Lung Cancer Care Outcomes/Surveillance Consortium-Iowa

我们已经组建了一个多学科的研究小组，以人口为基础，研究治疗模式的最初和持续的代表性样本的肺癌患者在爱荷华州。这些模式将在短期和长期治疗的患者决策过程中进行探索，并对适当的结局进行随访，包括无病间期、生活质量指标、临终关怀和总体生存率。建议探索的因素包括患者的人口统计学，经济和行为属性，包括患者的癌症学习环境和宿命论等特征，地理上分散的从业人员与不同的临床管理方法的影响，从业人员继续教育和信息来源，最佳方法不确定的治疗方法的应用，以及空间和财政获得护理的影响。该提案的特点包括：a）一个多学科的研究团队，包括流行病学、疾病登记、生物统计学、卫生经济学、行为科学和胸部肿瘤学; B）经证实的能力，每年访问约2000名肺癌患者，并实现98- 99%的长期随访率，使用爱荷华州癌症登记处（NCI SEER计划）; c）制定经济学模型，以指导患者和从业人员的理论和问卷设计，并提供了解患者决策及其与结果的关系;以及d）来自患者，癌症护理从业人员和病理学家的可证明的高水平社区合作。这项特殊研究的目的是使用工具变量（IV）技术来评估是否可以通过提高早期非小细胞肺癌（ENSCLC）患者的辅助治疗率来提高患者的生存率。如果医疗服务提供者根据患者的预期治疗获益对患者进行准确分类，并且只有预期受益于辅助治疗的患者实际接受了辅助治疗，那么我们预计患者的治疗获益将是最小的。我们假设ENSCLC患者的治疗生存获益很少或没有，这为本研究提供了依据。

We have assembled a team of multi-disciplinary investigators to study, on a population basis, the patterns of treatment initially and continuing for a representative sample of lung cancer patients in the state of Iowa. These patterns will be explored in terms of patient decision-making processes for short and long-term treatment, with follow-up for suitable outcomes including disease-free interval, quality-of-life measures, end of-life care and overall survivorship. Factors proposed for exploration include including patient demographic, economic and behavioral attributes, including traits such as the patient's cancer learning environment and fatalism, the influences of geographically-dispersed practitioners with varied clinical management approaches, practitioner continuing education and information sources, the application of treatments where optimal approaches are uncertain and the influence of spatial and fiscal access to care. Special features of this proposal include: a) a multi-disciplinary team of investigators including epidemiology, disease registration, biostatistics, health economics, behavioral science and thoracic oncology; b) proven ability to access approximately 2000 lung cancer patients per year and achieve long term follow-up rates of 98-99%, using the Iowa Cancer Registry (NCI SEER Program); c) the elaboration of an economics model to guide both theory and questionnaire design for patients and practitioners, and offered to understand patient decision-making and its relation to outcomes; and d) demonstrable high levels of community cooperation, from patients, cancer care practitioners and pathologists. The goal of the special study is to use Instrumental Variable (IV) techniques to assess whether patient survival rates can be increased by increasing adjuvant therapy treatment rates for early stage non-small cell lung cancer (ENSCLC) patients. If providers are accurately sorting patients by their expected treatment benefits, and only patients expected to benefit from adjuvant treatments actually receive them, we would expect that treatment benefits for patients on the extensive margin to be minimal. We hypothesize there will be little or no treatment survival benefits for patients on the ENSCLC patients provides the rationale for this study.