Cancer-Related Disparities in the Elderly Population

描述(申请人提供)：虽然癌症是老年人口的第二大死因，但有证据表明，美国老年人在癌症早期被诊断为癌症的可能性较小，或者接受早期癌症的潜在治愈治疗的可能性较小。对于较低社会经济群体的成员来说，这种差异尤为明显。尽管联邦医疗保险覆盖范围几乎是全民的，但自付费用可能会给资源有限的老年人带来巨大的经济负担，这意味着推迟或不寻求预防、常规或筛查服务的可能性更大。至于与癌症相关的结果，这在确诊时就转化为癌症的晚期，以及次佳的治疗和后续护理，因此预后很差。这项拟议的研究将比较1998-2002年研究期间65岁的乳腺癌、前列腺癌或结肠癌患者的癌症相关结果(诊断、治疗和后续护理阶段)。比较的目的将是根据年龄、种族、合并症、社会经济地位和医疗补助状况来确定差异。这项研究将把俄亥俄州癌症事件监测系统(OCISS)与联邦医疗保险和医疗补助文件联系起来，以识别仅符合联邦医疗保险和双重符合联邦医疗保险-医疗补助资格的个人。来自美国人口普查的数据将被用来得出只接受医疗保险的人口的社会经济地位的衡量标准。本提案中概述的研究计划将辅之以详细的培训计划，以提高候选人在测量癌症差异方面的技能，并在与癌症预防和控制相关的卫生保健政策的背景下分析研究结果。 研究、培训和教育计划是为促进候选人的职业生涯而独特设计的，其主要目标是成为一名独立的调查者，专门研究癌症差异以及医疗保健政策和融资的共同领域。该部门对研究癌症相关成果的承诺；被指定为导师、共同导师和顾问的杰出个人将获得的导师；以及本提案中概述的培训计划，将为候选人实现其职业目标提供最佳资源。

DESCRIPTION (provided by applicant): Although cancer is the second leading cause of death in the elderly population, there is evidence that older Americans are less likely to be diagnosed at early stages of cancer, or to receive potentially curative treatment for early stages of cancer. The disparities are especially pronounced for members of lower socioeconomic groups. Despite the nearly universal Medicare coverage, the out-of-pocket expenses may present significant financial burden to elderly individuals with limited resources, which implies a greater likelihood to delay or not to seek preventive, routine, or screening services. With respect to cancer-related outcomes, this translates into advanced stages of cancer upon diagnosis, and sub-optimal treatment and follow-up care, therefore poor prognosis. The proposed studies will compare cancer-related outcomes (stage at diagnosis, treatment, and follow-up care) among individuals >= 65 years of age diagnosed with breast, prostate, or colon cancer during the study period, 1998-2002. Comparisons will be aimed at identifying disparities by age, race, comorbidities, socioeconomic status, and Medicaid status. The study will link the Ohio Cancer Incidence Surveillance System (OCISS) with Medicare and Medicaid files, in order to identify Medicare-only, and dually eligible Medicare-Medicaid eligible individuals. Data from the U.S. Census will be used to derive measures of socioeconomic status in the Medicare-only population. The research plan outlined in this proposal will be complemented by a detailed training plan to enhance the Candidate's skills in relation to measuring cancer disparities, and in analyzing the findings in the context of health care policy relevant to cancer prevention and control. The research, training, and education plan is uniquely designed to advance the Candidate's career, the principal goal of which is to become an independent investigator specializing in the converging areas of cancer disparities and health care policy and financing. The commitment of the Department to study cancer-related outcomes; the mentorship to be received by the outstanding individuals designated as Mentor, Co-Mentors and Consultants; as well as the training plan outlined in this proposal, will provide the optimal resources for the Candidate to achieve her career goals.