A Multi-State Study of Cancer Treatment and Outcomes Among American Indians

描述（由申请人提供）：由于准入障碍和社会经济障碍，许多患有癌症的美国印第安人和阿拉斯加原住民（AIAN）存在未完成推荐治疗的风险。尽管存在这些担忧，但对于患有癌症的AIAN的治疗和结果知之甚少。AIAN癌症结局研究的重要障碍源于任何特定地区的AIAN癌症患者比例相对较小，以及个体数据库的范围有限。因此，我们建议将来自多个州和数据库的信息结合起来，建立一个全面的资源来评估诊断为肺癌、乳腺癌、结直肠癌、宫颈癌、前列腺癌和卵巢癌的AIAN的护理和结果。为了创建这个资源，我们将连接来自印第安人健康服务、州癌症登记处的患者记录，以及加州、俄勒冈州和华盛顿州的AIAN癌症患者的医疗补助和医疗保险登记和索赔。此外，为了识别不易从行政记录中识别出的潜在治疗障碍，我们将对俄勒冈州和华盛顿州的AIAN癌症幸存者及其护理人员进行访谈。这些访谈将侧重于对癌症和癌症治疗的态度，提供者与患者之间的沟通不端，患者的不信任或误解，文化不敏感，种族主义和歧视。Fred Hutchinson癌症研究中心、三个州的医疗补助计划和两个部落健康委员会与部落流行病学中心之间的密切合作，极大地加强了我们的研究。其中一个由西北波特兰地区印第安人健康委员会主办，另一个由加州农村印第安人健康委员会、河畔圣贝纳迪诺县印第安人健康公司和印第安人健康委员会合作。

DESCRIPTION (provided by applicant): Due to access barriers and socioeconomic obstacles, many American Indians and Alaska Natives (AIAN) with cancer are at risk for not completing recommended therapy. Despite these concerns, little is known about treatment and outcomes for AIAN with cancer. Important barriers to cancer outcomes research for AIAN stems from the relatively small proportion of AIAN cancer patients in any particular region, and limited scope of individual databases. In response, we propose to combine information from multiple states and databases to build a comprehensive resource for evaluating care and outcomes for AIAN diagnosed with lung, breast, colorectal, cervical, prostate, and ovarian cancer. To create this resource, we will link patient records from the Indian Health Service, state cancer registries, and Medicaid and Medicare enrollment and claims for AIAN cancer patients in California, Oregon, and Washington State. In addition, to identify potential barriers to care that are not easily recognized from administrative records, we will conduct interviews of AIAN cancer survivors and their caregivers in Oregon and Washington State. These interviews will focus on attitudes towards cancer and cancer care, provider-patient miscommunication, patient mistrust or misperceptions, cultural insensitivity, and racism and discrimination. Our study is greatly enhanced by the close working partnerships among the Fred Hutchinson Cancer Research Center, the Medicaid programs of all three states, and two tribal health boards with tribal epidemiology centers-one hosted at the Northwest Portland Area Indian Health Board, and the other a partnership among the California Rural Indian Health Board, the Riverside San Bernardino County Indian Health Inc., and the Indian Health Council Inc.