PREDICTION AND OUTCOME MEASUREMENT IN CHILDHOOD CANCER

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Research aimed at solving clinical problems often is limited because those who understand the medical questions lack the quantitative skills necessary to arrive at measurable solutions. In this application, i propose to utilize my doctoral training in health services research as well as my knowledge of pediatric oncology to solve problems related to long-term survivors of childhood cancer. Patient outcome measurement relating to quality of care, economic theory and modeling, statistics and health economics have been studied as part of my PH.D program and will be utilized to improve and refine pediatric oncology therapy. The work described in this proposal involves three sequential steps; (1) Prediction: develop new multivariate models and improve on those of others to predict second cancers, heart failure, pulmonary failure, growth abnormalities, and survival; (2)Outcome Measurement: develop and improve measures which quantify health status (quality of life) in order to supplement survival as a reasonable objective of children with malignancies in which high "cure" rates are now achieved; and 93) Decision Models: with improved prediction and measurement; and utilizing the mathematical tools of economics and operations research, to suggest refined therapeutic regimens which maximize patient utility. I plan to begin an academic career in Pediatric Oncology as an Assistant Professor of Pediatrics in the School of Medicine of the University of Pennsylvania, an ideal situation in which to combine my training in clinical oncology with health services research. The members of the Division of Pediatric Oncology have been pioneers in the study of delayed consequences of childhood cancer therapy and the large patient population provides an excellent resource for the study of multiple variables. Additional patients for specific projects are available from the children's Cancer Study Group, the National Wilms; tumor Study and the Late Effects Study Group, as leaders of these cooperative groups are faculty members. The Leonard Davis Institute of health Economics maintains very close ties with the Children;s Hospital and will provide a superb base of technical support as well as a stimulating group of peers interested in economic and statistical modelling.