Is Stroke a Late Effect of Chemotherapy?

描述(由申请人提供)：由于检测和治疗的进步延长了癌症后的存活期，导致人们对癌症诊断和治疗数年后出现的治疗并发症(称为后遗症)的认识日益增强。识别、预防和治疗这些后遗症为治疗决策提供信息，并优化幸存者的身体和心理社会健康。我们最近报道，有化疗病史的乳腺癌幸存者与未接受化疗的幸存者相比，中风的几率增加了2.3倍(95%可信区间1.4-3.8；Geiger等人，J Natl癌症研究所，2004年)。其他报告为化疗和中风之间的联系提供了一些支持，而且有一些病理机制可以解释这种联系。我们建议利用基于医疗保健服务系统的癌症研究网络独特的患者和数据资源，在癌症诊断一年多后进一步了解化疗和中风之间的关系。具体地说，我们的目标是使用COX比例风险回归模型来估计1994年至2003年期间被诊断为膀胱癌、女性乳腺癌、结直肠癌、霍奇金淋巴瘤、成人白血病、多发性骨髓瘤、非霍奇金淋巴瘤、卵巢癌和睾丸癌的110,000多名不同种族患者化疗后中风的相对风险，对年龄、性别、种族/民族、解剖癌症部位、诊断阶段、诊断年份以及分配的高血压、糖尿病、抗凝剂和他莫昔芬(仅适用于乳腺癌)进行调整。我们提议的研究响应了国家癌症研究所的项目公告04-012，使用基于健康声明的数据系统的癌症监测，该项目认识到癌症治疗并发症作为研究主题的重要性，以及现有自动化医疗数据解决该主题的独特资源。检查和量化化疗和卒中晚期效应风险之间的可能联系将为癌症幸存者的治疗决策和长期随访提供进一步的证据。此外，验证和更好地描述这种关联将指导对进一步研究的必要性的确定和设计，以提高我们对特定化疗方案对中风影响的理解。

DESCRIPTION (provided by applicant): Lengthening survival after cancer due to advances in detection and treatment has resulted in an increasing awareness of treatment complications, known as late effects, arising years after cancer diagnosis and treatment. Identifying, preventing and treating these late effects informs treatment decision-making and optimizes survivors' physical and psychosocial well-being. We recently reported a 2.3 increase in the odds of having a stroke among breast cancer survivors with a history of having undergone chemotherapy versus survivors not undergoing chemotherapy (95% confidence interval 1.4 - 3.8; Geiger et al., J Natl Cancer Inst, 2004). Other reports provide some support for an association between chemotherapy and stroke, and there are pathological mechanisms that could explain an association. We propose using the unique patient and data resources of the healthcare delivery system-based Cancer Research Network to understand further the relationship between chemotherapy and stroke more than one year after cancer diagnosis. Specifically, we aim to use Cox proportional hazards regression modeling to estimate the relative risks of stroke after chemotherapy in over 110,000 ethnically diverse patients diagnosed from 1994 to 2003 with bladder, female breast, colorectal, Hodgkin's lymphoma, adult leukemia, multiple myeloma, non-Hodgkin's lymphoma, ovary and testis cancers, adjusting for age, gender, race/ethnicity, anatomic cancer site, stage at diagnosis, year of diagnosis, and dispensed medications for hypertension, diabetes, anti-coagulants and tamoxifen (for breast cancer only). Our proposed study responds direction to the National Cancer Institute's Program Announcement 04-012, Cancer Surveillance Using Health Claims-Based Data Systems, which recognized both the importance of complications of cancer treatment as a research topic and the unique resource of existing automated healthcare data for addressing the topic. Examining and quantifying the possible association between chemotherapy and risk of the late effect of stroke will provide further evidence for treatment decision-making and long-term follow-up of cancer survivors. In addition, verifying and better characterizing the association will guide determinations of the need for and design of further research to improve our understanding of the impact of specific chemotherapy regimens on stroke.