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Decision making on aromatase inhibitors in breast cancer survivors 65 and older

65 岁及以上乳腺癌幸存者使用芳香酶抑制剂的决策

基本信息

批准号：
8716698
负责人：
Huibrie Christelle Pieters
金额：
$ 13万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-08-07 至 2016-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8716698
关键词：
Adherence Adjuvant Adverse effects Age Androgens Area Aromatase Aromatase Inhibitors Arthralgia Attention Award Behavior Therapy Bone Density Bone Pain Breast Cancer Treatment Cancer Survivor Cancer Survivorship Cardiovascular system Cessation of life Complex Consensus Data Decision Making Diagnosis Disease Early Diagnosis Early treatment Elderly Estrogen Antagonists Estrogen receptor positive Estrogens Event Family Foundations Fracture Funding Future Goals Guidelines Hormonal Hormone Receptor Hormones Hot flushes Intervention Interview Investigation Life Malignant Neoplasms Menopause Methodology Morbidity - disease rate Musculoskeletal Participant Population Populations at Risk Postmenopause Process Relative Risks Research Research Methodology Research Personnel Review Literature Risk Risk Factors Role Science Side Source Staging Survivors Syndrome Testing Time United States National Institutes of Health Woman Women&apos s Group base cancer diagnosis cancer recurrence cancer therapy cost cost effective design effective therapy experience improved joint stiffness malignant breast neoplasm mortality multidisciplinary novel older women oncology premature prevent public health relevance standard of care theories tumor young woman

项目摘要

DESCRIPTION (provided by applicant): Age is a strong and independent risk factor for dying from breast cancer (BC) in and of itself. This becomes highly significant when considering that BC is the most commonly diagnosed cancer in women and the second most deadly. Hormone positive BC is especially common among older women. While adjuvant hormonal treatment is proven to dramatically reduce the risk of cancer recurrence and mortality for hormone- sensitive BC, evidence shows that about half of all women 65 years discontinue this life-saving treatment. What contributes to discontinuation is poorly understood. Aromatase inhibitors (AIs) are associated with adverse side effects such as an arthralgia syndrome, hot flashes, loss of bone density, and cardiovascular events which may influence whether women persist with the treatment. Although the numbers of older women with BC is growing and this population has disproportionately high mortality rates compared with younger women, little or no research has explored the processes by which women 65 years decide to continue or discontinue AI treatment. Our multidisciplinary study will elicit in-depth narratives to explore what influences te trajectory of continuing or discontinuing an AI in the context of the lives of women 65 years and above. We will gain understanding of how women 65 years interpret, and act upon information that they have received about AIs. In addition, based on the pragmatic evidence in the women's own words, we will develop a novel descriptive framework of the decisional processes about using AIs within the context of the women's lives. The choice of research method is constructivist grounded theory, providing a methodology to access and understand meanings and decisional processes from a personal perspective. Approximately 50 personal interviews with 40 women, 65 years who were treated for primary, invasive loco-regional BC and are either taking an AI or have discontinued the treatment will supply the data. A focused interview guide has been developed from preliminary findings including the PI's research with women 70 years who recently completed treatment for early stage BC. The interview guide will extend previous research to include questions about preferred ways to receive information about AIs and what the women did to self-manage the modifiable factors of side effects. Furthermore, from the perspective of cancer survivorship science, the interview guide contains questions about the role of family and support people. A novel framework will result from this study to provide the foundation to design and test an age- appropriate and cost-effective supportive intervention to improve informed decision making and increase continuation with AIs. We also foresee that the findings may be transferable to women 65 years in other contexts of geriatric oncology and other areas of oncology such as the use of an AI to reduce the relative risk of a first time invasive BC in healthy postmenopausal women.

描述（由申请人提供）：年龄是死于乳腺癌（BC）本身的一个强大而独立的风险因素。当考虑到BC是女性最常见的诊断癌症和第二大致命癌症时，这一点变得非常重要。激素阳性BC在老年妇女中特别常见。虽然辅助激素治疗被证明可以大大降低激素敏感性BC的癌症复发和死亡风险，但有证据表明，大约一半的65岁女性停止了这种挽救生命的治疗。对导致停药的原因知之甚少。芳香化酶抑制剂（AIs）与不良副作用有关，如关节痛综合征，潮热，骨密度损失和心血管事件，这些事件可能影响女性是否坚持治疗。尽管患有BC的老年妇女人数正在增加，而且与年轻妇女相比，这一人群的死亡率不成比例地高，但很少或没有研究探讨65岁的妇女决定继续或停止AI治疗的过程。我们的多学科研究将引发深入的叙述，以探索在65岁及以上女性的生活背景下，是什么影响了继续或停止人工智能的轨迹。我们将了解65岁的女性如何解释，并根据他们收到的关于AI的信息采取行动。此外，基于妇女自己的话中的务实的证据，我们将开发一个新的描述框架的决策过程中使用人工智能的妇女的生活背景。研究方法的选择是建构主义扎根理论，提供了一种方法，从个人的角度来访问和理解的意义和决策过程。对40名65岁的女性进行了大约50次个人访谈，这些女性接受了原发性、侵入性局部区域BC治疗，正在接受AI治疗或已停止治疗，将提供数据。一个重点访谈指南已开发的初步调查结果，包括PI的研究与妇女70年谁最近完成治疗早期BC。采访指南将扩展以前的研究，包括有关接收有关AI信息的首选方式以及女性如何自我管理副作用的可修改因素的问题。此外，从癌症生存科学的角度来看，采访指南包含有关家庭和支持者角色的问题。本研究将产生一个新的框架，为设计和测试一种适合年龄且具有成本效益的支持性干预提供基础，以改善知情决策并增加AI的持续性。我们还预见，这些发现可能会转移到老年肿瘤学和其他肿瘤学领域的65岁女性，例如使用AI降低健康绝经后女性首次侵入性BC的相对风险。