Neighborhood effects on Quality of Life in Breast Cancer

描述（由申请人提供）：随着乳腺癌生存率的提高，人们越来越关注乳腺癌幸存者的健康相关生活质量（QoL）。虽然邻里不利影响成人健康行为、乳腺癌发病率和生存率以及独立于个体水平因素的一般人群的生活质量，但对乳腺癌诊断后生活质量相关的邻里因素的关注很少。修订后的申请将涉及以下目标：1)确定人口普查区水平上乳腺癌妇女和非乳腺癌妇女生活质量随时间变化的地理聚类程度；2)确定乳腺癌妇女和非乳腺癌妇女生活质量随时间的变化在多大程度上可以用邻里劣势来解释；3)确定社区不利因素影响乳腺癌妇女生活质量随时间变化的潜在途径。这项前瞻性的、以人群为基础的研究将把目前的个人水平因素和生活质量模型扩展到一个多层次的方法，包括在人口普道区水平上，与没有乳腺癌的社区居住妇女相比，乳腺癌妇女的社会和经济劣势的邻里指标。患有乳腺癌的妇女将在诊断一年后由密苏里州癌症登记处（MCR）确定。同意后，他们将在此时以及一年后接受访谈，以评估生活质量随时间的变化。将通过随机数字拨号确定以人群为基础的无乳腺癌社区居住妇女对照组，并在类似时间点进行访谈。根据人口普查数据构建社区弱势综合指数。该研究的多层次性质使得有可能识别障碍作为假设途径的一部分，这些障碍可以通过针对几个层面（例如，同时针对个人和社区）的干预研究来针对，使用多管齐下的方法来改善生活质量，这是医学研究所最近推荐的。

DESCRIPTION (provided by applicant): With improved survival following breast cancer, there is increasing focus on the health-related quality of life (QoL) of breast cancer survivors. Although neighborhood disadvantage affects adult health behaviors, breast cancer incidence and survival, and QoL of the general population independent of individual-level factors, little attention has been directed toward such neighborhood factors related to QoL following breast cancer diagnosis. The following aims will be addressed in this revised application: 1) Determine the extent of geographic clustering of the change in QoL over time among women with and those without breast cancer at the level of the census tract; 2) Determine the extent to which the change in QoL over time can be explained by neighborhood disadvantage among women with breast cancer and among women without breast cancer; and 3) Identify potential pathways by which neighborhood disadvantage affects changes in QoL over time among women with breast cancer. The proposed prospective, population-based study will extend the current model of individual-level factors and QoL to a multilevel approach by including neighborhood indicators of social and economic disadvantage at the census tract level among women with breast cancer as compared to community-dwelling women without breast cancer. Women with breast cancer will be identified one year following their diagnosis by the Missouri Cancer Registry (MCR). Following consent, they will be interviewed at this time as well as one year later to assess changes over time in QoL. A population-based control group of community-dwelling women without breast cancer will be identified through random-digit dialing and interviewed at similar time points. A composite index of neighborhood disadvantage will be constructed from census data. The multilevel nature of the study makes it possible to identify barriers as part of hypothesized pathways that could be targeted by intervention studies aimed at several levels (e.g., individual and neighborhoods simultaneously) using a multi-pronged approach to improve QoL, as recently recommended by the Institute of Medicine.