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.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
5K01CA184288-02
Application #
8910673
Study Section
Subcommittee G - Education (NCI)
Program Officer
Davani, Behrous
Project Start
2014-08-11
Project End
2019-07-31
Budget Start
2015-08-01
Budget End
2016-07-31
Support Year
2
Fiscal Year
2015
Total Cost
$164,496
Indirect Cost
$12,185
Name
University of Pennsylvania
Department
Biostatistics & Other Math Sci
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Dean, Lorraine T; Nicholas, Lauren Hersch (2018) Using Credit Scores to Understand Predictors and Consequences of Disease. Am J Public Health 108:1503-1505
Dean, Lorraine T; Moss, Shadiya L; Ransome, Yusuf et al. (2018) ""It still affects our economic situation"": long-term economic burden of breast cancer and lymphedema. Support Care Cancer :
Dean, Lorraine T; Schmitz, Kathryn H; Frick, Kevin D et al. (2018) Consumer credit as a novel marker for economic burden and health after cancer in a diverse population of breast cancer survivors in the USA. J Cancer Surviv 12:306-315
Goodman, Melody; Lyons, Sarah; Dean, Lorraine T et al. (2018) How Segregation Makes Us Fat: Food Behaviors and Food Environment as Mediators of the Relationship Between Residential Segregation and Individual Body Mass Index. Front Public Health 6:92
Dean, Lorraine T; Montgomery, Madeline C; Raifman, Julia et al. (2018) The Affordability of Providing Sexually Transmitted Disease Services at a Safety-net Clinic. Am J Prev Med 54:552-558
Dean, Lorraine T; Gehlert, Sarah; Neuhouser, Marian L et al. (2018) Social factors matter in cancer risk and survivorship. Cancer Causes Control 29:611-618
Johnson, Renee M; Fleming, Charles B; Cambron, Christopher et al. (2018) Race/Ethnicity Differences in Trends of Marijuana, Cigarette, and Alcohol Use Among 8th, 10th, and 12th Graders in Washington State, 2004-2016. Prev Sci :
Lee, Alice J; Montgomery, Madeline C; Patel, Rupa R et al. (2018) Improving Insurance and Health Care Systems to Ensure Better Access to Sexually Transmitted Disease Testing and Prevention. Sex Transm Dis 45:283-286
Knapp, Emily A; Dean, Lorraine T (2018) Consumer credit scores as a novel tool for identifying health in urban U.S. neighborhoods. Ann Epidemiol 28:724-729
Ransome, Yusuf; Thurber, Katherine A; Swen, Melody et al. (2018) Social capital and HIV/AIDS in the United States: Knowledge, gaps, and future directions. SSM Popul Health 5:73-85

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