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National Institutes of Health: National Cancer Institute: Division of Cancer Control and Population Sciences
Grant Details

Grant Number: 5R01CA119197-05 Interpret this number
Primary Investigator: Maly, Rose
Organization: University Of California Los Angeles
Project Title: Breast Cancer Care and Survivorship in Underserved Women
Fiscal Year: 2010
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Abstract

DESCRIPTION (provided by applicant): 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.

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Publications

Quality of life over 5 years after a breast cancer diagnosis among low-income women: effects of race/ethnicity and patient-physician communication.
Authors: Maly R.C. , Liu Y. , Liang L.J. , Ganz P.A. .
Source: Cancer, 2015-03-15; 121(6), p. 916-26.
EPub date: 2014-11-19.
PMID: 25411008
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Adjuvant chemotherapy dosing in low-income women: the impact of Hispanic ethnicity and patient self-efficacy.
Authors: Griggs J.J. , Liu Y. , Sorbero M.E. , Jagielski C.H. , Maly R.C. .
Source: Breast cancer research and treatment, 2014 Apr; 144(3), p. 665-72.
EPub date: 2014-03-05.
PMID: 24596046
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The impact of primary care physicians on follow-up care of underserved breast cancer survivors.
Authors: Maly R.C. , Liu Y. , Diamant A.L. , Thind A. .
Source: Journal of the American Board of Family Medicine : JABFM, 2013 Nov-Dec; 26(6), p. 628-36.
PMID: 24204059
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Early predictors of not returning to work in low-income breast cancer survivors: a 5-year longitudinal study.
Authors: Blinder V. , Patil S. , Eberle C. , Griggs J. , Maly R.C. .
Source: Breast cancer research and treatment, 2013 Jul; 140(2), p. 407-16.
EPub date: 2013-07-25.
PMID: 23884596
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Adherence to adjuvant hormone therapy in low-income women with breast cancer: the role of provider-patient communication.
Authors: Liu Y. , Malin J.L. , Diamant A.L. , Thind A. , Maly R.C. .
Source: Breast cancer research and treatment, 2013 Feb; 137(3), p. 829-36.
EPub date: 2012-12-23.
PMID: 23263740
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Breast cancer treatment decision making among Latinas and non-Latina Whites: a communication model predicting decisional outcomes and quality of life.
Authors: Yanez B. , Stanton A.L. , Maly R.C. .
Source: Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 2012 Sep; 31(5), p. 552-61.
EPub date: 2012-07-02.
PMID: 22746263
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Belief in divine control, coping, and race/ethnicity among older women with breast cancer.
Authors: Umezawa Y. , Lu Q. , You J. , Kagawa-Singer M. , Leake B. , Maly R.C. .
Source: Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 2012 Aug; 44(1), p. 21-32.
PMID: 22529040
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Patient satisfaction with breast cancer follow-up care provided by family physicians.
Authors: Thind A. , Liu Y. , Maly R.C. .
Source: Journal of the American Board of Family Medicine : JABFM, 2011 Nov-Dec; 24(6), p. 710-6.
PMID: 22086814
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Return to work in low-income Latina and non-Latina white breast cancer survivors: a 3-year longitudinal study.
Authors: Blinder V.S. , Patil S. , Thind A. , Diamant A. , Hudis C.A. , Basch E. , Maly R.C. .
Source: Cancer, 2012-03-15; 118(6), p. 1664-74.
EPub date: 2011-08-25.
PMID: 22009703
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What influences diagnostic delay in low-income women with breast cancer?
Authors: Maly R.C. , Leake B. , Mojica C.M. , Liu Y. , Diamant A.L. , Thind A. .
Source: Journal of women's health (2002), 2011 Jul; 20(7), p. 1017-23.
EPub date: 2011-04-12.
PMID: 21486163
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Depression and sexual adjustment following breast cancer in low-income Hispanic and non-Hispanic White women.
Authors: Christie K.M. , Meyerowitz B.E. , Maly R.C. .
Source: Psycho-oncology, 2010 Oct; 19(10), p. 1069-77.
PMID: 20014073
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Factors that determine satisfaction with surgical treatment of low-income women with breast cancer.
Authors: Thind A. , Diamant A. , Liu Y. , Maly R. .
Source: Archives of surgery (Chicago, Ill. : 1960), 2009 Nov; 144(11), p. 1068-73.
PMID: 19917945
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Breast reconstructive surgery in medically underserved women with breast cancer: the role of patient-physician communication.
Authors: Maly R.C. , Liu Y. , Kwong E. , Thind A. , Diamant A.L. .
Source: Cancer, 2009-10-15; 115(20), p. 4819-27.
PMID: 19626696
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Validity of self-reports of breast cancer treatment in low-income, medically underserved women with breast cancer.
Authors: Liu Y. , Diamant A.L. , Thind A. , Maly R.C. .
Source: Breast cancer research and treatment, 2010 Feb; 119(3), p. 745-51.
EPub date: 2009-06-24.
PMID: 19551500
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Treatment-related symptoms among underserved women with breast cancer: the impact of physician-patient communication.
Authors: Maly R.C. , Liu Y. , Leake B. , Thind A. , Diamant A.L. .
Source: Breast cancer research and treatment, 2010 Feb; 119(3), p. 707-16.
EPub date: 2009-05-16.
PMID: 19449101
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