Pub Date : 2018-07-01DOI: 10.1158/1538-7755.DISP17-IA27
L. Kushi, I. Ergas, Janise M. Roh, S. Gomez, M. Kwan, C. Thomsen, S. Yao, C. Ambrosone
In the U.S., women of European ancestry have historically had the highest incidence of breast cancer compared to other major race/ethnicity groups. In recent years, the incidence rate for black women has approached that of white women, while rates for Asian and Hispanic women are about 25% lower than for white or black women. However, once diagnosed with breast cancer, black women have poorer survival rates than white women. The most recent “Annual Report to the Nation on the Status of Cancer” using nationwide cancer-registry data from 2006-2013 (Jemal et al., JNCI, 2017) reported a higher age- and stage-adjusted relative mortality risk after breast cancer of 1.71 (95% confidence interval (CI), 1.66-1.76) for non-Hispanic blacks compared to non-Hispanic whites. Hispanic women also experienced a slightly increased relative mortality risk of 1.14 (95% CI, 1.10-1.18) compared to white women, while Asians experienced a lower relative mortality risk of 0.84 (95% CI, 0.80-0.88). The reasons for such disparities in outcomes after breast cancer are complex. One suggested contributing factor is differences in access to care, as blacks and Hispanics tend to be of lower socioeconomic status than whites or Asians. It is possible to minimize the effects of access to health care by examining outcomes after breast cancer diagnosis in an integrated health care setting such as Kaiser Permanente Northern California (KPNC), in which all patients have health insurance coverage with access to the same health care providers. We are currently conducting the Pathways Study, a prospective cohort study of 4,505 women diagnosed with breast cancer with enrollment from 2006-2013. This diverse cohort includes 557 Hispanics, 578 Asians, and 358 blacks. Preliminary analyses in the larger population of 11,176 women who were diagnosed with invasive breast cancer in KPNC and eligible for the Pathways Study found that, despite the uniform health care access, racial disparities in mortality after breast cancer were qualitatively similar to those observed nationally. With 1,738 total deaths as of September 20, 2016, and adjusted for age and stage at diagnosis, compared to white women, black women had an increased relative mortality risk of 1.59 (95% CI, 1.24-2.03). For Hispanic women, the relative risk was 0.92 (95% CI, 0.72-1.19), and for Asians it was 0.70 (95% CI, 0.51-0.97). Among the subset of women enrolled in the Pathways Study (n=538 total deaths), comparable relative risks were 1.74 (95% CI, 1.35-2.24) for black women, 0.99 (95% CI, 0.75-1.29) for Hispanic women, and 0.73 (95% CI, 0.52-1.02) for Asians. Similar black-white differences were also seen for breast cancer-specific mortality and recurrence in the Pathways Study cohort in which recurrences are being documented. These observations indicate that health care access is unlikely to explain racial/ethnic disparities in breast cancer outcomes. As the Pathways Study, we will be able to explore aspects of health care utiliz
在美国，与其他主要种族/民族相比，欧洲血统的女性历史上乳腺癌发病率最高。近年来，黑人女性的发病率已经接近白人女性，而亚洲和西班牙裔女性的发病率比白人或黑人女性低25%左右。然而，一旦被诊断出患有乳腺癌，黑人妇女的存活率就比白人妇女低。使用2006-2013年全国癌症登记数据的最新“国家癌症状况年度报告”(Jemal等人，JNCI, 2017)报告称，与非西班牙裔白人相比，非西班牙裔黑人乳腺癌后年龄和阶段调整的相对死亡风险更高，为1.71(95%置信区间(CI)， 1.66-1.76)。与白人妇女相比，西班牙裔妇女的相对死亡率风险也略有增加，为1.14 (95% CI, 1.10-1.18)，而亚洲妇女的相对死亡率风险较低，为0.84 (95% CI, 0.80-0.88)。乳腺癌后治疗结果差异的原因很复杂。其中一个因素是在获得医疗服务方面的差异，因为黑人和西班牙裔人的社会经济地位往往低于白人或亚洲人。在北加州凯撒医疗机构(Kaiser Permanente Northern California, KPNC)等综合医疗机构检查乳腺癌诊断后的结果，可以最大限度地减少获得医疗保健的影响，在这些机构中，所有患者都有医疗保险，可以获得相同的医疗保健提供者。我们目前正在进行pathway研究，这是一项前瞻性队列研究，纳入了2006-2013年期间4,505名被诊断患有乳腺癌的女性。这个多样化的队列包括557名西班牙裔，578名亚洲人和358名黑人。对在KPNC被诊断为浸润性乳腺癌的11,176名妇女进行的初步分析发现，尽管有统一的医疗保健服务，但乳腺癌后死亡率的种族差异在质量上与全国观察到的相似。截至2016年9月20日，总死亡人数为1738人，并根据年龄和诊断阶段进行调整，与白人女性相比，黑人女性的相对死亡风险增加了1.59 (95% CI, 1.24-2.03)。西班牙女性的相对危险度为0.92 (95% CI, 0.72-1.19)，亚洲女性的相对危险度为0.70 (95% CI, 0.51-0.97)。在纳入pathway研究的女性亚组(n=538例总死亡)中，黑人女性的可比相对危险度为1.74 (95% CI, 1.35-2.24)，西班牙裔女性为0.99 (95% CI, 0.75-1.29)，亚洲女性为0.73 (95% CI, 0.52-1.02)。类似的黑人和白人在乳腺癌特异性死亡率和复发率方面的差异也出现在有复发率记录的Pathways研究队列中。这些观察结果表明，获得医疗保健不太可能解释乳腺癌结局的种族/民族差异。作为途径研究，我们将能够探索卫生保健利用的各个方面，如治疗相关因素，如治疗延迟，依从性和早期停药。我们还将能够探索可能影响死亡率和乳腺癌预后的合并症或非癌症药物的使用。在路径研究中，我们正在收集有关生活方式和社会心理因素的数据(例如，食物摄入、身体活动、社会支持、医患沟通和生活质量);连接到地理空间数据库，以表征队列成员的社会和建筑环境;并进行全基因组分析。例如，在对雌激素受体状态、体重指数、受教育程度和体力活动进行额外调整的初步分析中，尽管黑人和白人的死亡率差异有所减弱，但仍然存在(相对风险为1.43;95% ci, 1.09-1.86)。与其他在不同人群中检查乳腺癌结果的研究一起，Pathways研究准备为更好地理解黑人和白人在乳腺癌后死亡率方面的持续差异做出贡献，从而确定改善所有乳腺癌女性预后的途径。引文格式:Lawrence H. Kushi, Isaac J. Ergas, Janise M. Roh, Scarlett Lin Gomez, Marilyn L. Kwan, Catherine Thomsen, Song Yao, Christine B. Ambrosone。乳腺癌生存和预后的差异[摘要]。见:第十届AACR会议论文集:种族/少数民族和医疗服务不足人群的癌症健康差异科学;2017年9月25-28日;亚特兰大,乔治亚州。费城(PA): AACR;癌症流行病学杂志[j]; 2018;27(7增刊):摘要11 - 27。
{"title":"Abstract IA27: Disparities in breast cancer survivorship and outcomes","authors":"L. Kushi, I. Ergas, Janise M. Roh, S. Gomez, M. Kwan, C. Thomsen, S. Yao, C. Ambrosone","doi":"10.1158/1538-7755.DISP17-IA27","DOIUrl":"https://doi.org/10.1158/1538-7755.DISP17-IA27","url":null,"abstract":"In the U.S., women of European ancestry have historically had the highest incidence of breast cancer compared to other major race/ethnicity groups. In recent years, the incidence rate for black women has approached that of white women, while rates for Asian and Hispanic women are about 25% lower than for white or black women. However, once diagnosed with breast cancer, black women have poorer survival rates than white women. The most recent “Annual Report to the Nation on the Status of Cancer” using nationwide cancer-registry data from 2006-2013 (Jemal et al., JNCI, 2017) reported a higher age- and stage-adjusted relative mortality risk after breast cancer of 1.71 (95% confidence interval (CI), 1.66-1.76) for non-Hispanic blacks compared to non-Hispanic whites. Hispanic women also experienced a slightly increased relative mortality risk of 1.14 (95% CI, 1.10-1.18) compared to white women, while Asians experienced a lower relative mortality risk of 0.84 (95% CI, 0.80-0.88). The reasons for such disparities in outcomes after breast cancer are complex. One suggested contributing factor is differences in access to care, as blacks and Hispanics tend to be of lower socioeconomic status than whites or Asians. It is possible to minimize the effects of access to health care by examining outcomes after breast cancer diagnosis in an integrated health care setting such as Kaiser Permanente Northern California (KPNC), in which all patients have health insurance coverage with access to the same health care providers. We are currently conducting the Pathways Study, a prospective cohort study of 4,505 women diagnosed with breast cancer with enrollment from 2006-2013. This diverse cohort includes 557 Hispanics, 578 Asians, and 358 blacks. Preliminary analyses in the larger population of 11,176 women who were diagnosed with invasive breast cancer in KPNC and eligible for the Pathways Study found that, despite the uniform health care access, racial disparities in mortality after breast cancer were qualitatively similar to those observed nationally. With 1,738 total deaths as of September 20, 2016, and adjusted for age and stage at diagnosis, compared to white women, black women had an increased relative mortality risk of 1.59 (95% CI, 1.24-2.03). For Hispanic women, the relative risk was 0.92 (95% CI, 0.72-1.19), and for Asians it was 0.70 (95% CI, 0.51-0.97). Among the subset of women enrolled in the Pathways Study (n=538 total deaths), comparable relative risks were 1.74 (95% CI, 1.35-2.24) for black women, 0.99 (95% CI, 0.75-1.29) for Hispanic women, and 0.73 (95% CI, 0.52-1.02) for Asians. Similar black-white differences were also seen for breast cancer-specific mortality and recurrence in the Pathways Study cohort in which recurrences are being documented. These observations indicate that health care access is unlikely to explain racial/ethnic disparities in breast cancer outcomes. As the Pathways Study, we will be able to explore aspects of health care utiliz","PeriodicalId":192928,"journal":{"name":"Disparities in Survivorship and Patient Outcomes","volume":"1880 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129982093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-07-01DOI: 10.1158/1538-7755.DISP17-IA26
Nadine J. Barrett, Kearston L Ingraham, K. Williams, P. Lin, H. Eisenson, M. Chirinos, D. Harvey, S. Patierno
Establishing sustainable and impactful partnerships to advance health equity and health disparities research requires a multipronged approach to assessing and aligning community and organizational priorities toward common goals and objectives. Partnerships to advance health equity and to ensure ongoing and meaningful health disparities research should ideally provide a win-win for community stakeholders and the health system. This often requires a cultural shift regarding how and to what extent academic/medical institutions value and fully engage diverse stakeholders as experts in the research process and delivery of care. At the Duke Cancer Institute, through the Office of Health Equity and Disparities, our intentional stakeholder engagement has led to robust partnerships with diverse community organizations and leaders capitalizing on each other9s strengths and expertise. Through this process the DCI, together with the community, has built a sustainable platform to advance health equity through research, capacity building, and open communication. Citation Format: Nadine Barrett, Kearston Ingraham, Kevin Williams, Pao-Hwa Lin, Howard Eisenson, Maritza Chirinos, Demetrius Harvey, Steven Patierno. Developing effective community and health system partnerships to advance health equity and health disparities research [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr IA26.
建立可持续和有影响力的伙伴关系以促进卫生公平和卫生差距研究，需要采取多管齐下的方法来评估社区和组织的优先事项，并使其与共同目标和目的保持一致。促进卫生公平和确保持续开展有意义的卫生差异研究的伙伴关系，理想情况下应为社区利益攸关方和卫生系统提供双赢。这通常需要一种文化上的转变，即学术/医疗机构如何以及在多大程度上重视并充分让不同的利益相关者作为专家参与研究过程和提供护理。在杜克癌症研究所，通过健康公平与差异办公室，我们有意让利益相关者参与进来，与不同的社区组织和领导人建立了强有力的伙伴关系，利用彼此的优势和专业知识。通过这一进程，DCI与社区一起建立了一个可持续的平台，通过研究、能力建设和公开沟通促进卫生公平。引文格式:Nadine Barrett, Kearston Ingraham, Kevin Williams, Pao-Hwa Lin, Howard Eisenson, Maritza Chirinos, Demetrius Harvey, Steven Patierno。发展有效的社区和卫生系统伙伴关系，促进卫生公平和卫生差距研究。见:第十届AACR会议论文集:种族/少数民族和医疗服务不足人群的癌症健康差异科学;2017年9月25-28日;亚特兰大,乔治亚州。费城(PA): AACR;癌症流行病学与生物标志物[j]; 2018;27(7增刊):摘要11 - 26。
{"title":"Abstract IA26: Developing effective community and health system partnerships to advance health equity and health disparities research","authors":"Nadine J. Barrett, Kearston L Ingraham, K. Williams, P. Lin, H. Eisenson, M. Chirinos, D. Harvey, S. Patierno","doi":"10.1158/1538-7755.DISP17-IA26","DOIUrl":"https://doi.org/10.1158/1538-7755.DISP17-IA26","url":null,"abstract":"Establishing sustainable and impactful partnerships to advance health equity and health disparities research requires a multipronged approach to assessing and aligning community and organizational priorities toward common goals and objectives. Partnerships to advance health equity and to ensure ongoing and meaningful health disparities research should ideally provide a win-win for community stakeholders and the health system. This often requires a cultural shift regarding how and to what extent academic/medical institutions value and fully engage diverse stakeholders as experts in the research process and delivery of care. At the Duke Cancer Institute, through the Office of Health Equity and Disparities, our intentional stakeholder engagement has led to robust partnerships with diverse community organizations and leaders capitalizing on each other9s strengths and expertise. Through this process the DCI, together with the community, has built a sustainable platform to advance health equity through research, capacity building, and open communication. Citation Format: Nadine Barrett, Kearston Ingraham, Kevin Williams, Pao-Hwa Lin, Howard Eisenson, Maritza Chirinos, Demetrius Harvey, Steven Patierno. Developing effective community and health system partnerships to advance health equity and health disparities research [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr IA26.","PeriodicalId":192928,"journal":{"name":"Disparities in Survivorship and Patient Outcomes","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126817157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-07-01DOI: 10.1158/1538-7755.DISP17-IA25
S. Bhatia
Outcome disparities in pediatric, adolescent, and young adult cancer are multifaceted. While disparities are commonly described along racial/ethnic lines, the underlying causes of these differences in outcome are often rooted in socioeconomic status, host genetics, disease biology, health literacy lifestyle factors, health behaviors, and comorbidities. Nonetheless, by the middle of this century, racial/ethnic minority populations will collectively constitute 50% of the U.S. population. This temporal shift in the racial/ethnic composition of the U.S. population demands a close examination of the observed disparities in both the quality and quantity of survival in pediatric, adolescent, and young adult cancer. In this talk we describe the differences in overall and event-free survival by race/ethnicity as well as by age (children vs. adolescent and young adult) across a variety of cancer types. We examine the causes of the difference in these outcomes. We describe the burden of morbidity carried by cancer survivors across racial/ethnic and socioeconomic lines and present the current evidence for the causes of observed differences in morbidity. We speculate that any racial/ethnic differences in outcome are likely to be multifactorial, and draw on extant literature to illustrate the various contributors (socioeconomic characteristics, health behaviors, disease biology, and comorbidities) that could explain any observed differences in key treatment-related complications. Finally, we outline challenges in conducting race/ethnicity-specific survivorship research, demonstrating that there are limited absolute numbers who are diagnosed and survive histologically distinct cancers in any one racial/ethnic minority population, thereby precluding a rigorous evaluation of adverse events among specific primary cancer diagnoses and treatment exposure groups. Citation Format: Smita Bhatia. Disparities in survivors of pediatric, adolescent, and young adult cancers [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr IA25.
{"title":"Abstract IA25: Disparities in survivors of pediatric, adolescent, and young adult cancers","authors":"S. Bhatia","doi":"10.1158/1538-7755.DISP17-IA25","DOIUrl":"https://doi.org/10.1158/1538-7755.DISP17-IA25","url":null,"abstract":"Outcome disparities in pediatric, adolescent, and young adult cancer are multifaceted. While disparities are commonly described along racial/ethnic lines, the underlying causes of these differences in outcome are often rooted in socioeconomic status, host genetics, disease biology, health literacy lifestyle factors, health behaviors, and comorbidities. Nonetheless, by the middle of this century, racial/ethnic minority populations will collectively constitute 50% of the U.S. population. This temporal shift in the racial/ethnic composition of the U.S. population demands a close examination of the observed disparities in both the quality and quantity of survival in pediatric, adolescent, and young adult cancer. In this talk we describe the differences in overall and event-free survival by race/ethnicity as well as by age (children vs. adolescent and young adult) across a variety of cancer types. We examine the causes of the difference in these outcomes. We describe the burden of morbidity carried by cancer survivors across racial/ethnic and socioeconomic lines and present the current evidence for the causes of observed differences in morbidity. We speculate that any racial/ethnic differences in outcome are likely to be multifactorial, and draw on extant literature to illustrate the various contributors (socioeconomic characteristics, health behaviors, disease biology, and comorbidities) that could explain any observed differences in key treatment-related complications. Finally, we outline challenges in conducting race/ethnicity-specific survivorship research, demonstrating that there are limited absolute numbers who are diagnosed and survive histologically distinct cancers in any one racial/ethnic minority population, thereby precluding a rigorous evaluation of adverse events among specific primary cancer diagnoses and treatment exposure groups. Citation Format: Smita Bhatia. Disparities in survivors of pediatric, adolescent, and young adult cancers [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr IA25.","PeriodicalId":192928,"journal":{"name":"Disparities in Survivorship and Patient Outcomes","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132568234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：