Multilevel determinants of racial disparities in receipt of guideline-concordant endometrial cancer treatment

项目摘要/摘要 在所有实体肿瘤中，子宫内膜癌(EC)表现出最严重的种族差异--黑白比例-- 死亡率差距从1992-2001年的79.5%上升到2014-2018年的97.8%。接受与NA一致的治疗-- 建议性建议是一个重要的可修改因素，它影响欧共体的结果，并导致种族 生存方面的差距。国家综合癌症网络建议将手术分期作为第一步 符合指导原则的治疗步骤和手术获取的病理因素为辅助治疗提供信息 建议。我们之前的工作表明，接受符合指南的EC治疗可以改善 黑人或白人EC患者的存活率。因此，较低的指导方针--一致性EC治疗 在黑人女性中，我们观察到的是令人担忧的，并导致了疾病的显著差异 结果。我们缺乏对构成不同指导方针的决定因素的全面了解。 科丹特EC治疗，阻止循证干预开发的任何有意义的进展。这个 现有的文献只关注个体水平的因素作为指南一致性EC的预测因素 治疗。这项工作没有导致有效的干预，并忽略了已知的多层次影响 以巩固基于种族的健康差异。此外，在与指导方针一致的范例中，可以 推荐治疗的强度水平差异很大，对生活质量的影响明显不同。 在符合指南的范例中，种族对治疗强度的影响目前尚不清楚。多数 重要的是，没有定性数据来了解黑人女性或她们的提供者是如何重新做出决定的 正在接受EC治疗。没有这些关键的基础，我们就不能在以下方面推进以证据为基础的- 改进符合指南的EC治疗收据的措施。我们建议确定以下决定因素 指南-通过结合对监测的多水平数据的分析，符合EC治疗差异， 流行病学和最终结果(SEER)-与医疗保险索赔相关的数据集(目标1-2)，以及对 拥有EC和EC提供者的黑人妇女(目标3)。目标1：确定预测黑白疾病的多水平因素 符合指南的EC治疗中的胎次。目标2：量化种族差距和潜在的预测因素 指南-一致性EC治疗强度和检验指南-一致性EC治疗- 运动强度和存活率。目标3：检查推动和制约治疗选择的多层次动态 使用定性方法为患有EC的黑人妇女提供和帮助。通过使用以下工具分析高质量的多级数据集 黑人和白人EC患者，并捕获治疗经验和偏好的第一手描述 黑人女性和她们的提供者，我们的团队将评估种族障碍的重要性，以指导- 协调的EC处理。我们的研究将确定可以针对的多级别可修改因素集 缩小差距，改善对所有妇女的护理。

PROJECT SUMMARY/ABSTRACT Of all solid tumors, endometrial cancer (EC) exhibits one of the worst racial disparities - the Black-White mor- tality gap has increased from 79.5% in 1992-2001 to 97.8% in 2014-2018. Receipt of treatment in line with na- tional recommendations is an important modifiable factor that influences EC outcomes and contributes to racial disparities in survival. The National Comprehensive Cancer Network recommends surgical staging as the first step of guideline-concordant treatment and pathology factors captured from surgery inform adjuvant treatment recommendations. Our prior work demonstrates that receipt of guideline-concordant EC treatment improves survival among EC patients who are Black or White. Therefore, the lower guideline-concordant EC treatment among Black women that we have observed is concerning and contributes to the marked disparities in disease outcomes. We lack a comprehensive understanding of the determinants that underlie disparate guideline-con- cordant EC treatment, preventing any meaningful progress in evidence-based intervention development. The extant literature has exclusively focused on individual-level factors as predictors of guideline-concordant EC treatment. This work has not led to effective intervention and ignores the multilevel influences that are known to undergird race-based differences in health. In addition, within guideline-concordant paradigms, there can be wide variation in intensity level of recommended treatments, with markedly different impact on quality of life. The impact of race on intensity of treatment within guideline-concordant paradigms is currently unknown. Most important, there are no qualitative data to understand how Black women or their providers make decisions re- garding EC treatment. Absent these critical building blocks, we cannot move forward with evidence-based in- terventions to improve guideline-concordant EC treatment receipt. We propose to identify determinants of guideline-concordant EC treatment disparities by combining analysis of multilevel data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare claims linked dataset (Aims 1-2) with in-depth interviews of Black women with EC and EC providers (Aim 3). Aim 1: Identify multilevel factors that predict Black-White dis- parities in guideline-concordant EC treatment. Aim 2: Quantify racial disparities and underlying predictors of guideline-concordant EC treatment intensity and examine associations between guideline-concordant EC treat- ment intensity and survival. Aim 3: Examine the multilevel dynamics that drive and constrain treatment choices by and for Black women with EC using qualitative methods. By analyzing a high-quality, multilevel dataset with Black and White EC patients, and capturing first-hand accounts of treatment experiences and preferences of Black women and their providers, our team will assess the importance of race-specific barriers to guideline- concordant EC treatment. Our study will identify the set of multilevel modifiable factors that can be targeted to reduce disparities and improve care for all women.