Survivorship: Mentoring and Bridging Primary Care and Oncology

生存：初级保健和肿瘤学的指导和桥梁

• 批准号: 8884546
• 负责人: Kevin Charles Oeffinger
• 金额: $ 16.43万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-05 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8884546
• 关键词: Adherence; Adult; African American; Age; Age-Years; Area; Asians; Breast Cancer survivor; Breast Cancer survivorship; Cancer Center; Cancer Control; Cancer Survivor; Cardiovascular Diseases; Caring; Chest; Childhood; Childhood Cancer Survivor Study; Chronic; Cisplatin; Client satisfaction; Clinical; Collaborations; Colorectal Cancer; Communication; Communities; Consensus; Data; Data Set; Disadvantaged; Education; Enrollment; Face; Feasibility Studies; Female; Focus Groups; Funding; Future; Goals; Grant; Group Interviews; Guidelines; Health; Healthcare; Hodgkin Disease; Immigrant; Incidence; Institute of Medicine (U.S.); Insulin Resistance; Intervention; Intervention Trial; Interview; Late Effects; Latina; Life; Long-Term Survivors; Malignant Childhood Neoplasm; Malignant Neoplasms; Measurement; Mediastinal; Medical; Memorial Sloan-Kettering Cancer Center; Mentors; Methods; Minority Groups; Modeling; Morbidity - disease rate; New York City; Oncologist; Outcome; Outcome Measure; Outpatients; Participant; Patient Care Planning; Physicians; Population; Premature Mortality; Primary Care Physician; Primary Health Care; Primary Nursing Care; Radiation; Recording of previous events; Relative (related person); Reporting; Research; Research Personnel; Resources; Risk; Risk Reduction; Sampling; Services; Severities; Societies; Staging; Strategic Planning; Study models; Survival Rate; Survivors; Target Populations; Testing; United States; Update; Woman; Work; base; cancer health disparity; cancer risk; cancer therapy; career; childhood cancer survivor; cohort; design; endothelial dysfunction; ethnic minority population; experience; follow-up; health disparity; improved; irradiation; leukemia/lymphoma; malignant breast neoplasm; meetings; oncology; predictive modeling; research study; socioeconomics; survivorship; usability; young adult

DESCRIPTION (provided by applicant): Five-year survival rates for pediatric and adult cancer are 81.5% and 66%, respectively. Currently in the United States, there are over 12 million cancer survivors, representing about 3.8% of the population. Importantly, many of these survivors face a significantly increased risk of late occurring serious morbidity or premature mortality. Fortunately, the incidence and severity of many late effects of therapy can be reduced with cancer control strategies. Based upon the evidence of the long-term health risks of cancer survivors and the potential to modify these outcomes, the authors of the two survivorship-focused Institute of Medicine reports recommend lifelong medical care for all cancer survivors. The goals of my research are to reduce premature mortality and serious morbidity associated with common late effects, in particular radiation-induced breast cancer, and to improve the quality of risk-based survivorship health care. Two studies are proposed. Study 1. Promoting breast cancer surveillance and reducing health disparities among female Hodgkin lymphoma survivors treated for a pediatric or young adult cancer with chest radiation. Project 1 - Characterizing Risk Using the updated 2008 Childhood Cancer Survivor Study (CCSS) second malignant neoplasm dataset, we aim to 1) estimate the standardized incidence ratio (SIR) and the absolute excess risk (AER) of breast cancer in women who were treated with chest radiation for a pediatric malignancy relative to the general US population and 2) describe the cumulative incidence of breast cancer in this population as a function of the number of years post radiation exposure and of attained age. Project 2 - Communicating Risk Among female Hodgkin lymphoma survivors, ages 25-49 years, with a history of chest radiation, and seen in the MSKCC outpatient setting, we will conduct in-depth interviews (N=20 or saturation of themes) to evaluate the usability and acceptability of the EMPOWER Education Toolkit for communicating breast cancer risk in the clinical setting. Project 3 - Barriers to Risk Reduction Among Ethnic Minorities Identify potentially eligible, ethnic minority female Hodgkin lymphoma survivors living in the New York City area for a future intervention trial aimed at increasing breast cancer surveillance rates. We will work with cancer centers, community-based oncologists in the New York City area, the local chapter of the Leukemia & Lymphoma Society and through collaboration with the MSKCC Immigrant Health and Cancer Disparities Service. From a sample of women in this eligible pool, characterize the barriers and facilitators to breast cancer surveillance through qualitative study using in-depth interviews (N=10) followed by focus group interviews (N=3 groups: African American, Latina, and Asian). Study 2. Bridging Primary Care and Oncology and the Shared Care Model Project 4 - Predicting Risk Using CCSS data, develop and validate a risk-prediction model to predict the likelihood of serious health condition by treatment exposure among long-term survivors of childhood cancer. Project 5 - Risk-Based Transition of Care Conduct a 12-month feasibility study to (1) determine the proportion of eligible survivors and PCPs who will: (a) enroll and (b) complete the baseline and 12-month measurements; (2) estimate resources needed by MSKCC to conduct the study; (3) test usability and refine outcome measurements. The target populations are early stage breast cancer survivors (N=341) at MSKCC being transitioned to PCPs (N=20) at two community-based groups. Outcome measures will include adherence to follow-up guidelines, participant satisfaction (patient, PCP), and understanding/clarity/utility of the MSKCC Survivorship Care Plan (patient, PCP). Project 6 Consensus-Building on Survivorship Care The three aims of this project are to: (1) obtain funding for a 2-day summit meeting of key stakeholders focused on the delivery of survivorship care; (2) convene the meeting; and (3) develop a strategic plan for transitioning survivors to primary care physicians. The key stakeholders will be national and community leaders in oncology, primary care, nursing, payers, and cancer survivors. Mentoring Plan: In addition, in the proposed K05 grant, I will mentor five early career investigators who are investigating: methods to reduce health disparities of socioeconomically disadvantaged ethnic minority women who have breast cancer and subsequently experience delays in returning to work; cisplatin-related endothelial dysfunction; cardiovascular disease following mediastinal irradiation; colorectal and breast cancer survivorship care plans; and mechanisms leading to insulin resistance following cancer therapy.

描述(申请人提供)：儿童癌症和成人癌症的五年生存率分别为81.5%和66%。目前在美国，有超过1200万癌症幸存者，约占总人口的3.8%。重要的是，这些幸存者中的许多人面临着晚发严重发病率或过早死亡的显著增加的风险。幸运的是，许多治疗后遗症的发生率和严重程度可以通过癌症控制策略来降低。根据癌症幸存者长期健康风险的证据以及改变这些结果的可能性，两份以生存为重点的医学研究所报告的作者建议对所有癌症幸存者进行终身医疗。我的研究目标是减少与常见后遗症相关的过早死亡率和严重发病率，特别是辐射诱发的乳腺癌，并提高基于风险的生存医疗保健的质量。提出了两项研究。 研究1：促进乳腺癌监测，减少接受儿童或青年癌症胸部放射治疗的女性霍奇金淋巴瘤幸存者的健康差距。 项目1--描述风险 使用更新的2008年儿童癌症幸存者研究(CCSS)第二恶性肿瘤数据集，我们的目标是1)估计因儿童恶性肿瘤而接受胸部放射治疗的女性相对于普通美国人口的乳腺癌标准化发病率(SIR)和绝对超额风险(AER)，2)描述该人群中乳腺癌的累积发病率作为辐射后暴露后的年数和达到的年龄的函数。 项目2--沟通风险 对于年龄在25-49岁、有胸部放射病史并在MSKCC门诊环境中出现的女性霍奇金淋巴瘤幸存者，我们将进行深入访谈(N=20或主题饱和)，以评估EMPOWER教育工具包在临床环境中用于沟通乳腺癌风险的可用性和可接受性。 项目3--在少数族裔中减少风险的障碍 确定居住在纽约市地区的潜在符合条件的少数民族女性霍奇金淋巴瘤幸存者，进行未来旨在提高乳腺癌监测率的干预试验。我们将与纽约地区的癌症中心、社区肿瘤学家、白血病和淋巴瘤协会当地分会合作，并与MSKCC移民健康和癌症差异服务合作。从符合条件的女性样本中，通过深入访谈(N=10)和焦点小组访谈(N=3组：非裔美国人、拉丁美洲人和亚洲人)进行定性研究，确定乳腺癌监测的障碍和促进者。 研究2.连接初级保健和肿瘤学与共享保健模式 项目4--预测风险 利用CCSS数据，开发和验证风险预测模型，以预测儿童癌症长期幸存者接受治疗后出现严重健康状况的可能性。 项目5-基于风险的护理过渡 进行为期12个月的可行性研究，以(1)确定符合条件的幸存者和初级保健医生的比例，他们将：(A)登记和(B)完成基线和12个月的测量；(2)估计MSKCC进行研究所需的资源；(3)测试可用性和改进结果测量。目标人群是MSKCC的早期乳腺癌幸存者(N=341)，在两个基于社区的群体中过渡到PCP(N=20)。结果测量将包括对后续指南的遵守、参与者满意度(患者，PCP)以及对MSKCC生存护理计划(患者，PCP)的了解/清晰度/效用。 项目6--就生存关怀达成共识 该项目的三个目标是：(1)获得资金，以提供生存护理为重点，召开为期两天的主要利益攸关方首脑会议；(2)召开会议；(3)制定将幸存者过渡到初级保健医生的战略计划。主要利益相关者将是肿瘤学、初级保健、护理、支付者和癌症幸存者方面的国家和社区领导人。 指导计划：此外，在拟议的K05拨款中，我将指导五名职业生涯早期的研究人员，她们正在调查：缩小患有乳腺癌并随后延迟重返工作岗位的社会经济弱势少数族裔妇女健康差距的方法；顺铂相关的内皮功能障碍；纵隔照射后的心血管疾病；结直肠癌和乳腺癌生存护理计划；以及癌症治疗后导致胰岛素抵抗的机制。

项目成果

Screening for thyroid cancer in survivors of childhood and young adult cancer treated with neck radiation.

• DOI: 10.1007/s11764-016-0588-6
• 发表时间: 2017-06
• 期刊: Journal of cancer survivorship : research and practice
• 作者: Tonorezos ES;Barnea D;Moskowitz CS;Chou JF;Sklar CA;Elkin EB;Wong RJ;Li D;Tuttle RM;Korenstein D;Wolden SL;Oeffinger KC
• 通讯作者: Oeffinger KC

Childhood cancer, endocrine disorders, and cohort studies.

• DOI: 10.1016/s0140-6736(14)60114-8
• 发表时间: 2014-06-07
• 期刊: LANCET
• 影响因子: 168.9
• 作者: Oeffinger, Kevin C.;Sklar, Charles A.
• 通讯作者: Sklar, Charles A.

Are we ready to predict late effects? A systematic review of clinically useful prediction models.

我们准备好预测后期影响了吗？

• DOI: 10.1016/j.ejca.2015.02.002
• 发表时间: 2015
• 期刊: European journal of cancer (Oxford, England : 1990)
• 作者: Salz,Talya;Baxi,ShrujalS;Raghunathan,Nirupa;Onstad,ErinE;Freedman,AndrewN;Moskowitz,ChayaS;Dalton,SusanneOksbjerg;Goodman,KarynA;Johansen,Christoffer;Matasar,MatthewJ;deNullyBrown,Peter;Oeffinger,KevinC;Vickers,AndrewJ
• 通讯作者: Vickers,AndrewJ

Causes of death in long-term survivors of head and neck cancer.

• DOI: 10.1002/cncr.28588
• 发表时间: 2014-05-15
• 期刊: CANCER
• 影响因子: 6.2
• 作者: Baxi, Shrujal S.;Pinheiro, Laura C.;Patil, Sujata M.;Pfister, David G.;Oeffinger, Kevin C.;Elkin, Elena B.
• 通讯作者: Elkin, Elena B.

Survivorship care plans: is there buy-in from community oncology providers?

幸存者护理计划：社区肿瘤学提供者是否支持？

• DOI: 10.1002/cncr.28472
• 发表时间: 2014
• 期刊: Cancer
• 影响因子: 6.2
• 作者: Salz,Talya;McCabe,MaryS;Onstad,ErinE;Baxi,ShrujalS;Deming,RichardL;Franco,ReginaA;Glenn,LynA;Harper,GregoryR;Jumonville4th,AlceeJ;Payne,RoxanneM;Peters,ElissaA;Salner,AndrewL;Schallenkamp,JohnM;Williams,SheronR;Yi
• 通讯作者: Yi