Factors Contributing to the Development of Chemotherapy Intolerance in African American Females Age 65 Years and Older Diagnosed with Breast Cancer
Question
Per your request, I've placed an 18 pages order. Based on your request, I expect the quality of the writing for this research proposal to be as equally high as the amount being requested. You've already been working on this project and know what to do. I don't need to explain again. Please be sure to follow the power point slide I've share as your guide while writing this research proposal. I believe you have access to order #687603 and you can always refer back to that order should you need any information on what you have been working on in that order or need to refer back to it. This order is just a continuation of order #687603. Just in case I've shared the power point slides which explains the expectation of how to write the research proposal. Please strictly adhere to this when writing this research proposal. Thank you. If you have any questions or concern then please do not hesitate to reach out. I will be looking forward to it.


Solution
Factors
Contributing to the Development of Chemotherapy Intolerance in African American
Females Age 65 Years and Older Diagnosed with Breast Cancer
Introduction
After years of
unrestrained growth and multiplication, breast cancer cells accumulate into an unmanageable
mass of tissue that eventually becomes a tumor. In addition to breast size and
appearance changes, breast cancer symptoms may include changes in skin texture
and appearance of the breasts. Mammography makes it possible to detect breast
cancer in its earliest stages, which is extremely important. Breast cancer is
the second most common cancer in women, after skin cancer, in terms of
incidence. Women in their fifties and sixties are particularly vulnerable.
Breast cancer can affect men as well as women. This, on the other hand, is a
rare occurrence in this particular community. According to scientific research,
transgender women are more likely than cisgender men to develop breast cancer.
Although breast cancer is more common in women, transgender guys are at a lower
risk of developing the disease than female transgender individuals. Breast
cancer is slightly more common among non-Hispanic white women than non-Hispanic
white women of different races and ethnicities. Non-Hispanic black women have historically
been more than twice as likely as non-Hispanic white women to contract the
virus. Women of Asian, Hispanic, and Native American heritage are less likely
to develop breast cancer than other women.
Women over the age of 50
are at a higher risk of having breast cancer than younger women. Therefore,
women 65 and over are responsible for more than half of all new breast cancer
diagnoses and most breast cancer-related deaths worldwide. There is still much
to learn about how breast cancer and its therapies will affect the long-term
functioning abilities of breast cancer survivors. If chemotherapy hinders an older
adult’s ability to maintain independence, significant side effects may result. People
can better tailor treatment plans and interventions for women at risk of
functional loss by identifying them and treating them. Several breast cancer institutes
have provided funding for research on adjuvant treatment for older women with breast
cancer. These studies’ results could help identify survivors at risk of
physical function decrease and develop long-term strategies to counteract that
risk. Breast cancer death rates for African American (AA) women have been
higher than for white women for more than two decades, even though AA women’s
disease is less common.
Background and
Significance
Diagnostic and treatment
delays that might negatively influence patient outcomes play a role in developing
chemotherapy intolerance in African American females’ aged 65 years and older
diagnosed with breast cancer. Patients with early-stage breast cancer who delay
therapy by more than two months are reported to have a worse chance of
surviving. Even the most generally used vocabulary and analytical techniques
leave significant gaps in understanding how race affects individuals’
discrepancies when researching racial disparity. Medical consultations and
diagnosis are two separate processes over a long period. Researchers frequently
conduct their studies using administrative datasets or population-based breast
cancer registries that do not include information on a patient diagnosed with breast
cancer. Due to the absence of patient care delays from the analysis, the delay
in diagnosis has been primarily disregarded. Consequently, it is possible to
underestimate the amount of time required to perform a specific task due to
this phenomenon. It is more common for minorities to self-identify as
experiencing a delay in seeking care than for non-minorities, which may impact
the results of racial comparisons of delays in seeking care.
For population research,
multivariate adjustment of race minimizes risk factors that may be accounted
for by other variables, which helps researchers better understand racial
variations. Health disparities research should begin with unadjusted health
outcomes models and then go on to race-segregated data to discover the
underlying causes of disparity. A few investigations into the effect of race on
breast cancer patients’ delayed diagnosis and surgical treatment have been
conducted, but the findings are intriguing. Using racial stratification in
epidemiological research has allowed researchers to compare risk factors
between and within races in a wide range of diseases. Medical records and
interviews from women with early-stage breast cancer have always been recorded.
There may be disparities among races when it takes to find symptoms, identify
them and treat them.
Review of Prior
Studies and Literature
AA breast cancer is more
common in women with a history of the disease in their families. According to Yedjou
et al. (2019), 80 percent of women with breast cancer mutations have chemotherapy
intolerance to triple-negative tumors and early-onset breast cancer.
Only a tiny percentage of AA women diagnosed with breast cancer before age 65
and who have a strong family history have a gene mutation. One-tenth of all breast
cancer patients have genetic defects that increase their likelihood of
developing the disease. It is known that multiple genes, including PTEN, BARD1,
STK11/LKB1, CDH1, CHEK2, ATM, MRE11, NBS1 and BRIP1, FANCA and FANCM, RAD50 and
RAD51 (B and C), XRCC2 and others, are connected with an increased risk of
breast cancer in the germline (Yedjou et al., 2019). Early menarche, oral
contraceptive use, anovulatory infertility, being older at the time of the
first pregnancy, and being in the postpartum period increase the risk of breast
cancer in AA women.
Breast cancer can occur
in any woman of any age who has received mantle irradiation or used alcohol.
Those aged 20–44 who had smoked for more than ten years had a 1.6-fold
increased incidence of estrogen receptor (ER)-positive breast cancer compared
to women who had never smoked (Zavala et al., 2020). However, according to
Zavala et al. (2020), gaining weight after 65 increases the risk of developing
ER-negative breast cancer by a factor of two. Excessive calorie intake, a lack
of physical activity, and being overweight all increase the risk of heart
disease and stroke in postmenopausal women, but regular, intensive exercise
minimizes the risk of chemotherapy intolerance in this population. A
high-energy diet, such as one that consists primarily of red meat or fast food,
increases the risk of breast cancer in postmenopausal women. However, there is
some evidence that a diet heavy in whole foods and plant-based proteins can
help reduce the risk of AA breast cancer in some women. Women after menopause
who replace one serving of meat with one serving of beans have a 19 percent
lower chance of developing breast cancer, according to Ali et al. (2018).
According to research, women of all ages who have a high mammographic density
are at a higher risk of developing breast cancer.
The density of
postmenopausal women’s breasts is regulated by various factors, including
alcohol consumption, vitamin D and calcium intake, interleukin-6 and
dehydroepiandrosterone sulfate levels, and estrogen levels. Postmenopausal
women with low vitamin D levels are more prone to develop breast cancers that
are more severe in their progression. Genetic profiling can be used to detect
and predict the outcome of aging breast tumor biology, which can be
accomplished through gene expression profiling techniques. Young women under
the age of 30 are more often than older women to be diagnosed with aggressive
triple-negative tumors with stromal-related characteristics, according to
Nayana (2020). Even after considering factors such as subtype, grade, tumor
size, and nodal status, relapse risk was found to be higher among AA women.
Using a candidate gene method tailored to each subtype, more than 12 gene sets
were found to be associated with adolescence. Nayana (2020) evaluated more than
700 early-stage breast cancers in two cohorts for more than 700 cases of breast
cancer. According to the findings, the analysis of gene set enrichment revealed
367 gene sets that were more abundant in the younger cohort. She discovered
that the younger man had lower levels of estrogen receptor, progesterone
receptor, her2neu, and epidermal growth factor receptor expression than the
older man. After considering tumor subtype and clinicopathologic
characteristics such as tumor grade, there were no longer any age-related
variations in gene expression to be observed.
Later investigations by
Richardson et al. (2017), using a candidate gene method to control for tumor
grade and subtype, indicated that the expression of specific breast cancer
genes varied over time after controlling for these variables. BUB1, KRT5, and
MYCN levels were higher in AA women than in older women, although CXCL2 levels
were lower in AA women than in older women. Changes in gene expression were
found to impact the prognosis of specific tumor subtypes. Because AA women had
a greater frequency of aggressive basal-like and Her2-enriched subtypes of
breast cancer, age-related biochemical modifications may occur in the disease.
AA women have a significant proportion of aggressive personalities when seen as
a group. More in-depth research into this matter is required. Between 2012 and
2014, one out of every 253 American women under the age of 70 was diagnosed
with breast cancer, with a mortality rate of 0.052 percent between the two
years (Hair et al., 2017). Patients under the age of 35 diagnosed with breast
cancer have recurrence-free survival rates of 1.70 months and 1.50 percent, which
are both higher than the national average and higher than the national median.
The mortality risk for AA women with early-stage breast cancer is 39 percent
higher than for other women diagnosed with the disease. The fact remains that
AA women have a poorer overall survival rate for breast cancer than other
women, regardless of how early in the condition they are diagnosed. Women
between 40 and 55 have more excellent relative survival rates for stage II-IV
disease.
AA women have a worse
overall survival rate than men, regardless of the stage of the disease at when
they are diagnosed. According to the American Cancer Society, women who are
diagnosed with stage IV breast cancer have a poor outlook. Breast cancer of any
form (including invasive breast cancer) had a worse prognosis for AA women than
other women, regardless of ethnicity. Although ductal carcinoma is the most
frequent type of breast cancer, it can also occur in situations of medullary
breast cancer, inflammatory breast cancer, and lobular breast cancer. AA women
are well behind the average population (Freedman et al., 2010). Patients with
ER-negative breast cancers are more likely to develop a relapse two years after
completing treatment than other breast cancer patients. During the past eight years,
the mortality rate for women with ER-positive cancers has decreased
significantly. Since 1985, there has been a considerable improvement in the
survival rates of AA women diagnosed with breast cancer compared to older
women, confirmed for all stages of the disease. Improved palliative and
supportive care strategies for AA women with remote disease may have led to the
most substantial relative benefit experienced by these patients. It did not
affect the survival of breast cancer patients with high-grade tumors and more
advanced illness at the time of diagnosis. According to Freedman et al. (2010),
environmental and genetic factors are likely to impact differences between
geographic locations in age-related outcomes. Those diagnosed early have a more
significant chance of surviving the disease and surviving to tell the tale.
Patients with early-stage
breast cancer under the age of 40 are at a higher risk of getting metastatic
disease than those above the age of 40. The risk of breast cancer-related death
is higher among AA women with breast cancer subtypes such as triple-negative
and hormone receptor-negative, HER2-enriched, than among AA women with breast
cancer subtypes such as hormone receptor-positive, HER2-nonenriched. Those
suffering from the hormone-receptor-negative condition are at a higher risk of
dying due to their disease. Mutations in the PALB2 gene in the mother have been
linked to earlier development of breast cancer and a worse outcome in the case
of the disease. Breast cancer mortality may be higher in African-American women
with co-existing medical conditions. Obesity and type 2 diabetes have also been
related to a bad prognosis in cancer. According to the findings, patients with
postmenopausal breast cancer who were obese or had diabetes were at increased
risk of death (Stringer-Reasor et al., 2021).
Curing breast cancer and
extending a patient’s life are the primary goals of breast cancer treatment,
ensuring that patients have the highest possible standard of living during and
after treatment. Examining a patient’s medical history to see if breast cancer
has returned is critical to determining whether or not the patient’s breast
cancer has been entirely removed. The most common reason for tumors not being
able to be cured is that they have reached an advanced stage. Patients with
metastatic breast cancer, for example, can be treated as chronically ill even
though their breast cancer has spread far and wide (Siddharth & Sharma, 2018).
To treat breast cancer, there is a wide range of treatment methods that can be
employed alone or in combination, such as surgery and radiation therapy. In
conjunction with standard breast cancer treatment, supportive therapies can
benefit patients and their families by reducing side effects and addressing
other aspects of health and well-being that are important to them and their
loved ones, like sleep, nutrition, and exercise. Depending on the type of
slow-growing breast cancer, delaying therapy and continuing to monitor it may
be an option. This strategy can effectively treat prostate breast cancer with
low risk and other blood breast cancers. Using high-energy beams or particles
from outside or within the body can effectively kill breast cancer cells.
Systemic medications enter the bloodstream and have the potential to impact the
entire body. They use a range of methods to carry out their duties. A typical
example of this is chemotherapy medications, which aim to kill fast
proliferating cells.
Breast cancer risk can also
be reduced with hormone therapy, which lowers or eliminates the body’s natural
hormones. As the name suggests, targeted therapies target specific proteins necessary
for breast cancer to grow and spread to treat it effectively. The patient’s
immune system is stimulated in immunotherapy, used to treat breast cancer. A
patient’s overall quality of chemotherapy intolerance outcomes is impacted by
how well their breast cancer treatment manages their physical and mental
symptoms and limitations. Survivors’ capacity to return to everyday life and
financial stability might be severely impacted by these concerns (Release, 2018).
Breast cancer rehabilitation can help patients cope more efficiently with
symptoms, perform better in everyday activities, and enjoy a better quality of
life during treatment. Therapy can reduce some adverse effects for some people,
but for others, they remain. It may take months or even years for lymphedema to
develop after breast cancer surgery. A lack of information on long-term and
late-term detrimental implications has led to the most overall breast cancer-related
side effects, such as pain, fatigue, and emotional distress, being the most
common.
To improve long-term and
late effects surveillance and early detection and treatment, information on
health-related quality of life and patient-reported outcomes is integrated with
data from a population-based breast cancer registry—every stage of recovery,
from start to finish (Yee et al., 2017). Therapy can
reduce some adverse effects for some people, but for others, they remain. As a
result of their diagnosis, patients may experience long-term adverse effects
from their chemotherapy intolerance, such as lymphedema following breast cancer
surgery. A patient’s risk of and response to side effects are influenced by the
kind of breast cancer, treatment, and other factors. A lack of information on
long-term and late-term detrimental implications has led to the most overall breast
cancer-related side effects, such as pain, fatigue, and emotional distress,
being the most common. To improve long-term and late effects surveillance and
early detection and treatment, information on health-related quality of life
and patient-reported outcomes is integrated with data from a population-based breast
cancer registry. According to Schneider (2020), 65 years and
older African and African-American women who are obese are more likely to resist
breast cancer treatment. Numerous biochemical processes have been implicated in
the development of obesity. Inflammation thrives in adipose tissue because of
the unique physiological conditions it provides in the body’s midsection. Other
pro-inflammatory mediators are released by fatty tissue, such as TNF,
interleukin-6, and retinol-binding protein-4, all contributing to inflammation
(Schneider,
2020). The NF-kappa B, MAP kinase, PI3-K, and
AKT signaling pathways and the PI3-K and TNF signaling pathways were stimulated
by TNF in human breast cancer cells.
Metastatic breast cancer
patients with elevated interleukin-6 have a significant chemotherapy
intolerance rate than those with lower levels of IL-6. In the early stages of breast
cancer, IL-6 can predict tumor size, progression, and metastasis. For the
growth of the breast gland and the delivery of milk during lactation, Leptin, a
cytokine produced primarily by fat tissue, is essential. Serum leptin levels are
much more significant in obese individuals than in those of average weight.
Proliferation, angiogenesis, and the production of insulin-like growth factor 1
have been activated by excess adipose tissue, leading to tumor progression and
metastasis (Foy
et al., 2018). As the hormone produced by adipose
tissue, adiponectin blocks Leptin’s breast cancer-promoting effects. Insulin
resistance and obesity affect the expression of this gene. Because of this,
adiponectin levels rise, allowing breast cancer cells to proliferate and
spread. It has been shown that having high serum adiponectin levels reduces one’s
risk of getting breast cancer. According to Foy et al. (2018),
the hormone adiponectin appears to have a role in the pathways that relate
insulin sensitivity to muscle shape. In the development of metabolic diseases
like obesity, high blood pressure, and type 2 diabetes, there is evidence that
this heterogeneous tissue, which comprises numerous distinct fiber types with various
metabolic properties, plays a role.
Type IIa and Type IIb
muscle fibers are sometimes referred to as type IIx based on the properties of Type
I and type II muscle fibers. As a result of their more significant myoglobin
levels, capillaries, and mitochondria, order I muscle fibers have a greater
aerobic metabolic capacity than type II muscle fibers. There is less myoglobin
and capillaries in Type II muscle fibers than in Type I fibers, resulting in a
lower aerobic capacity. A more considerable aerobic potential is found in Type
IIa fibers than in type IIx fibers. In contrast, a lower aerobic potential is
found in Type I fibers than in Type I fibers. Blood adiponectin levels are
higher in style I muscle fibers, while these levels are lower in type IIb
muscle fibers. According to the findings of Jiang et al. (2016),
NH Black individuals have more anaerobic muscle fibers, while NH White people
have more Type I muscle threads, In contrast to insulin-resistant type IIb
(IIx) muscle fibers, which have lower insulin sensitivity, type I muscle fibers
have higher insulin sensitivity. New Hampshire Blacks have myofiber type II
linked to obesity, hypertension, and diabetes. Thus, type 2 diabetes is
significantly increased by obesity.
Regarding BMI and body
fat percentage, the percentage of type IIx (IIb) muscle fibers strongly
correlates with the rate of type I muscle threads in a specific individual. A more
significant percentage of type IIx muscle fibers in obese diabetics than in non-diabetics.
A more substantial proportion of their muscle fibers are of type IIb in obese
African American Black women than lean ones. Sreenivas (2020) shows that
type I muscle fibers are less common in African American women than in obese
Caucasians. Still, type IIx muscle fibers are more common in African American
women. These findings support the hypothesis that African American Blacks are
more likely than other ethnic groups to be obese, acquire weight rapidly, and
develop insulin resistance.
African-American Blacks
may have an inherited tendency to develop type 2 diabetes, leading to fat
storage within muscle tissue due to decreased metabolic capacity and fat oxidation.
Insulin levels, insulin resistance, and insulin resistance contribute to
obesity development. High blood glucose and insulin levels and insulin
resistance have been reported in breast cancer patients with poor prognoses.
Evidence from human lung tumors suggests that breast cancer cells consume more
glucose than usual, which could serve as fuel for the breast cancer cells. Chemotherapy
intolerance, characterized by robust lipogenesis, increases aerobic glycolysis.
Limited mitochondrial oxidative phosphorylation capacity, even in the presence
of adequate oxygen, among other characteristics, results from increased glucose
metabolism in breast cancer cells (Núñez Abad et al., 2021).
In the fight against breast cancer, higher blood glucose levels and
hyperinsulinemia associated with obesity and overweight may provide breast
cancer cells a competitive edge. Obese adults, particularly postmenopausal
women, have elevated estrogens, estrone, and estradiol levels, while the sex
hormone-binding globulin binds estradiol and limits its action and has lower
levels.
Since obesity increases
levels of steroid hormones, this could hasten tumor growth and recurrence. SHBG
levels fall due to increased androgen production in adipose tissue, contributing
to tumor growth and promotion by increasing estrogen production in the
bloodstream. The output of Leptin is also stimulated by estrogens, which aid in
developing breast cancer cells and the spread of the disease. Núñez Abad et al. (2021) have
found an association between elevated levels of insulin and IGF-1 and worse
outcomes, such as obesity. Postmenopausal TNBC is more common in young
African-American and Hispanic women than in other women, which may be linked to
obesity’s effect on the incidence of postmenopausal. In obese black women, the
percentage of tumors devoid of estrogen and progesterone should be the same in
both sexes. Non-African-American women, on the other hand, are less likely to
have triple-negative breast cancer tumors than obese African-American women
are. Both expressions in the body appear to be influenced by the possible
pathways that lead to obesity throughout the body.
Aims and Research
Questions
Aims
1. The
research aims to find factors contributing to chemotherapy intolerance in
African American females age 65 years and older diagnosed with breast cancer.
2. The
cohort study’s goal will be to understand better the impact of health care
inequities on breast cancer patients of color.
Research Questions
1. Can
breast cancer deaths among African Americans rise because of intolerance to
detection and treatment?
2. Is
breast cancer chemotherapy intolerance affected by situational barriers to
African American females aged 65 years and older?
Research Design and
Methods
Implications
and Contribution to Knowledge
If a woman is aware of breast
cancer awareness and education inequities, she may be less likely to get
checked out or treated for the condition. This study aims to gather information
regarding a group of women’s experiences, knowledge, and health behaviors
before and after their breast cancer diagnosis. The study also investigates the
association between participants’ degree of knowledge and demographic variables
and their involvement in their breast cancer treatment.
A retrospective cohort
analysis of 6oo African Americans diagnosed with invasive breast cancer in New
Jersey between 2005 and 2010 will be included. Six hundred women with stage
I-III breast cancer aged 65 and over will participate in the study and undergo
adjuvant chemotherapy were assessed for physical function. Medical records and
interviews with patients will also both conducted. It will be determined how
long it will take for a symptom to be recognized and diagnosed and how long it
will take for the sign to be identified and then operated on. Racism will also
be included in the investigation of the delay in diagnosis.
Compliance with
Ethical Principles
To get the most out of a
study, this study will make every effort to ensure that participants and
researchers are as safe as possible while still achieving their goals. Every
volunteer in the study must be free of coercion or undue influence and must
have their privacy and dignity respected throughout this study. The research
will yield results worth the time and effort invested in it and benefits that
outweigh any potential downsides. Patients will fill out the Organization for Breast
Cancer Research and Treatment Quality of Life Questionnaire’s physical function
subscale during and after chemotherapeutic treatment. Whenever a participant’s
score falls by more than ten points from the baseline, it will be considered
deterioration. When a person’s blood pressure rebounded to within 10 points of
its initial number, it will be regarded as a sign of resilience.
To prevent any possible
harm or risk, it is imperative to build strong safeguards. Regression analysis will
be performed to examine the correlation between pre-treatment variables and
changes in physical function following therapy. Breast Cancer cases will only be
included if they meet the following criteria: Only non-melanoma skin breast
cancer is found in AA or white women with no prior history of breast or ovarian
cancer. Health care providers’ records will be retrieved and thoroughly
analyzed to provide an accurate medical history of a patient who had previously
identified all of their doctors. Records of diagnostic information, pathology
reports, and operation notes will be collected, and reports of adjuvant
treatment and hospital discharge summaries during the first year following the
initial diagnosis. Trained abstractors will review medical records to determine
when and why preoperative mammography was performed. They will document the
patient’s first symptoms. When the patient misses an appointment and treatment,
there will be a record of the doctor’s suggestions and the patient’s compliance
with those recommendations, which will be documented.
Researchers and
participants will be given appropriate information about the study to obtain
informed consent. The study’s purpose must be clearly explained without undue
pressure or improper enticement. Socioeconomic variables, family history of breast
cancer, comorbidities, tumor and receptor characteristics, and the institution
where therapy was delivered will be considered. As a result of race information
being recorded in multiple places throughout medical records, abstractors will
not be blinded to it, and the study’s premise will not go unnoticed. A standard
training program for all abstractors will be designed to ensure completeness
and avoid systematic inconsistencies in data abstraction among abstractors. As
a temporary workaround, all abstractors will be provided with a copy of the
course materials.
An overview of the study will
be included in the resources, information on abstraction techniques, the abstraction
form, and an instruction manual for coding. The protocol will dictate that
group and one-on-one meetings will be held with the lead research coordinator.
Each section of the manual’s abstract form and coding instructions will be
thoroughly examined during these sessions. The primary investigator and lead
research coordinator will closely supervise the abstractors during the medical
record abstraction process to ensure they know breast cancer treatment
terminology. They will also examine any differences in the first ten medical
records abstracts from each medical record abstractor with the principal
research coordinator.
Studies are only as good
as their participants’ and groups’ wishes for anonymity and their capacity to
keep data collected on them confidential. The coordinator and his team will
meet weekly to discuss challenging cases and unresolved abstraction issues. If
there is any doubt regarding the meetings, surgeons and doctors from oncology will
be invited to the forum. There will be changes in the procedure manual and in
the training of the abstractors as the group’s recommendations change. After
extracting the data, it will be necessary to store it in a Microsoft Access
2010 database. Once an error is identified, the original abstractor will be
contacted and asked to check their medical records. Through this technique,
abstractors will be allowed to reflect on and learn from their mistakes.
Using semi-structured
phone interviews, the research will acquire more information on breast cancer
diagnosis while also enhancing the quality of the data gleaned from medical
records. The 30-minute interviews, which will take an average of 30 minutes
each, will be recorded using a telephone recording jack. After the initial,
more organized consultation, a more in-depth, semi-structured interview will be
conducted. As part of the structured component of the discussion, patients will
be questioned on how and when their breast cancer was initially discovered,
when they first saw a doctor for their breast cancer and the recommended
therapies. They will also be asked yes/no questions about whether or not they
had any situational impediments at the time of their breast cancer diagnoses,
such as difficulties getting around or the necessity of daily care for
dependents.
In-depth training in
breast cancer biology, treatment, and interviewing techniques will be provided
to the interviewers, who will be female. During the semi-structured interview,
patients will be asked about the elements that influence their treatment
choice, and the effect of situational barriers will be examined more
thoroughly. Only quantitative data collected during the structured interview
phase will be used to draw findings in this study.
A significant emphasis will
be placed on conducting semi-structured interviews during the training. The
interviewers will review the semi-structured interview questions in a small
group before checking breast cancer pathology and treatment. Before training,
all interviewees will be given reading material to familiarize themselves with
staging and treatment terminology. Interviewers will also be given a detailed
procedure manual with step-by-step instructions. The goal will be to interview
half of the patients because of the smaller sample size required for
qualitative than quantitative research.
Budget
The
total research budget is estimated to be between $5000 and $10000 from the
beginning to the end. The participants will be enumerated in every meeting. The
first cohort will be reimbursed with a $50 cheque for each individual.
Timeline
The project will run for two months, with the
first month dedicated to collecting data from the first cohort. The group will
involve the telephone responses and the physical questionnaires filled by the
participants. The remaining month will be dedicated to the analysis and
finalizing of the report.
Conclusion
Despite significant gains
in understanding these issues, multidisciplinary efforts are needed to reduce
or eradicate racial/ethnic disparities in breast cancer incidence, tumor
biology, and outcomes. To better understand the possible heterogeneity of
etiology, tumor behavior, and treatment response, several federal efforts have
encouraged the participation of a broad spectrum of persons and groups in
research studies and clinical trials. To reduce and eliminate breast cancer
health disparities, it is necessary to gather and analyze extensive data on
biological, behavioral, physical/built environment, sociocultural environment, and
health care system components. The inclusion of cell lines and xenograft models
from different ethnic and racial backgrounds will help researchers conduct more
representative tests of human variation. When it comes to eliminating gaps in
health outcomes, raising awareness of breast cancer’s causes will not be
enough. To better understand breast cancer etiology and develop appropriate
treatments for diverse populations, people must address the lack of sufficient
data and expand culturally and linguistically tailored breast cancer awareness,
education, and navigation programs, as well as programs to promote behavioral
changes in at-risk groups that focus on already known modifiable factors. A
structural component or policy, such as tobacco regulation, can help people
change their behavior. Without systemic changes that promote health equity,
universal health insurance coverage, and access to high-quality care for all
individuals, eliminating health inequities will be unachievable, to put it
simply.
References
Ali,
G. B., Ali, S. A., Suhail, N., & Ali, S. A. (2018). Sociocultural Factors
Affecting the Treatment of Breast Cancer Among Pakistani Women and Potential
Strategies to Prevent Breast Cancer: A Narrative Review. Open Access Journal
of Reproductive System and Sexual Disorders, 2(1), 1–6. https://lupinepublishers.com/reproductive-medicine-journal/fulltext/socio-cultural-factors-affecting-the-treatment-of-breast-cancer.ID.000126.php
Foy, K. C., Fisher, J. L., Lustberg,
M. B., Gray, D. M., DeGraffinreid, C. R., & Paskett, E. D. (2018).
Disparities in breast cancer tumor characteristics, treatment, time to
treatment, and survival probability among African American and white women. npj
Breast Cancer, 4(1). https://doi.org/10.1038/s41523-018-0059-5
Freedman, R. A., Virgo,
K. S., He, Y., Pavluck, A. L., Winer, E. P., Ward, E. M., & Keating, N. L.
(2010). The association of race/ethnicity, insurance status, and socioeconomic
factors with breast cancer care. Cancer, 117(1), 180–189. https://doi.org/10.1002/cncr.25542
Hair, B. Y., Hayes, S.,
Tse, C.-K., Bell, M. B., & Olshan, A. F. (2017). Racial differences in
physical activity among breast cancer survivors: Implications for breast cancer
care. Cancer, 120(14), 2174–2182. https://doi.org/10.1002/cncr.28630
Jiang, Y., Sereika, S., Bender, C.,
Brufsky, A., & Rosenzweig, M. (2016). Beliefs in Chemotherapy and Knowledge
of Cancer and Treatment Among African American Women With Newly Diagnosed
Breast Cancer. Oncology Nursing Forum, 43(2), 180–189. https://doi.org/10.1188/16.onf.180-189
Nayana. (2020). Breast
Cancer, Race, and Ethnicity. WebMD. https://www.webmd.com/breast-cancer/guide/race-ethnicity
Núñez Abad, M., Calabuig-Fariñas,
S., Lobo de Mena, M., José Godes Sanz de Bremond, M., García González, C.,
Torres Martínez, S., García-García, J. Á., Iranzo González-Cruz, V., &
Camps Herrero, C. (2021). Update on systemic treatment in early triple negative
breast cancer. Therapeutic Advances in Medical Oncology, 13,
175883592098674. https://doi.org/10.1177/1758835920986749
Release, M. A. N. (2018). The
study may explain why some triple-negative breast cancers are resistant to
chemotherapy. MD Anderson Cancer Center. https://www.mdanderson.org/newsroom/study-may-explain-why-some-triple-negative-breast-cancers-are-resistant-to-chemotherapy.h00-159223356.html#:~:text=Triple%2Dnegative%20breast%20cancer%20(TNBC
Richardson, L. C.,
Henley, S. J., Miller, J. W., Massetti, G., & Thomas, C. C. (2017).
Patterns and Trends in Age-Specific Black-White Differences in Breast Cancer
Incidence and Mortality - the United States, 1999-2014. MMWR. Morbidity and
Mortality Weekly Report, 65(40), 1093–1098. https://doi.org/10.15585/mmwr.mm6540a1
Schneider. (2020). Researchers
aim to personalize chemotherapy for black patients with breast cancer.
Www.healio.com. https://www.healio.com/news/hematology-oncology/20200126/researchers-aim-to-personalize-chemotherapy-for-black-patients-with-breast-cancer
Siddharth, S., & Sharma, D.
(2018). Racial Disparity and Triple-Negative Breast Cancer in African-American
Women: A Multifaceted Affair between Obesity, Biology, and Socioeconomic
Determinants. Cancers, 10(12), 514. https://doi.org/10.3390/cancers10120514
Sreenivas, S. (2020). Racial
Disparities in Breast Cancer. WebMD. https://www.webmd.com/breast-cancer/features/racial-disparity-breast-cancer
Stringer-Reasor, E. M., Elkhanany,
A., Khoury, K., Simon, M. A., & Newman, L. A. (2021). Disparities in Breast
Cancer Associated With African American Identity. American Society of
Clinical Oncology Educational Book, 41, e29–e46. https://doi.org/10.1200/edbk_319929
Yedjou, C. G., Sims, J.
N., Miele, L., Noubissi, F., Lowe, L., Fonseca, D. D., Alo, R. A., Payton, M.,
& Tchounwou, P. B. (2019). Health and Racial Disparity in Breast Cancer. Advances
in Experimental Medicine and Biology, 1152, 31–49. https://doi.org/10.1007/978-3-030-20301-6_3
Yee, M. K., Sereika, S. M., Bender,
C. M., Brufsky, A. M., Connolly, M. C., & Rosenzweig, M. Q. (2017). Symptom
incidence, distress, cancer-related distress, and adherence to chemotherapy
among African American women with breast cancer. Cancer, 123(11),
2061–2069. https://doi.org/10.1002/cncr.30575
Zavala, V. A., Bracci,
P. M., Carethers, J. M., Carvajal-Carmona, L., Coggins, N. B., Cruz-Correa, M.
R., Davis, M., de Smith, A. J., Dutil, J., Figueiredo, J. C., Fox, R., Graves,
K. D., Gomez, S. L., Llera, A., Neuhausen, S. L., Newman, L., Nguyen, T.,
Palmer, J. R., Palmer, N. R., & Pérez-Stable, E. J. (2020). Cancer health
disparities in racial/ethnic minorities in the United States. British
Journal of Cancer, 1–18. https://doi.org/10.1038/s41416-020-01038-6
Appendix
Appendix 1:
Project budget
First Cohort |
$50 each for 600 participants = $3000 |
Weekly Meetings |
$400 per meeting for 4 meetings = $1600 |
Remuneration and Miscellaneous |
$1000-$5000 |
Appendix 2: Project Timeline
First Cohort Study |
One month |
Weekly Meetings |
Three weeks |
Analysis and Report |
One week |



About Author
Tough Essay Due? Hire Tough Essay Writers!
We have subject matter experts ready 24/7 to tackle your specific tasks and deliver them ON TIME, ready to hand in. Our writers have advanced degrees, and they know exactly what’s required to get you the best possible grade.
Find the right expert among 500+
We hire Gradewriters writers from different fields, thoroughly check their credentials, and put them through trials.
View all writers