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

项目总结/摘要：肺癌具有高度致死性， 乳腺癌、宫颈癌、结直肠癌和前列腺癌的总和，但大多数肺癌病例可能是 可以预防的大约80-90%的病例与吸烟有关，筛查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共同推荐的两个补充支柱 力和其他指导方针来降低肺癌死亡率。不幸的是，肺癌筛查的使用 (LCS)仍然很低，尽管社会经济因素，包括农村， 虽然被广泛承认，但仍然没有得到充分研究。有证据表明，农村地区肺癌发病率较高 死亡率高于城市人口，这可能与风险因素和医疗保健的可及性有关。然而，努力 农村人口在公共部门的代表性低，阻碍了对城乡差距的理解和解决 数据系统。该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治疗的循证干预措施（EBI）的特点。 通过评估使用戒烟干预措施的差异，比较农村和城市地区的发现情况 和LCS在多个层次的影响;（2）确定潜在的修改护理差距整个LCS连续， 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 （3）评价城乡地位的障碍和促进因素的异同 在整个LCS连续体（戒烟，共同决策，筛查， 在农村和城市环境中。我们将使用一个多层面的健康公平框架， 收敛，混合方法的方法，我们的研究。我们将利用罗切斯特流行病学项目， 一个独特的基于人口的数据资源，用于美国中西部27个县的毗连地区，沿着 南方社区队列研究，横跨美国东南部12个州，在50岁以下的不同人群中进行， 80岁的人。我们将使用城乡通勤区代码来定义乡村性，并将评估自我和自我 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， 临床工作人员获得LCS障碍和促进因素的观点，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，这将直接转化为解决我们国家中顽固的肺癌差异的战略， 研究人群，超越。因此，我们将处理NCI和总统癌症小组的优先事项， 提高公平性，并解决COVID-19对LCS交付的潜在影响。我们的跨学科团队 拥有高影响力研究的跟踪记录，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.