While social and environmental factors are associated with disparities in breast cancer screening and outcomes, no studies have examined the impact of these factors on cancer survivorship disparities. Upper body breast-cancer related lymphedema (BCRL) is a persistent adverse outcome of cancer treatment that affects the physical health and quality of life of up to 1 in 3 of the 2.9 million breast cancer survivors in te US. Observational studies have found that Black women are more likely than Whites to develop BCRL, and that there are geographic differences in prevalence rates. For those with BCRL, known predictors of progression include BMI, type of surgery and radiation treatment, all of which are associated with social factors. However, no studies have explored the association of race/ethnicity, geography or other social and environmental factors with BCRL progression. The purpose of this study is to explore the relationship between macro- (neighborhood) and micro-level (individual) social and environmental risk factors for the persistent adverse effects of cancer treatment, and the costs they pose, using the example of breast cancer survivors who have BCRL as a persistent adverse effect of breast cancer surgery. This project will use BCRL arm volume and cost data from all 350 participants in the ongoing Women in Steady Exercise Research (WISER) Survivor Study, who all have BCRL and are overweight or obese. To compare costs of those with BCRL to those who do not, this project will collect additional cost data from participants in the PAL trial (n=295) which includes breast cancer survivors with and without BCRL. It will expand on WISER Survivor by (1) quantifying Black-White differences in BCRL progression;(2) collecting additional data from former PAL participants to assess differences in cost burden for survivors with or without BCRL;and (3) exploring the contributions of macro- and micro-level social and environmental factors associated with BCRL to determine their association with health care costs. This K01 will provide protected time for training in cancer survivorship and economic analysis through mentorship, and didactic research activities.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Scientist Development Award - Research & Training (K01)
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Subcommittee G - Education (NCI)
Program Officer
Ojeifo, John O
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University of Pennsylvania
Biostatistics & Other Math Sci
Schools of Medicine
United States
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Ransome, Yusuf; Dean, Lorraine T; Crawford, Natalie D et al. (2017) How Do Social Capital and HIV/AIDS Outcomes Geographically Cluster and Which Sociocontextual Mechanisms Predict Differences Across Clusters? J Acquir Immune Defic Syndr 76:13-22
Graul, Ashley; Latif, Nawar; Zhang, Xiaochen et al. (2017) Incidence of Venous Thromboembolism by Type of Gynecologic Malignancy and Surgical Modality in the National Surgical Quality Improvement Program. Int J Gynecol Cancer 27:581-587
Dean, Lorraine T; Moss, Shadiya L; McCarthy, Anne Marie et al. (2017) Healthcare System Distrust, Physician Trust, and Patient Discordance with Adjuvant Breast Cancer Treatment Recommendations. Cancer Epidemiol Biomarkers Prev 26:1745-1752
Ransome, Yusuf; Kawachi, Ichiro; Dean, Lorraine T (2017) Neighborhood Social Capital in Relation to Late HIV Diagnosis, Linkage to HIV Care, and HIV Care Engagement. AIDS Behav 21:891-904
Sturgeon, Kathleen M; Dean, Lorraine T; Heroux, Mariane et al. (2017) Commercially available lifestyle modification program: randomized controlled trial addressing heart and bone health in BRCA1/2+ breast cancer survivors after risk-reducing salpingo-oophorectomy. J Cancer Surviv 11:246-255
Swen, Melody; Mann, Amandeep; Paxton, Raheem J et al. (2017) Do Cancer-Related Fatigue and Physical Activity Vary by Age for Black Women With a History of Breast Cancer? Prev Chronic Dis 14:E122
Dean, Lorraine T; Zhang, Xiaochen; Latif, Nawar et al. (2016) Race-based disparities in loss of functional independence after hysterectomy for uterine cancer. Support Care Cancer 24:3573-80
Dean, Lorraine T; Kumar, Anagha; Kim, Taehoon et al. (2016) Race or Resource? BMI, Race, and Other Social Factors as Risk Factors for Interlimb Differences among Overweight Breast Cancer Survivors with Lymphedema. J Obes 2016:8241710
Rowe, Steven P; Gorin, Michael A; Hammers, Hans J et al. (2016) Detection of 18F-FDG PET/CT Occult Lesions With 18F-DCFPyL PET/CT in a Patient With Metastatic Renal Cell Carcinoma. Clin Nucl Med 41:83-5
Rowe, Steven P; Macura, Katarzyna J; Mena, Esther et al. (2016) PSMA-Based [(18)F]DCFPyL PET/CT Is Superior to Conventional Imaging for Lesion Detection in Patients with Metastatic Prostate Cancer. Mol Imaging Biol 18:411-9

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