Social networks, breast cancer treatment, and survival

 描述（由申请人提供）：每年有超过20万名妇女被诊断患有乳腺癌，近4万人死于乳腺癌（BC）。先前的文献表明，社会决定因素，如社交网络，围绕个人的社会关系网，在不列颠哥伦比亚省的生存有一个重要的作用。然而，社交网络影响预后的机制，特别是对BC治疗的影响，是未知的。此外，目前在临床护理中没有系统的方法来识别社会孤立的BC患者以促进干预。Kroenke博士的职业目标是成为社会环境和癌症结果的多学科，独立资助的学术研究人员，以确定增强社交网络的杠杆点，以优化BC治疗和改善临床结果。职业发展目标是发展以下方面的知识和专业知识：1）社会环境（包括社会网络理论，测量和分析）; 2）社会网络行为干预的进行; 3）临床BC治疗和电子病历（EMR）在研究中的使用;和4）专业研究技能。目标将通过与杰出的导师团队合作、正式教学法、研讨会、会议和大会来实现。具体目的（SA）包括：1）在Pathways研究中，一个由4，505名BC幸存者组成的大型KPNC队列，具有关于社会因素和癌症治疗的广泛数据，评估社交网络和BC治疗的相关性; 2）评估社交网络、BC复发和死亡率的相关性，以及与社交网络相关的治疗差异解释与生存相关性的程度;以及3）开发、试验、评估和改进一个简短的“社交网络作为生命体征”（SVS）测量，该测量将在KP奥克兰医疗中心的BC患者中收集，以输入EMR。将使用线性回归和生存方法分析与BC治疗的相关性，包括接受治疗和治疗时间以及辅助激素治疗的依从性以及生存结局。我们预计，妇女与更大程度的支持关系，更大的密度，强度和多样性的关系，将有更早，更好地坚持治疗，治疗的变化将有助于解释与生存的关联。SA 1-2的调查结果和拟议的培训将为制定SA 3中的SVS措施提供基础。这项研究首次探讨了社会网络结构如何影响BC治疗和生存。KPNC是这个职业发展奖的理想环境，因为它有强大的导师，机构承诺，关于社会因素和治疗的独特而广泛的数据，医生对改善患者社会支持的兴趣，以及临床干预的机会。本研究的结果将B用于识别大型管理型医疗保健系统中社交网络受损的个体患者，并制定个体和系统级R级社交网络干预措施，以优化治疗和预后。将结果转化为全国范围内的KP可能会改善每年在KP诊断的10，000例BC病例中高达20%的BC患者的结局。

 DESCRIPTION (provided by applicant): Each year, more than 200,000 women are diagnosed with, and nearly 40,000 die from their breast cancer (BC). Previous literature shows that social determinants, such as social networks, the web of social relationships that surround an individual, have a major role in BC survival. However, the mechanisms through which social networks influence prognosis, particularly effects on BC treatment, are unknown. Also, there is currently no systematic way in clinical care to identify socially isolated BC patients to facilitat intervention. Dr. Kroenke's career goal is to become a multidisciplinary, independently funded academic researcher in the social environment and cancer outcomes, to determine points of leverage for augmenting social networks to optimize BC treatment and improve clinical outcomes. Career development goals are to develop knowledge and expertise in: 1) The social environment (including social network theory, measurement, and analysis); 2) The conduct of social network behavioral interventions; 3) Clinical BC treatment and the use of electronic medical records (EMR) in research; and 4) Professional research skills. Goals will be accomplished through work with an outstanding group of mentors; formal didactics; seminars; meetings; and conferences. Specific Aims (SA) include: 1) In the Pathways study, a large KPNC cohort of 4,505 BC survivors with extensive data on social factors and cancer treatment, evaluate associations of social networks and BC treatment; 2) Evaluate associations of social networks, BC recurrence and mortality and the extent to which treatment variation related to social networks explains associations with survival; and 3) Develop, pilot, evaluate, and refine a brief "social networks as a vital sign" (SVS) measure to be collected in BC patients at the KP Oakland Medical Center, for entry into the EMR. Linear regression and survival methods will be used to analyze associations with BC treatment including receipt of and time to treatment and adherence to adjuvant hormonal therapy, as well as survival outcomes. We expect that women with a greater degree of supportive ties, and greater density, strength, and diversity of ties, wil have earlier, and better, adherence to treatment, and that treatment variations will help explain associations with survival. Findings from SA 1-2 and the proposed training will provide the foundation for developing the SVS measure in SA 3. The proposed study is the first to examine how social network structure influences BC treatment and survival. KPNC is an ideal environment for this career development award given strong mentors, institutional commitment, unique and extensive data on social factors and treatment, physician interests in improving patient social support, and opportunities for clinical intervention. Results from this study will b used to identify individual patients with compromised social networks within a large managed health care system and develop individual and system-level R-level social network interventions to optimize treatment and prognosis. Translating results to KP nationwide may improve outcomes in up to 20% of BC patients among the 10,000 incident BC cases diagnosed in KP each year.