Neighborhood effects on Quality of Life in Breast Cancer

描述(申请人提供)：随着乳腺癌后存活率的提高，人们越来越关注乳腺癌幸存者与健康相关的生活质量(QOL)。虽然邻里劣势影响成人健康行为、乳腺癌发病率和存活率，以及一般人群的生活质量，但这些与乳腺癌确诊后的生活质量相关的邻里因素却鲜有人关注。这一修订后的申请将涉及以下目标：1)在人口普查区域确定患有和非乳腺癌妇女的生活质量随时间变化的地理聚集程度；2)确定乳腺癌妇女和非乳腺癌妇女的邻里劣势在多大程度上可以解释生活质量随时间的变化；以及3)确定邻里劣势影响乳腺癌妇女随时间改变生活质量的潜在途径。这项拟议的基于人群的前瞻性研究将把目前的个人水平因素和生活质量模型扩展到多水平方法，包括在人口普查区域一级与未患乳腺癌的社区居住妇女相比，在乳腺癌妇女中处于社会和经济劣势的邻里指标。密苏里州癌症登记处(MCR)将在确诊一年后确认患有乳腺癌的女性。在同意后，他们将在此时以及一年后接受采访，以评估随着时间的推移生活质量的变化。将通过随机数字拨号确定社区居住的非乳腺癌妇女的人口控制组，并在类似的时间点进行访谈。将根据人口普查数据构建社区劣势的综合指数。这项研究的多层次性质使得有可能将障碍识别为假想路径的一部分，根据医学研究所最近的建议，针对多个水平(例如，同时针对个人和社区)的干预研究可以使用多管齐下的方法来改善生活质量。

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.