Promoting Equity of Cancer Screening and Follow-up for Lung Cancer

项目摘要/摘要：肺癌具有很高的致命性，死亡人数几乎与 乳腺癌、宫颈癌、结直肠癌和前列腺癌加在一起，但大多数肺癌病例都有可能 是可以预防的。大约80%-90%的病例与吸烟有关，筛查之后进行高质量的治疗 已被证明可以降低高危人群的死亡风险。因此，戒烟干预加上 筛查是美国预防服务工作组建议的两个相辅相成的支柱 FORCE和其他指南，以降低肺癌死亡率。不幸的是，肺癌筛查的接受度 (LCS)仍然很低，尽管包括农村在内的社会经济因素导致的肺癌死亡人数存在差异， 虽然得到了广泛的认可，但对它们的研究仍然不足。有证据表明，农村地区的肺癌发病率较高 死亡率高于城市人口，可能与风险因素和医疗保健获得有关。然而，努力实现 理解和解决城乡差距，因为农村人口在公众中的代表性较低 数据系统。这项提案的目的是阐明导致肺癌差异的因素。 并为今后的干预措施和政策提供背景信息。我们的具体目标 目的是：(1)描述肺癌预防和早期循证干预(EBI)的特征 通过评估戒烟干预措施的使用差异，对农村和城市地区进行检测 和LCS在多个级别的影响；(2)识别整个LCS连续体中潜在的可修改的护理缺口， 包括风险评估和及时治疗，通过检查死于肺癌的患者相对于患者 谁以城乡地位为生；以及(3)评估障碍和促进者的异同 在整个LCS连续体(戒烟、共享决策、筛查和 治疗)在农村和城市的情况下。我们将使用多维健康公平框架来应用 收敛的、混合的方法是我们的研究方法。我们将利用罗切斯特流行病学项目，一个 美国中西部27个县毗连地区的唯一基于人口的数据资源，以及 美国东南部12个州的南部社区队列研究，在50名不同的人口中进行- 80岁的老人。我们将使用城乡通勤区号来定义乡村，并将评估两个自我 报告的和地区一级的社会经济信息。我们将对患者进行半结构化访谈，并 临床工作人员对LCS障碍和促进剂的看法，包括吸烟相关的潜在作用 耻辱。这项拟议的研究有可能通过阐明肺癌预防方面的差距而产生重大影响。 和早期发现，这将直接转化为战略，以解决我们的顽固肺癌差异 研究人口，甚至更远的地方。因此，我们将解决NCI和总统癌症小组的优先事项 预付股本，并解决新冠肺炎对LCS交付的潜在影响。我们的跨学科团队 有高影响力研究的记录，并拥有成功完成这项研究所需的专业知识。

PROJECT SUMMARY/ABSTRACT: Lung cancer is highly lethal and accounts for nearly as many deaths as breast, cervical, colorectal, and prostate cancers combined, but most lung cancer cases are potentially preventable. About 80-90% of cases are smoking-related, and screening followed by high-quality treatment has been shown to reduce the risk of death in people at high-risk. Therefore, smoking cessation interventions plus screening are two complementary pillars that are recommended together by the US Preventive Services Task Force and other guidelines to reduce the lung cancer death rate. Unfortunately, uptake of lung cancer screening (LCS) remains low and although disparities in lung cancer deaths by socioeconomic factors, including rurality, are widely acknowledged, they remain understudied. Evidence shows that rural areas have higher lung cancer death rates than urban populations, likely related to risk factors and healthcare access. However, efforts to understand and address rural-urban disparities are hampered by low representation of rural populations in public data systems. The goal of this proposal is to elucidate factors that contribute to lung cancer disparities between rural and urban areas and provide contextual information for future interventions and policies. Our specific aims are to: (1) Characterize the delivery of evidence-based interventions (EBIs) for lung cancer prevention and early detection, comparing rural to urban areas, by assessing differences in use of smoking cessation interventions and LCS at multiple levels of influences; (2) Identify potentially modifiable care gaps across the LCS continuum, including risk assessment and timely treatment, by examining patients who died of lung cancer relative to patients who are alive by rural-urban status; and (3) Evaluate similarities and differences in the barriers and promoters to delivery of EBIs across the LCS continuum (smoking cessation, shared decision-making, screening, and treatment) in the rural and urban contexts. We will use a multidimensional health equity framework to apply a convergent, mixed methods approach for our studies. We will leverage the Rochester Epidemiology Project, a unique population-based data resource for a 27-county contiguous area in the Midwestern US, along with the Southern Community Cohort Study across 12 states in the Southeastern US, among a diverse population of 50- 80-year-old people. We will use Rural-Urban Commuting Area codes to define rurality and will assess both self- reported and area-level socioeconomic information. We will conduct semi-structured interviews with patients and clinical staff to gain perspectives on LCS barriers and promoters, including the potential role of smoking-related stigma. The proposed research has the potential for high impact by elucidating gaps on lung cancer prevention and early detection that will translate directly into strategies to address intransigent lung cancer disparities in our study population, and beyond. We will thus address priorities of the NCI and the President’s Cancer Panel to advance equity and address the potential COVID-19 impact on the delivery of LCS. Our transdisciplinary team has a track record of high-impact research and has the needed expertise to successfully complete this research.