Working to Eliminate Care Disparities in Liver Cancer in Southeast Asian Americans: Transportation and Other Social Determinants of Health.

项目摘要 东南亚(SEA)美国人被诊断为肝细胞癌的比率是美国的8倍 亚裔美国人的比例是其他亚裔美国人的两倍。令人心酸的是，这些患者中的大多数都是 从未治疗过他们的癌症。这些令人不安的观察--再加上候选人/她的指导团队的 初步数据表明，海裔美国人在癌症治疗方面存在持续的、同期的差异 -为K23指导的职业发展应用程序提供动力。这项提议是合乎逻辑的下一步 支持陈博士成为视差研究的独立调查员的长期目标 肝细胞癌。目前的提案包括第一批全面的方法之一，重点是社会 健康的决定因素；建立在该团队关于交通/癌症护理距离的先前数据基础上，以解释 上述差异；利用多站点梅奥诊所(明尼苏达州、亚利桑那州、佛罗里达州)的资源 和3个州(明尼苏达州、威斯康星州、爱荷华州)、以社区为基础的梅奥诊所医疗系统；并利用 陈博士对肝癌和差异的热情兴趣和日益增长的专业知识以及她的能力 5位声誉卓著的导师。这项两个目标的提案首先寻求描述健康的社会决定因素： 特别是旅行--限制获得癌症护理以及其他决定因素，包括失业、麻烦 在苗族人、越南裔美国人和非亚洲人中寻找儿童保育、有限的教育和其他 美国人。Tran博士将创建和维护一组预期的肝细胞癌患者队列，这些患者中 为了调查健康的社会决定因素之间的关系， 人种/种族、癌症治疗的效果和癌症结果。然后，在目标2中，了解 ，她将进行一对一的定性访谈，以 直接从患者那里学习如何克服接受癌症治疗的障碍。她也会用这些 访谈探讨低病毒性肝炎治疗率和低肝细胞癌筛查率。在5年内 在授予期间，陈博士将通过以下途径获得定性方法、统计和调查研究的新技能 课程作业和实践经验。她将与她杰出的多学科团队密切合作 导师(医学肿瘤学家、健康差距研究人员、统计学家和定性研究人员)；发展 并磨练管理多站点团队的技能；在撰写手稿、赠款和 在展示她的数据时变得更加熟练。这项研究的长期影响是进一步了解和 获得有关患有肝癌的海美人健康的社会决定因素的强有力的初步数据，并 让陈博士在未来的R01应用中实施新的、可行的干预措施，目标是 消除患有肝癌的海裔美国人的这些差异。

PROJECT ABSTRACT Southeast Asian (SEA) Americans are diagnosed with hepatocellular cancer (HCC) at 8 times the rate of the general population and at twice the rate of other Asian Americans. Poignantly, most of these patients are never treated for their cancer. These troubling observations – coupled with the candidate/her mentoring team’s preliminary data which point to persistent, contemporaneous disparities in cancer care among SEA Americans – provide the impetus for this K23 mentored career development application. This proposal is the logical next step to support Dr. Tran’s long-term goal of becoming an independent investigator in disparity research in HCC. The current proposal includes one of the first comprehensive approaches that focuses on social determinants of health; builds on this team’s prior data on transportation/distance to cancer care to explain the foregoing disparities; leverages resources from within the multi-site Mayo Clinic (Minnesota, Arizona, Florida) and the 3-state (Minnesota, Wisconsin, Iowa), community-based Mayo Clinic Health System; and capitalizes on Dr. Tran’s passionate interests and growing expertise in HCC and disparities and on the capabilities of her 5 well-established mentors. This 2-aim proposal first seeks to characterize the social determinants of health – specifically travel-limiting access to cancer care as well as other determinants including joblessness, trouble finding childcare, limited education, and others – among Hmong and Vietnamese Americans and non-Asian Americans. Dr. Tran will create and maintain a prospective cohort of patients with HCC – enriched with those of SEA American heritage – to investigate the relationships between social determinants of health, ethnicity/race, the rendering of cancer therapy, and cancer outcomes. Then, in aim 2, to understand barriers to access of cancer care among SEA Americans with HCC, she will conduct one-on-one qualitative interviews to learn directly from patients how to overcome barriers to the receipt of cancer care. She will also use these interviews to explore low rates of viral hepatitis treatment and low rates of HCC screening. During the 5-year grant period, Dr. Tran will acquire new skills in qualitative methods, statistics, and survey research through coursework and hands-on experience. She will work closely with her outstanding multi-disciplinary team of mentors (a medical oncologist, health disparity researchers, statistician, and qualitative researcher); develop and hone skills in managing a multi-site team; acquire greater expertise in writing manuscripts, grants and become more adept in presenting her data. The long-term impact of this research is to further understand and obtain strong preliminary data on the social determinants of health in SEA Americans with liver cancer and to position Dr. Tran to implement novel and feasible interventions in a future R01 application with the goal of eliminating these disparities in SEA Americans with HCC.