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

描述（由申请人提供）：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，未来幸存者的数量将进一步增长。改善幸存者及其家人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任务之一。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，政策制定者和临床医生都知道癌症通常会对患者和幸存者的家庭造成经济上的破坏，但其影响从未得到充分描述。以前的研究很少，通常使用小的，非代表性的样本，只关注老年人，并采用主观的财务需求报告。该项目将提供第一套准确的，因果的，客观的估计，在经济福祉的变化，发生在家庭中的癌症的结果。本研究在几个关键方面具有创新性。我们使用收入动态面板研究（PSID），这是一项对8，400多个家庭进行的大型全国代表性纵向调查，被广泛认为是美国家庭经济行为可靠信息的最重要来源。这个数据源使我们能够研究幸存者和配偶的就业，应纳税和转移收入，医疗支出和家庭财富的变化。PSID癌症信息以4个波重复收集。健康报告的质量很好，调查的纵向结构增加了额外的力量，因为它提供了疾病发作的多个回顾性报告。第一个具体目标是评估多份报告在一段时间内的报告一致性和准确性。这种类型的分析从未进行过，并将提供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减轻了疾病的经济影响。以前的研究只使用幸存者的报告或将幸存者与健康对照组进行比较。相比之下，我们采用了计量经济学中开发的独特混合效应模型结构，以隔离诊断后与诊断前相比，个人（或家庭）内发生的经济指标变化。这种分析模型也有可能改变癌症生存率研究，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儿童的结果。 公共卫生相关性： 美国人口中有超过1000万成年癌症幸存者。提高他们的生活质量是国家癌症研究所的战略目标之一，也是一个重要的公共卫生问题。该项目将为癌症幸存者及其家庭提供第一个全面和客观的就业，收入和财富变化估计。了解这一疾病的经济影响将有助于了解和满足幸存者的需要。

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.