Although cancer is the second leading cause of death in the elderly population, there is evidence that older Americans are less likely to be diagnosed at early stages of cancer, or to receive potentially curative treatment for early stages of cancer. The disparities are especially pronounced for members of lower socioeconomic groups. Despite the nearly universal Medicare coverage, the out-of-pocket expenses may present significant financial burden to elderly individuals with limited resources, which implies a greater likelihood to delay or not to seek preventive, routine, or screening services. With respect to cancer-related outcomes, this translates into advanced stages of cancer upon diagnosis, and sub-optimal treatment and follow-up care, therefore poor prognosis. The proposed studies will compare cancer-related outcomes (stage at diagnosis, treatment, and follow-up care) among individuals >= 65 years of age diagnosed with breast, prostate, or colon cancer during the study period, 1998-2002. Comparisons will be aimed at identifying disparities by age, race, comorbidities, socioeconomic status, and Medicaid status. The study will link the Ohio Cancer Incidence Surveillance System (OCISS) with Medicare and Medicaid files, in order to identify Medicare-only, and dually eligible Medicare-Medicaid eligible individuals. Data from the U.S. Census will be used to derive measures of socioeconomic status in the Medicare-only population. The research plan outlined in this proposal will be complemented by a detailed training plan to enhance the Candidate's skills in relation to measuring cancer disparities, and in analyzing the findings in the context of health care policy relevant to cancer prevention and control. The research, training, and education plan is uniquely designed to advance the Candidate's career, the principal goal of which is to become an independent investigator specializing in the converging areas of cancer disparities and health care policy and financing. The commitment of the Department to study cancer-related outcomes; the mentorship to be received by the outstanding individuals designated as Mentor, Co-Mentors and Consultants; as well as the training plan outlined in this proposal, will provide the optimal resources for the Candidate to achieve her career goals.
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