Innovative Clinical Pathways in Lung Cancer Care for Vulnerable Populations

描述（由申请人提供）：肺癌是世界上癌症死亡的主要原因，在美国死亡的人数是任何其他形式癌症的三倍。1，2所有确诊肺癌患者的五年生存率约为15%，远低于结肠癌的64%，乳腺癌的89%和前列腺癌的99%。与一般人群相比，患病率和死亡率明显较高。4研究表明，许多疾病，包括肺癌，5肺癌护理中的健康差异是多因素造成的，包括获得护理的机会、文化差异、与提供者的沟通问题导致拒绝护理、生物差异以及种族和阶级的系统性和结构性影响。研究表明，即使在平等获取系统中，也存在着差距，这种差距贯穿于癌症谱系的所有领域，包括筛查、诊断、治疗以及生存和临终关怀1 -6。医学研究所报告的不平等待遇和个别研究都表明，即使在医疗保险等平等准入制度中也存在差距。7-11鉴于解决弱势群体肺癌发病率差异的重要性，布里格姆妇女医院妇女健康司寻求一笔小额会议赠款，以支持与达纳法伯癌症研究所（DFCI）的一项联合倡议，题为“弱势群体肺癌护理的创新临床途径”。这是一个为期两天的利益攸关方传播和实施会议。仅限受邀者参加的会议将于2012年冬季在马萨诸塞州波士顿的布里格姆妇女医院举行。会议的目标是设计沿着全方位肺癌护理的创新途径，解决导致弱势群体健康差异的因素。肺癌治疗的全方位将包括风险评估、检测、诊断和治疗非小细胞肺癌（NSCLC），这是最常见的肺癌类型。7 NSCLC治疗的创新途径的设计将通过检查影响健康差异的许多因素来了解，包括获得治疗的机会、文化差异、沟通问题、生物差异、以及种族和阶级的系统性和结构性影响，包括贫困和社会不公正。8，9与会者还将设计一项试点研究，以测试拟议途径在弱势人群中提供NSCLC护理的有效性。 公共卫生相关性：项目主任/主要研究者（最后，第一，中间）：Colson，Yolanda叙述肺癌是世界上癌症死亡的主要原因，杀死的美国人是任何其他形式癌症的三倍。对于某些弱势群体，肺癌的发病率、流行率和死亡率与一般人群相比明显更高。本次会议汇集了利益相关者，以设计创新的途径沿着全方位的肺癌护理，以解决这些健康差距的因素，并设计一个试点研究，以测试拟议的途径的疗效。

DESCRIPTION (provided by applicant): Lung cancer is the leading cause of cancer death in the world and kills three times as many Americans as any other form of cancer. 1, 2 The five-year survival rate for all patients in whom lung cancer is diagnosed is approximately 15 percent, much lower than the 64 percent for colon cancer, 89 percent for breast cancer and 99 percent for prostate cancer.3 For certain vulnerable populations, lung cancer incidence, prevalence and mortality rates are significantly higher when compared to the general population.4 Research has shown that many diseases, including lung cancer, are caused by differences in access to and quality of care.5 Health disparities in lung cancer care are multifactorial and include access to care, cultural differences, communication issues with providers leading to refusal of care, biologic differences, and the systemic and structural impacts of race and class.6 In addition, studies indicate that disparities exist even in an equal access system, and throughout all areas of the cancer spectrum spanning screening, diagnosis, treatments, as well as survivorship and end of life care1-6. Both the Institute of Medicine Report Unequal Treatment, and individual studies show that disparities exist even in equal access systems like Medicare. 7-11 Given the importance of addressing disparities in lung cancer rates across vulnerable populations, the Division of Women's Health at the Brigham and Women's Hospital seeks a small conference grant to support a joint- initiative with the Dana Farber Cancer Institute (DFCI) entitled Innovative Clinical Pathways in Lung Cancer Care for Vulnerable Populations. This is a two-day stakeholder dissemination and implementation conference. The invitation-only conference will be held at Brigham and Women's Hospital in Boston, Massachusetts in the winter of 2012. The goal of the conference is to design innovative pathways along the full spectrum of lung cancer care that address factors contributing to health disparities in vulnerable populations. The full spectrum of lung cancer care will include risk assessment, detection, diagnosis, and treatment of non-small cell lung cancer (NSCLC), the most common type of lung cancer.7 Design of the innovative pathways to NSCLC care will be informed by an examination of the many factors that influence health disparities, including access to care, cultural differences, communication issues,, biologic differences, and the systemic and structural impacts of race and class including poverty and social injustice.8, 9 Conference attendees will also design a pilot study to test the efficacy of the proposed pathways in providing NSCLC care across vulnerable populations. PUBLIC HEALTH RELEVANCE: Program Director/Principal Investigator (Last, First, Middle): Colson, Yolanda Narrative Lung cancer is the leading cause of cancer death in the world and kills three times as many Americans as any other form of cancer. For certain vulnerable populations, lung cancer incidence, prevalence and mortality rates are significantly higher when compared to the general population. This conference brings together stakeholders to design innovative pathways along the full spectrum of lung cancer care to address factors contributing to these health disparities and to design a pilot study to test the efficacy of the proposed pathways.