Optimizing Treatment of Rectal Cancer Using a Markov Decision Model

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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.