Social networks, breast cancer treatment, and survival

 描述(申请人提供)：每年有超过200,000名妇女被诊断患有乳腺癌，近40,000人死于乳腺癌(BC)。以前的文献表明，社会决定因素，如社会网络，即围绕个人的社会关系网络，在卑诗省的生存中发挥着重要作用。然而，社会网络影响预后的机制，特别是对BC治疗的影响，尚不清楚。此外，目前在临床护理中还没有系统的方法来识别社会孤立的BC患者以便于干预。Kroenke博士的职业目标是成为社会环境和癌症结果方面的一名独立资助的多学科学术研究人员，确定扩大社会网络的杠杆作用点，以优化BC治疗并改善临床结果。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)进行社会网络行为干预；3)临床BC治疗和在研究中使用电子病历(EMR)；以及4)专业研究技能。目标将通过与一群杰出的导师合作、正式的教学、研讨会、会议和会议来实现。具体目标(SA)包括：1)在Path研究中，KPNC对4,505名BC幸存者进行了大规模的队列研究，获得了关于社会因素和癌症治疗的广泛数据，评估了社会网络与BC治疗之间的关联；2)评估了社会网络、BC复发和死亡率之间的关联，以及与社会网络相关的治疗差异在多大程度上解释了与生存的关联；以及3)开发、试点、评估和改进了一种简短的“社会网络作为生命体征”(SVS)的测量方法，将其收集到KP Oakland医学中心的BC患者中，以便进入EMR。线性回归和生存方法将被用来分析与BC治疗的关系，包括接受治疗的时间和坚持辅助激素治疗，以及生存结果。我们预计，拥有更多支持性关系的女性，以及更高密度、强度和多样性的关系，将更早、更好地坚持治疗，治疗差异将有助于解释与生存的关联。SA1-2的发现和拟议的培训将为发展SA3中的SVS措施提供基础。拟议的研究是第一次考察社会网络结构如何影响BC的治疗和生存。KPNC是这一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。这项研究的结果将被用来识别大型管理医疗保健系统中具有受损社会网络的个别患者，并开发个人和系统级别的R级社会网络干预措施，以优化治疗和预后。在全国范围内将结果转换为KP可能会改善每年在KP诊断的10,000例偶发BC病例中高达20%的BC患者的预后。

 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.