The numbers of breast cancer survivors are increasing yearly, as is the number of uninsured patients, who may experience greater burdens accessing care and poorer outcomes after a diagnosis of breast cancer. However, little is known about breast cancer care and survivorship issues facing underserved women, who are disproportionately poor and minority. The Breast and Cervical Cancer Treatment Program (BCCTP) is a federally legislated Medicaid (""""""""Medi-Cal"""""""" in California) program to address the needs of low-income, un- and under-insured women with breast cancer. In California there are two arms to the program - one federally funded, one state funded - the latter with more limited coverage. From an initial, statewide cohort of 1000 women enrolled in BCCTP, we will conduct prospective, longitudinal patient surveys at 3- and 5-years post breast cancer diagnosis, supplemented by 6- and 18-month treatment and patient survey data collected in our current study to assess: 1) Follow-up breast cancer care and age- and gender-appropriate cancer screening for the 3 years after diagnosis, and determinants of receipt of appropriate care at the individual- (e.g., comorbid medical conditions, competing life needs), interpersonal- (e.g., patient-physician communication, social support), and system-levels (e.g., state vs. federal BCCTP, provider characteristics, setting of care); 2) survivorship over the 5 years after diagnosis, including health, functioning, quality of life, and recurrence, as a function of these individual-, interpersonal-, and system-level factors. Because of their health policy implications, we will examine outcome differences between state and federal BCCTP enrollees. Additionally, we will be able to closely investigate these outcomes among Latinas, the second largest racial/ethnic group in the U.S., about which little is known, and who constitute 53% of our sample. As far we are aware, this is the first longitudinal study to examine determinants of quality of follow-up breast cancer care, as well as long-term survivorship, in a large Medicaid cohort of breast cancer patients. The project addresses three of NCI's four priority areas - health disparities, quality of care, and survivorship. The findings will lend a strong empirical basis to developing interventions and, given the project's partnership with Medi-Cal, the platform for instituting health policy changes at a state level, with possible national implications, to improve breast cancer care and survivorship for underserved women. ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA119197-03
Application #
7495526
Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Jeffery, Diana D
Project Start
2006-09-15
Project End
2011-07-31
Budget Start
2008-08-01
Budget End
2009-07-31
Support Year
3
Fiscal Year
2008
Total Cost
$353,789
Indirect Cost
Name
University of California Los Angeles
Department
Family Medicine
Type
Schools of Medicine
DUNS #
092530369
City
Los Angeles
State
CA
Country
United States
Zip Code
90095
Maly, Rose C; Liu, Yihang; Liang, Li-Jung et al. (2015) Quality of life over 5 years after a breast cancer diagnosis among low-income women: effects of race/ethnicity and patient-physician communication. Cancer 121:916-26
Griggs, Jennifer J; Liu, Yihang; Sorbero, Melony E et al. (2014) Adjuvant chemotherapy dosing in low-income women: the impact of Hispanic ethnicity and patient self-efficacy. Breast Cancer Res Treat 144:665-72
Maly, Rose C; Liu, Yihang; Diamant, Allison L et al. (2013) The impact of primary care physicians on follow-up care of underserved breast cancer survivors. J Am Board Fam Med 26:628-36
Blinder, Victoria; Patil, Sujata; Eberle, Carolyn et al. (2013) Early predictors of not returning to work in low-income breast cancer survivors: a 5-year longitudinal study. Breast Cancer Res Treat 140:407-16
Liu, Yihang; Malin, Jennifer L; Diamant, Allison L et al. (2013) Adherence to adjuvant hormone therapy in low-income women with breast cancer: the role of provider-patient communication. Breast Cancer Res Treat 137:829-36
Yanez, Betina; Stanton, Annette L; Maly, Rose C (2012) Breast cancer treatment decision making among Latinas and non-Latina Whites: a communication model predicting decisional outcomes and quality of life. Health Psychol 31:552-61
Blinder, Victoria S; Patil, Sujata; Thind, Amardeep et al. (2012) Return to work in low-income Latina and non-Latina white breast cancer survivors: a 3-year longitudinal study. Cancer 118:1664-74
Umezawa, Yoshiko; Lu, Qian; You, Jin et al. (2012) Belief in divine control, coping, and race/ethnicity among older women with breast cancer. Ann Behav Med 44:21-32
Maly, Rose C; Leake, Barbara; Mojica, Cynthia M et al. (2011) What influences diagnostic delay in low-income women with breast cancer? J Womens Health (Larchmt) 20:1017-23
Thind, Amardeep; Liu, Yihang; Maly, Rose C (2011) Patient satisfaction with breast cancer follow-up care provided by family physicians. J Am Board Fam Med 24:710-6

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