RESIDENTIAL MOBILITY, TREATMENT QUALITY AND SURVIVAL IN LOW-INCOME WOMEN WITH BREAST CANCER

项目摘要/摘要 乳腺癌结果的差异在种族和社会经济地位之间仍然存在。参加医疗补助的妇女 不会获得与参加其他类型健康保险的人相同程度的生存福利，但 与未参保的女性一样，预后也很差。较年轻的低收入患者面临更多障碍 获得和坚持高质量的癌症护理，因为癌症的医疗费用构成了更严重的经济问题 与老年患者相比，年轻患者的负担更大。为医疗补助参保者提供高质量癌症护理的障碍 女性还没有被完全理解。我们的初步数据显示，参加医疗补助的女性 乳腺癌确诊后的手机。尽管有充分的证据表明，住房搬迁对 行为和健康结果，缺乏评估居住搬迁的影响的研究 癌症确诊后患者对治疗和预后的坚持程度。参加医疗补助的人没有足够的资金 获得专家护理的机会。乳腺癌的大部分辅助治疗都是在门诊进行的。作为一名 因此，协调多个提供者的预约和治疗对住院医生来说是一个巨大的挑战 流动病人。癌症诊断后的住宅搬迁可能是继续和 低收入患者癌症治疗的完成率，从而影响他们的预后。在我们的 与密苏里州癌症登记处和密苏里州医疗补助计划建立了合作关系，我们将 建立以当代人群为基础的低收入乳腺癌妇女队列，将 医疗补助向密苏里州癌症登记处索赔。还将使用其他五个有价值的数据源来定义 社区、供应商和设施的特点。我们将研究住宅搬迁的影响 低收入乳腺癌患者确诊前12个月坚持治疗的情况(目的) 1)。将定义住宅搬迁及其地理模式，这将使我们能够捕获动态 社区曝光率。我们还将评估住房搬迁与乳房之间的联系 低收入妇女的癌症结局(目标2)。它将控制住宅的流动性--导致空间不确定性 并准确估计社区对癌症结果的影响。此外，我们将研究其程度 居住地搬迁解释了接受治疗的种族差异和预后 低收入乳腺癌妇女(目标3)。这将是第一次评估住宅的作用的研究。 低收入患者中坚持乳腺癌治疗和预后的重新安置。它将加深我们的 了解医疗服务不足的乳腺癌患者预后不良的原因。这个 这项研究将有助于指导针对常住流动低收入人群的乳腺癌差异干预措施 并减轻居住搬迁对癌症治疗和结果的不利影响。

PROJECT SUMMARY/ABSTRACT Disparities in breast cancer outcomes persist across race and socioeconomic status. Medicaid-insured women do not gain the same degree of survival benefit as those enrolled in other types of health insurance, but experience similarly poor prognosis as uninsured women. Younger, low-income patients face more barriers to access and adherence to high-quality cancer care as medical costs for cancer pose a more severe financial burden to younger compared to older patients. The barriers to high-quality cancer care for Medicaid-insured women have not been fully understood. Our preliminary data showed that Medicaid-insured women are highly mobile after breast cancer diagnosis. Despite the well documented effects of residential relocation on behaviors and health outcomes, there is lack of research that assesses the impacts of residential relocation after cancer diagnosis on patient's adherence to therapy and outcomes. Medicaid enrollees have inadequate access to specialist care. Much of adjuvant therapy for breast cancer is delivered in outpatient settings. As a result, coordination of multiple provider appointments and treatments is a significant challenge for residentially mobile patients. Residential relocation following cancer diagnosis may act as a key barrier to continuation and completion of cancer treatment for low-income patients and thus influences their prognosis. Drawing on our established collaborations with the Missouri Cancer Registry and the Missouri Medicaid Program, we will develop a contemporary population-based cohort of low-income women with breast cancer by linking the Medicaid claims to the Missouri Cancer Registry. Five other valuable data sources will be used to define characteristics of neighborhoods, providers and facilities. We will examine the impact of residential relocation on adherence to therapy in the first 12 months of diagnosis among low-income women with breast cancer (Aim 1). Residential relocation and its geographic patterns will be defined, which allows us to capture the dynamics of neighborhood exposures. We will also assess the associations between residential relocation and breast cancer outcomes in low-income women (Aim 2). It will control for residential mobility-induce spatial uncertainty and accurately estimate neighborhood impacts on cancer outcomes. Furthermore, we will examine the extent to which residential relocation explains racial disparities in adherence to therapy and prognostic outcomes in low-income women with breast cancer (Aim 3). This will be the first study to assess the role of residential relocation in adherence to breast cancer therapy and prognosis among low-income patients. It will deepen our understanding of the reasons for poor prognosis in medically underserved populations with breast cancer. The study will help guide breast cancer disparity interventions that could target residentially mobile, low-income patients and mitigate the adverse impacts of residential relocation on cancer treatment and outcomes.