Optimizing Treatment of Rectal Cancer Using a Markov Decision Model

该项目提出了一个指导研究计划，以dejvelop乔治J张，医学博士。成一个独立 专门从事癌症相关卫生服务研究的临床科学家，汇集了癌症流行病学， 结果评估和临床决策分析，以改善结肠癌和直肠癌的治疗 以及预防和控制癌症治疗相关的疾病。张医生是双板外科医生 在普通外科和结肠和直肠手术的认证和在这一主题的临床专业知识， 提议职业发展计划包括教学教育，包括科学硕士学位， 临床研究，一个基础广泛的体验式学习计划，和指导研究经验， 指导研究将在由Scott B组成的指导委员会的指导下进行。 康托博士，生物统计学教授M。D.安德森癌症中心和社会的前任主席， 医疗决策;乔恩E。泰森医学博士M.P.H.儿科教授和中心主任， 临床研究和循证医学，德克萨斯大学健康科学中心;和J.罗伯特 贝克，医学博士，高级副总裁兼首席学术官，福克斯大通癌症中心将作为场外 导师和委员会成员。 这项研究的重点是通过开发毒性最小化和生活质量的应用癌症控制 保留直肠癌患者的治疗策略。直肠癌是一种常见的疾病， 目前的治疗是非常有效的，但可能与高比率的治疗相关的毒性有关 与显着的病人的生活质量和社会成本。不幸的是，所有最近的尝试，在传统的临床 基于美国国内调查的审判已经失败。拟议的研究将使用完善的 先进的建模技术和患者偏好研究，以执行虚拟随机对照 临床试验，以确定毒性最小和最临床有效的治疗策略或数以万计的 患这种常见癌症的病人的数量 相关性（参见说明）： 目前的直肠癌治疗策略没有考虑到诊断和治疗的进展， 影响结果的各种患者相关差异。这项建议将有助于改善 选择直肠癌患者进行术前放化疗， 经验较少的慢性毒性，医生将有证据的基础上治疗 建议，社会将负担更少的治疗和毒性相关的费用。

This project proposes a mentored research program todejvelop George J. Chang, M.D. into an independent clinician-scientist specializing in cancer-related health services research that brings together cancer epidemiology, outcomes evaluation, and clinical decision analysis in order to improve the treatment of colon and rectal cancer and to prevent and control cancer treatment related morb dities. Dr. Chang is a surgeon with dual board certifications in General Surgery and Colon and Rectal Sijrgery and a clinical expertise in the subject of this proposal. The career development plan consists of didactic education including a Master of Science degree in Clinical Research, a broad-based experiential learning program, and a mentored research experience, Mentored research will be conducted under the direction af the mentorship committee composed of Scott B. Cantor, Ph.D., Professor of Biostatistics at M. D. Anderson Cancer Center and past-president of the Society for Medical Decision Making; Jon E. Tyson, M.D., M.P.H., Professor of Pediatrics and Director of the Center for Clinical Research and Evidence-Based Medicine, Univers>ity of Texas Health Sciences Center; and J. Robert Beck, M.D., Senior Vice President and Chief Academic Officer, Fox Chase Cancer Center will serve as an off-site mentor and committee member. The proposed research focuses on applied cancer controI bydeveloping toxicity minimized and quality-of-life preserving strategies for the treatment of patients withrec;tal cancer. Rectal cancer is a common disease for which the current treatment is highly effective but can be associated with high rates of treatment-related toxicity with significant patient quality-of-life and societal costs.Unfortunately, all recent attempts at traditional clinical trials based on investigation within the United States have; failed. Theproposed research will use well-established advanced modeling techniques and patient preferences research to perform a virtual randomized controlled clinical trial to determine the least toxic and most clinicallyi effective treatment strategies orthetens ofthousands of patients affected by this common cancer each year. RELEVANCE (See instructions): Current treatment strategies for rectal cancer do not account for advances in diagnosis and treatment or for the wide variety of patient related differences that affect outcomes. This proposal will help improve the selection of patients with rectal cancer for preoperative chemoradiotherapy in order that patients will experience less chronic toxicity, physicians will have evidence on which to base treatment recommendations, and society will encumber fewer treatment and toxicity related costs.