Is Stroke a Late Effect of Chemotherapy?

描述（由申请人提供）：由于检测和治疗方面的进步，癌症后的长期生存导致人们越来越多地认识到癌症诊断和治疗后数年出现的治疗并发症，称为晚期效应。识别、预防和治疗这些迟发效应可为治疗决策提供信息，并优化幸存者的身心健康。我们最近报道，与未接受化疗的幸存者相比，有化疗史的乳腺癌幸存者中风的几率增加了2.3倍（95%置信区间1.4 - 3.8;盖革等人，J Natl Cancer Inst，2004）。其他报告提供了一些支持化疗和中风之间的关联，并且有病理机制可以解释这种关联。我们建议使用基于医疗保健系统的癌症研究网络的独特患者和数据资源，以进一步了解癌症诊断后一年以上化疗和中风之间的关系。具体而言，我们的目标是使用考克斯比例风险回归模型来估计1994年至2003年诊断为膀胱癌、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卒中的相对风险，调整年龄、性别、种族/民族，解剖学癌症部位、诊断时的分期、诊断年份以及分发的高血压、糖尿病、抗凝剂和他莫昔芬（仅用于乳腺癌）药物。我们提出的研究响应了国家癌症研究所计划公告04-012，使用基于健康索赔的数据系统进行癌症监测的方向，该系统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医疗保健数据的独特资源。检查和量化化疗与卒中晚期效应风险之间的可能关联将为治疗决策和癌症幸存者的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进一步研究的需求和设计，以提高我们对特定化疗方案对卒中影响的理解。

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.