The Impact of COVID-19 Pandemic on Cancer Care and Health-Related Quality of Life of Racial and Ethnic Minority Women Diagnosed with Breast Cancer

COVID-19大流行带来的前所未有的负担对癌症治疗的提供产生了重大影响：患者对该疾病的脆弱性更大，新实施的治疗途径和方案可能会因治疗不理想或延迟而影响长期生存。对于接受乳腺癌治疗的少数种族和族裔妇女，为规范患者进入医疗环境和修改治疗顺序而实施的体制措施可能会加剧该疾病现有的不成比例的负担。因此，了解COVID-19对少数群体接受癌症治疗的影响，并确定潜在的可改变因素，为未来的医疗服务模式提供信息至关重要。U-HAND（休斯顿大学/MD安德森）减少癌症差异项目（P20CA221697; 9/22/17-8/31/21）是休斯顿大学和德克萨斯大学MD安德森癌症中心之间的合作伙伴关系，旨在支持卓越的教育规划和研究创新，以影响受癌症差异不成比例影响的种族/族裔群体的健康公平。拟议的行政补充申请是UHAND伙伴关系目标的自然延伸，它反映了其总体使命，即执行创新的社会/行为科学，旨在减轻黑人和西班牙裔群体的癌症不平等。具体而言，拟议的补充报告将通过调查COVID-19大流行对受该疾病及其社会心理后遗症严重影响的种族和族裔社区妇女获得最佳乳腺癌护理的影响，作为这一目标的延伸。根据行政申请人在癌症相关结果的中间决定因素方面的专业知识，该提案是合乎逻辑的下一步。收集的试点数据将评估诊断为早期乳腺癌的黑人和西班牙裔妇女（与非西班牙裔白人妇女相比）癌症护理中断率和健康相关生活质量的差异，并检查差异的近端、中间和远端决定因素如何影响这些结果。预计这项研究将提供有关“高危”患者的信息，以及利用现有社会资源的方法。最后，这些发现将用于为未来的多层次干预提供信息，以便在COVID-19急性后环境中维持有效的医疗服务模式。在为期一年的行政补充拨款期间，研究和指导培训活动将帮助申请人完成拟议项目的研究目标，并培养技能，以帮助她理解导致不同群体之间医疗保健利用和结果差异的机制，从而在减少和消除癌症差异方面取得成功。

The unprecedented burden of the COVID-19 pandemic has critical consequences for the delivery of cancer care: patients present greater vulnerability to the disease and newly implemented treatment pathways and protocols may affect long-term survival because of suboptimal or delayed care. For racial and ethnic minority women receiving treatment for breast cancer, institutional measures implemented to regulate access of patients to medical settings and modifications in therapy sequence may exacerbate the existing disproportionate burden of the disease. Therefore, understanding the impact of COVID-19 on the cancer care received by minority groups and identifying potentially modifiable factors to inform future models of care delivery is critical. The U-HAND (University of Houston/MD Anderson) Program to Reduce Cancer Disparities (P20CA221697; 9/22/17-8/31/21) is a collaborative partnership between the University of Houston and The University of Texas MD Anderson Cancer Center that supports excellence in educational programming and innovation in research that affects health equity among racial/ethnic groups disproportionately affected by cancer disparities. The proposed Administrative Supplement application is a natural extension of the aims of the UHAND partnership and it is reflective of its overarching mission to execute innovative social/behavioral science aimed at mitigating cancer inequities for Black and Hispanic groups. Specifically, the proposed Supplement will be an extension of this goal by investigating the impact that the COVID-19 pandemic has on the receipt of optimal breast cancer care among women from racial and ethnic communities disproportionately affected by the illness and its psychosocial sequelae. This proposal is a logical next step building upon the Administrative Applicant’s expertise on the intermediate determinants of cancer-related outcomes. Pilot data collected will assess differential rates of cancer care disruption and health-related quality of life among Black and Hispanic women diagnosed with early-stage breast cancer (as compared with non-Hispanic white women), and examine how proximal, intermediate, and distal determinants of disparities contribute to these outcomes. It is envisioned that the study will yield information about “at-risk” patients and ways to leverage existing social resources. Finally, these findings will be used to inform future multilevel interventions able to sustain effective models of care delivery in a post-acute COVID-19 environment. During the one-year Administrative Supplement grant period, research and mentored training activities will help the applicant complete the research aims of the proposed project, and develop skills that will support her understanding of mechanisms that contribute to disparities in both health care utilization and outcomes among diverse groups to foster a successful career in reducing and eliminating cancer disparities.