Effect of Cancer on the Survivors' and Their Families' Economic Well-Being

项目概述/摘要在美国人口中有1000万成年癌症幸存者。由于更好的诊断、更好的治疗以及随着人口老龄化而增加的癌症发病率，幸存者的数量将在未来进一步增长。改善幸存者及其家属的生活质量是一个突出的公共卫生问题，也是国家癌症研究所的首要优先事项之一。幸存者及其家人面临着癌症及其治疗带来的多重挑战，包括经济问题。虽然研究人员、政策制定者和临床从业人员都明白，癌症对患者和幸存者的家庭往往是经济上的毁灭性打击，但其影响从未得到充分的描述。以前的研究很少，而且经常使用小的、不具代表性的样本，只关注老年人，并采用主观的财务需求报告。这个项目将提供第一套准确的、因果的、客观的癌症对家庭经济福利变化的估计。这项研究在几个关键方面具有创新性。我们使用了收入动态面板研究（PSID），这是一项对8400多个家庭进行的具有全国代表性的大型纵向调查，被广泛认为是美国家庭经济行为最重要的可靠信息来源。这一数据来源使我们能够研究幸存者及其配偶的就业、应税收入和转移收入、医疗支出和家庭财富的变化。分4波反复收集PSID肿瘤信息。健康报告的质量非常好，调查的纵向结构增加了额外的力量，因为它提供了疾病发病的多个回顾性报告。第一个具体目标是评估跨多个报告的一致性和准确性。这种类型的分析从未进行过，并将深入了解自我报告的健康状况的可靠性。利用这些结果，第二个具体目标是评估诊断如何影响幸存者及其配偶的就业、收入、医疗支出和财富，以及哪些家庭和癌症特异性特征可以改善该疾病的经济影响。以前的研究只使用幸存者的报告，或者将幸存者与健康对照者进行比较。相比之下，我们采用了计量经济学中开发的独特的混合效应模型结构，以隔离诊断后个人（或家庭）内发生的经济指标的变化，与诊断前相比。这个分析模型也有可能改变癌症生存研究，因为它适用于检查癌症对家庭的广泛影响，包括婚姻状况动态或父母被诊断患有癌症的孩子的结果。

DESCRIPTION (provided by applicant): PROJECT SUMMARY/ABSTRACT There are 10 million adult cancer survivors in the U.S. population. Thanks to better diagnosis, improved treatment, and increased cancer incidence as the population ages, the number of survivors will grow further in the future. Improving the quality of life among the survivors and their families is a prominent public health issue and one of the top priorities of the National Cancer Institute. The survivors and their families face multiple challenges resulting from cancer and its treatment, including economic issues. While researchers, policy makers, and clinical practitioners understand that cancer is often financially devastating to the families of patients and survivors, the effects have never been adequately described. Previous studies are few, and often use small, non-representative samples, focus only on older adults, and employ subjective reports of financial need. This project will provide the first set of exact, causal, objective estimates of the changes in economic well-being that occur in families as a result of cancer. This study is innovative in several key aspects. We use the Panel Study of Income Dynamics (PSID), a large, nationally-representative longitudinal survey of over 8,400 families, widely regarded as the most prominent source of reliable information on the economic behavior of American families. This data source allows us to study changes in the survivors' and spouses' employment, taxable and transfer incomes, medical expenditures, and household wealth. The PSID cancer information was collected repeatedly in 4 waves. The quality of the health reporting is excellent and the longitudinal structure of the survey adds additional strength because it provides multiple retrospective reports of the disease onset. The first specific aim is to evaluate the reporting consistency and accuracy across the multiple reports over time. This type of analysis has never been conducted and will offer insight into the reliability of self-reported health conditions. Using the results, the second specific aim is to assess how the diagnosis affects the survivors' and their spouses' employment, income, medical expenditures, and wealth, as well as what family and cancer-specific characteristics ameliorate the economic impact of the disease. Previous studies have used only the survivors' reports or compared the survivors with healthy controls. In contrast, we employ a unique mixed-effects model structure developed in econometrics to isolate the changes in economic indicators that occur within individuals (or within families) after the diagnosis, compared to before the diagnosis. This analytic model also has the potential to change the cancer- survivorship research because it is applicable to examining a wide range cancer's effects on the family, including marital status dynamics or outcomes of children whose parents have been diagnosed with cancer. PUBLIC HEALTH RELEVANCE: PROJECT NARRATIVE There are over 10 million adult cancer survivors in the US population. Improving their quality of life is one of the strategic objectives of the National Cancer Institute and an important public health issue. This project will provide the first comprehensive and objective estimates of employment, income, and wealth changes caused by cancer for survivors and their families. Understanding the economic impact of this disease will contribute information critical to understanding and meeting the survivors' needs.