Commonly Used Medications and Risk of Colorectal Cancer Recurrence

描述（由申请人提供）：目前，美国有超过1，200，000人是结直肠癌（CRC）幸存者;每年有140，000多名美国人被诊断患有这种疾病。因此，寻找具有成本效益的方法来预防CRC复发是一个重要的公共卫生目标。我们研究的长期目标是改善真实的世界中癌症幸存者的健康状况，人们患有慢性疾病，他们服用处方药和非处方药。我们的目标与国家癌症研究所2012财年的年度计划和预算提案一致，该提案强调了癌症患者多种慢性疾病研究的重要性。诊断时的中位年龄为70岁，CRC倾向于发生在患有合并症的年龄组中。在实验室、动物和流行病学研究中，这些疾病的药物治疗与CRC风险有关。然而，令人惊讶的是，人们对通常用于治疗流行的慢性疾病（如糖尿病和高血压）的药物如何影响CRC复发风险知之甚少。因此，我们试图评估常用药物对CRC复发的影响。我们的假设是，药物是可改变的风险因素，其中一些显示出作为化疗预防剂的前景，一些与CRC幸存者复发风险增加有关。我们将通过在两个综合医疗保健提供系统中进行的回顾性基于人群的队列研究来验证我们的假设。我们将确定1995- 2014年诊断的约3300例I-IIIA期结直肠癌。癌症复发-这是没有记录在肿瘤登记-将确定从有针对性的医疗图表审查。通过依赖所有分发药物的数据库和审查非处方药的病历，该研究将避免选择和召回偏倚。关于可能混淆分析的因素的高质量信息将从有针对性的图表审查、完整的自动化健康计划数据和最近诊断的患者调查中有效收集。将使用各种成熟的方法控制生存分析中的混杂因素，以估计与常用药物相关的复发相对风险。次要分析将侧重于无病生存率和全因死亡率。这项临床相关的高影响力研究的结果将帮助CRC幸存者及其提供者就如何管理慢性病做出基于证据的决定。

DESCRIPTION (provided by applicant): Currently, more than 1,200,000 people in the United States are colorectal cancer (CRC) survivors; each year, 140,000 more Americans are diagnosed with the disease. Finding cost-effective ways to prevent CRC recurrence is therefore an important public health goal. The long-term objective of our research is to improve the health of cancer survivors in the real world, where people have chronic conditions for which they take prescription and over-the-counter medications. Our objective aligns with the National Cancer Institute's Annual Plan and Budget Proposal for Fiscal Year 2012, which highlights the importance of research on multiple chronic conditions in cancer patients. With a median age at diagnosis of 70 years, CRC tends to occur in an age group burdened with comorbidities. Medications for these conditions are linked to CRC risk in laboratory, animal, and epidemiologic studies. However, surprisingly little is known about how medications commonly used to treat prevalent chronic conditions, such as diabetes and hypertension, affect CRC recurrence risk. Therefore, we seek to evaluate the influence of commonly used medications on CRC recurrence. Our hypothesis is that medications are modifiable risk factors, with some showing promise as chemo preventive agents and some associated with an increased risk of recurrence in CRC survivors. We will test our hypotheses through a retrospective population-based cohort study in two integrated healthcare delivery systems. We will identify approximately 3300 incident stage I-IIIA colorectal cancers diagnosed from 1995- 2014. Cancer recurrence-which is not documented in tumor registries-will be ascertained from targeted medical chart review. By relying on a database of all dispensed medications and reviewing medical charts for over-the-counter medications, the study will avoid selection and recall bias. High-quality information on factors that might confound analyses will be efficiently collected from targeted chart review, complete automated health plan data, and surveys of recently diagnosed patients. A variety of well-established methods will be used to control for confounding in survival analysis to produce estimates of the relative risk of recurrence associated with common medications. Secondary analyses will focus on disease-free survival and all-cause mortality. The results from this clinically relevant, high-impact study will help CRC survivors and their providers make evidence-based decisions about how to manage chronic conditions.