EMPOWER Study: Promoting BC Screening in Women Who Survived Childhood Cancer

项目摘要 到50岁时，几乎三分之一的妇女，因儿童癌症接受胸部放射治疗， 被诊断为乳腺癌乳腺癌的早期发现与生存率密切相关， 建议从25岁开始，每年进行乳房MRI和乳房X光检查。可惜 这些妇女中绝大多数没有遵守建议的监测。放大这个问题， 大多数儿童癌症幸存者不再在癌症中心接受随访，不知道他们的风险， 被初级保健提供者（PCP）跟踪，他们不知道推荐的后续护理。 基于我们之前在EMPOWER-I中的发现，我们现在提出EMPOWER-II，一个3臂随机 扩展EMPOWER-I干预核心组成部分的对照试验（邮寄教育材料） 评估患者激活（有和没有添加PCP激活）增加乳腺癌发生率的效用 监视我们建议随机选择291名年龄在25岁以上，有胸部疾病史的女性， 没有乳腺癌病史，没有乳腺MRI和 在过去的两年里，乳房X光检查。 主要结果是在12个月的研究期间获得乳房MRI和乳房X线照片。 我们将确定（1）基于智能手机的患者激活干预和 (2)患者激活加PCP激活，与对照组相比。次要目标包括探索调节 以及预测监测完成的中介因素、获得监测的时间和估计 干预措施的复制成本和干预措施产生的成本。 拟议的EMPOWER-II研究汇集了一个具有必要专门知识的研究小组， 在生存研究，智能手机提供的干预措施，和独特的资源， 31-儿童癌症幸存者研究（CCSS）。值得注意的是，CCSS代表了 目标人群中的妇女队列以及开展拟议研究的基础设施。结果 这种干预将对所有在年轻时接受胸部放射治疗的高危妇女产生重要影响。 年龄

PROJECT SUMMARY By age 50, almost one in three women, treated with chest radiation for a childhood cancer, will be diagnosed with breast cancer. Early detection of breast cancer is strongly associated with survival, and surveillance with annual breast MRI and mammography is recommended, starting at age 25. Unfortunately, the vast majority of these women are not adherent to the recommended surveillance. Magnifying this problem, most childhood cancer survivors are no longer followed at a cancer center, are unaware of their risks, and are being followed by primary care providers (PCPs) who are not informed about the recommended follow-up care. Based upon our prior findings in EMPOWER-I, we now propose EMPOWER-II, a 3-arm randomized controlled trial that extends the core component of the EMPOWER-I intervention (mailed educational materials) to evaluate the utility of patient activation with and without added PCP activation to increase breast cancer surveillance. We propose to randomize 291 women, who are at least 25 years of age, with a history of chest radiation for a childhood cancer, without a history of breast cancer, and without both a breast MRI and mammogram in the previous two years. The primary outcome is obtaining a breast MRI and mammogram during the 12-month study period. We will determine the comparative effectiveness of (1) a smartphone-based patient activation intervention and (2) patient activation plus PCP activation, compared to control. Secondary aims include exploring moderating and mediating factors that predict surveillance completion, timing of the obtained surveillance, and estimating the intervention replication costs and costs resulting from the intervention. The proposed EMPOWER-II study brings together a research team with the necessary expertise and experience in both survivorship research, smart-phone delivered interventions, and the unique resource of the 31-insitution Childhood Cancer Survivors Study (CCSS). Notably, the CCSS represents the single largest cohort of women in the target population and the infrastructure to conduct the proposed study. Results from this intervention will have important implications for all high-risk women treated with chest radiation at a young age.