant Childhood Neoplasm; Malignant Neoplasms; Medical; Monitor; Necrosis; Neighborhoods; North Carolina; Oncology; Outcome; Outpatients; Patients; Phase; Population; Population Intervention; Prevention; Primary Health Care; Provider; Race; Registries; Reporting; Research; Research Infrastructure; Research Personnel; Research Priority; Resources; Risk; Second Primary Cancers; Socioeconomic Status; Source; Specialist; Stroke; Surveys; Survivors; System; Utah; Visit; age group; barrier to care; body system; cancer survival; cancer therapy; cancer type; care coordination; care seeking; care systems; clinical care; clinical examination; clinical infrastructure; cohort; cost; data resource; disparity reduction; diverse data; evidence based guidelines; experience; follow-up; health care service; health care service utilization; health disparity; high risk; improved; medical specialties; medically underserved; neoplasm registry; population based; preventive intervention; programs; respiratory; rural dwellers; rural underserved; social factors; survivorship

ABSTRACT – Project 3, Late Effects in the AYA Cancer Population Few studies have evaluated long-term medical outcomes in US survivors of adolescent and young (AYA) cancers, a population with among the greatest number of life-years affected by cancer. Studies on AYA survivors find elevated risks of medical conditions such as asthma, diabetes, and second cancers, but typically do not consider treatment in detail or examine results by clinical or patient factors to identify those at higher risk for late effects and poorer survival. This limited research hinders creating long-term care guidelines and interventions to improve health outcomes in this population. To address these evidence gaps, we propose a detailed examination of clinical care factors and their association with late effects in AYA cancer survivors using integrated P01 data resources: the clinical and research infrastructure of Kaiser Permanente (KP); the population-based California Cancer Registry (CCR) and Utah Cancer Registry (UCR), both linked to statewide healthcare data; and survey data from ~5,000 AYAs with cancer, including from North Carolina. The KP Northern California (KPNC) and Southern California (KPSC) integrated healthcare systems provide comprehensive healthcare services and use electronic health records that facilitate investigating late effects of cancer and its treatment. The CCR-hospitalization are from linking one of the largest, most diverse U.S. cancer registries with statewide hospitalization, emergency department, and ambulatory surgery data. The UCR-hospitalization are from similar sources for many rural and medically underserved residents. With these diverse resources, this study will assess chronic medical conditions and late effects (collectively called late effects) in AYA cancer survivors and will: 1) determine the incidence of late effects, examining how risks vary by primary cancer type, specific treatment approaches, race/ethnicity, neighborhood socioeconomic status, and health insurance coverage; 2) examine how guideline-concordant survivorship care and inpatient and outpatient visits to multiple provider types are associated with the risk of late effects; and 3) evaluate the influence of patient-reported barriers to care on late effects. We will use a cohort of ~53,000 AYAs diagnosed with cancer from 2006 through 2019 in California; ~13,000 will have been diagnosed and treated at KPNC or KPSC. Data from KPNC, KPSC and California hospitals allows medical outcome follow-up of AYA cancer survivors who leave or seek coverage outside the KP system and facilitates comparisons between those seeking care within and outside an integrated care system for late effects requiring hospitalization. Our analyses will be enhanced by approximately 8,400 AYAs from Utah, of whom ~1,700 are rural residents. We hypothesize a higher burden of late effects among AYAs with care barriers such as insurance and financial concerns that impact both initial and survivorship care. Results from this project will inform evidence-based guidelines on prevention and surveillance of late effects among AYAs with cancer by characterizing disparities and unique barriers to receipt of necessary care and lead to strategies to mitigate the impact of late effects.

摘要-项目3，AYA癌症人群的晚期效应 很少有研究评估美国青少年和年轻人幸存者的长期医疗结果 (AYA)癌症，是受癌症影响的生命年数最多的人群。AYA研究 幸存者发现患哮喘、糖尿病和第二种癌症等疾病的风险增加，但通常情况下， 不详细考虑治疗或通过临床或患者因素检查结果，以确定那些在更高 晚期效应和生存率降低的风险。这种有限的研究阻碍了制定长期护理指南， 采取干预措施，改善这一人群的健康状况。为了解决这些证据差距，我们提出了一个 详细检查临床护理因素及其与AYA癌症幸存者晚期效应的相关性 使用集成的P01数据资源：Kaiser Permanente（KP）的临床和研究基础设施; 基于人口的加州癌症登记处（CCR）和犹他州癌症登记处（UCR），两者都与全州范围的 医疗保健数据;以及来自约5，000名患有癌症的AYA的调查数据，包括来自北卡罗来纳州的数据。金伯利进程 北方加州（KPNC）和南加州（KPSC）的综合医疗保健系统提供 提供全面的医疗保健服务，并使用电子健康记录，以便于调查 癌症及其治疗CCR住院治疗是从连接一个最大的，最多样化的美国。 癌症登记处提供全州住院、急诊和门诊手术数据。的 对于许多农村和医疗服务不足的居民来说，UCR住院治疗来自类似的来源。与这些 这项研究将评估慢性疾病和晚期效应（统称为晚期效应）。 影响），并将：1）确定晚期效应的发生率，检查风险如何变化 按原发癌症类型、具体治疗方法、种族/民族、社区社会经济地位， 和健康保险覆盖范围; 2）检查指南一致的生存护理和住院病人， 对多种提供者类型的门诊访问与晚期效应的风险相关;以及3）评估 患者报告的护理障碍对晚期效应的影响。我们将使用一个约53，000名确诊的AYA队列， 从2006年到2019年，加州将有大约13,000名癌症患者在KPNC或 KPSC来自KPNC、KPSC和加州医院的数据允许对AYA癌症的医疗结果进行随访 离开金伯利进程系统或在金伯利进程系统外寻求保险的幸存者， 在综合护理系统内外寻求护理，以治疗需要住院治疗的晚期效应。我们 来自犹他州的约8,400名AYA将加强分析，其中约1,700名是农村居民。我们 假设有医疗障碍（如保险和财务障碍）的AYA的迟发效应负担更高 影响初始和生存护理的问题。该项目的结果将为基于证据的 通过描述差异来预防和监测癌症AYA患者的晚期效应的指南 和独特的障碍，以获得必要的照顾，并导致战略，以减轻后期效应的影响。