Obstetrical and Oncological Outcomes Among Reproductive Age Women with Gynecological and Breast Cancer

项目摘要 对于许多被诊断患有癌症的年轻女性来说，生育能力非常重要。手术，化疗，还有 放射治疗会影响生育和妊娠结局。相反，在癌症发生时怀孕 确诊或癌症治疗后会影响患者的存活率。尽管有越来越多的年轻女性患有 妇科或乳腺癌以及准确信息在指导咨询中的重要性，证据 关于怀孕或辅助生殖技术(ART)对肿瘤学和产科的影响 癌症治疗后的结果仍然有限。为了解决这些知识差距，劳海恩博士计划 进行一项以人群为基础的观察性研究，以评估生育力、产科和肿瘤学结果 18-45岁被诊断为早期卵巢癌、子宫癌、宫颈癌或乳腺癌的女性 选择保留生育能力的肿瘤治疗。我们提出了一种新的四个唯一数据源的链接：1) 加州癌症登记处(CCR)数据，其中包括有关肿瘤特征、原发癌症- 加州所有确诊癌症病例的定向治疗和存活率；2)加州全州办事处 卫生规划和发展(OSHPD)出生数据，包括产妇产前和产后 分娩前9个月和分娩后1年的住院记录；3)加州OSHPD住院患者和 门诊手术出院数据集，其中包含所有住院患者和门诊患者的治疗数据 手术；以及4)疾病控制和预防中心(CDC)国家辅助生殖 技术(ART)监测系统数据集，其中包括美国生育率启动的所有ART周期 诊所。我们将用横断面调查来补充这些数据，以确定预防的障碍 育龄妇女不能成功怀孕。这项研究将提供以下信息 怀孕或接受抗逆转录病毒治疗的妇女的肿瘤学、生育力和产科结局 妇科或乳腺癌的诊断，并找出阻碍育龄妇女 成功怀孕导致活产。 Rauh-Hain博士是德克萨斯大学MD的妇科肿瘤学家和卫生服务研究员 安德森癌症中心。他对了解育龄护理的质量特别感兴趣。 身患癌症的女性。他的长期职业目标是成为一家创新的、独立出资的健康公司 妇科癌症服务和比较有效性研究人员。所描述的研究计划 本课程旨在补充包括高级统计培训在内的职业发展计划 建模和调查的设计和实施。该奖项将为后续两项研究奠定基础： 1)一项前瞻性多中心队列研究，旨在评估未来的障碍和决策 2)使用相关数据库将研究扩大到更广泛的范围 患有常见癌症的育龄妇女群体。

Project Summary Fertility is very important to many young women diagnosed with cancer. Surgery, chemotherapy, and radiotherapy can impact fertility and pregnancy outcomes. Conversely, pregnancy at the time of cancer diagnosis or after cancer treatment can impact survival. Despite the increasing number of young women with gynecological or breast cancer and the importance of accurate information in guiding counseling, evidence regarding the impact of pregnancy or assisted reproductive technologies (ART) on oncological and obstetrical outcomes following cancer treatment remains limited. To address these knowledge gaps, Dr. Rauh-Hain plans to conduct a population-based observational study to estimate fertility, obstetrical, and oncological outcomes in women age 18–45 years who are diagnosed with early-stage ovarian, uterine, cervical, or breast cancer and opt for fertility-sparing oncologic treatment. We propose a novel linkage of four unique data sources: 1) California Cancer Registry (CCR) data, which include information about tumor characteristics, primary cancer- directed therapy, and survival for all cancer cases diagnosed in California; 2) California Office of Statewide Health Planning and Development (OSHPD) Birth Data, which include maternal antepartum and postpartum hospital records for the 9 months prior to and 1 year after delivery; 3) California OSHPD inpatient and ambulatory surgery discharge data sets, which contain patient treatment data for all inpatient and ambulatory surgeries; and 4) the Centers for Disease Control and Prevention (CDC) National Assisted Reproductive Technologies (ART) Surveillance System data set, which includes all ART cycles initiated in U.S. fertility clinics. We will supplement these data with a cross-sectional survey to identify barriers preventing reproductive-age women from achieving successful pregnancies. This study will provide information about oncological, fertility, and obstetrical outcomes among women who become pregnant or underwent ART after a gynecological or breast cancer diagnosis and identify barriers that prevent reproductive-age women from achieving successful pregnancies leading to a live birth. Dr. Rauh-Hain is a gynecologic oncologist and health services researcher at The University of Texas MD Anderson Cancer Center. He has a particular interest in understanding the quality of care for reproductive-age women with cancer. His long-term career goal is to become an innovative and independently funded health services and comparative effectiveness researcher in gynecological cancer. The research program described here is designed to complement a career development plan that includes training in advanced statistical modeling and survey design and implementation. This award will lay the foundation for two follow-up studies: 1) a prospective multicenter cohort study to assess barriers to, and decision-making regarding, future pregnancies in this population and 2) the use of the linked databases to expand the study to a broader population of reproductive-age women with common cancers.