Treatment Modifications, Outcomes and Provider Decision Making in the Management of Subsequent Breast Cancers Among Survivors of Childhood Cancer

儿童癌症幸存者后续乳腺癌管理的治疗修改、结果和提供者决策

• 批准号: 10232092
• 负责人: Lucie Marie Turcotte
• 金额: $ 17.84万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-17 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10232092
• 关键词: Address; Adult; Age; Alkylating Agents; Anthracycline; Attention; Breast Cancer Patient; Breast Cancer Risk Factor; Breast Cancer Treatment; Breast Cancer therapy; Cancer Survivor; Cardiovascular system; Caring; Characteristics; Chest; Childhood Cancer Survivor Study; Childhood Cancer Treatment; Childhood Hodgkin' s Lymphoma; Complex; Consequentialism; Data; Decision Making; Diagnosis; Disease; Disease-Free Survival; Educational Intervention; Ethnic Origin; Exposure to; Face; Female; Geography; Goals; Health; Hodgkin Disease; Hodgkin Lymphoma survivors; Incidence; Individual; Inferior; Institution; Interview; Knowledge; Late Effects; Leadership; Life; Long-Term Survivors; Malignant Childhood Neoplasm; Malignant Neoplasms; Mastectomy; Medical; Medical Oncologist; Mentors; Methodological Studies; Methods; Modification; Morbidity - disease rate; National Comprehensive Cancer Network; Neoplasms; Outcome; Participant; Physicians; Population; Provider; Race; Radiation; Radiation Oncologist; Radiation therapy; Recording of previous events; Reporting; Research Design; Research Personnel; Risk; Risk Factors; Scientist; Second Primary Cancers; Secondary to; Skin Carcinoma; Structure; Surveys; Survivors; Toxic effect; Treatment-related toxicity; United States; Vulnerable Populations; Woman; cancer diagnosis; cancer therapy; chemotherapy; childhood cancer survivor; cohort; comorbidity; epidemiology study; experience; follow-up; high risk; high risk population; improved; improved outcome; leukemia; malignant breast neoplasm; mortality; mortality risk; novel; practice setting; response; sarcoma; skills; standard of care; survivorship; therapy development; treatment comparison; treatment guidelines

Project Summary Survivors of childhood cancers face multiple late effects of their initial cancer therapy. One of the most difficult and consequential is the occurrence of a subsequent neoplasm. Subsequent breast cancers are the second most frequently observed subsequent neoplasm, exceeded only by non-melanoma skin cancers. Although much attention has been given to subsequent breast cancer risk and risk factors among survivors, there are limited data on treatment, treatment-related toxicities, survival and physician decision making for these challenging subsequent neoplasms. Survivors of childhood cancer have previously been exposed to therapies, including radiation and/or anthracycline chemotherapies, which may limit their ability to safely receive standard-of-care breast cancer therapy. The overall goals of this study will be: 1) to quantify how overall and event-free survival among long-term survivors of childhood cancer who develop a subsequent breast cancer compare to a geographically diverse, age-, race and ethnicity-,breast cancer stage-, and treatment era- matched cohort of women with similar breast cancer characteristics, and how their overall survival compares to SEER survival estimates; 2) to describe how survivors of childhood cancer who develop a subsequent breast cancer are medically managed and how treatment compares to a contemporarily-treated, age-, race and ethnicity-, breast cancer stage-, and treatment era-matched matched comparison cohort and to contemporary National Comprehensive Cancer Network treatment guidelines, and to describe treatment-related toxicities among survivors with subsequent breast cancer and compare the toxicity profile with a matched comparison cohort of women with primary breast cancer; and 3) to describe how breast cancer treatment decisions are made, through semi-structured interviews and surveys, among medical and radiation oncologists. This project will provide data necessary to improve health outcomes in this growing high-risk and vulnerable population of survivors of childhood cancer. Understanding the drivers of decision-making, the way women with subsequent breast cancers are treated, and how their outcomes compare to other women with breast cancer will guide educational interventions and the development of treatment guidelines for women with subsequent breast cancer. The skills developed through the completion of the aims in this proposal, in complex epidemiological study design, qualitative and mixed methods study methodology, and study leadership, will lay the groundwork for leading novel and high-impact survivorship studies. This project will serve as a transition point from working as a mentored physician scientist to an independent investigator, as demonstrated by a planned R01 submission during the final year of this study.

项目概要 儿童癌症的幸存者面临着初始癌症治疗的多种后期影响。最困难的之一 随之而来的是随后肿瘤的发生。随后的乳腺癌是第二位 最常见的后续肿瘤，仅超过非黑色素瘤皮肤癌。虽然 人们对幸存者的后续乳腺癌风险和危险因素给予了很多关注，有 有关治疗、治疗相关毒性、生存率和医生决策的数据有限 挑战随后的肿瘤。儿童癌症幸存者之前曾接受过治疗， 包括放射和/或蒽环类化疗，这可能会限制他们安全接受治疗的能力 标准护理乳腺癌治疗。本研究的总体目标是： 1）量化总体和 儿童癌症长期幸存者随后发展为乳腺癌的无事件生存率 与不同地域、年龄、种族和民族、乳腺癌分期和治疗时代进行比较 匹配具有相似乳腺癌特征的女性队列，以及她们的总体生存率与 SEER 生存估计； 2) 描述儿童癌症幸存者如何发展出随后的乳房 癌症是通过药物治疗的，以及治疗方法与同时代治疗方法的比较，年龄、种族和 种族、乳腺癌分期和治疗时代匹配的匹配比较队列和当代 国家综合癌症网络治疗指南，并描述与治疗相关的毒性 在随后患有乳腺癌的幸存者中进行研究，并通过匹配比较来比较毒性特征 患有原发性乳腺癌的女性队列； 3) 描述乳腺癌治疗决策是如何进行的 通过对医学和放射肿瘤学家的半结构化访谈和调查进行。这个项目 将提供必要的数据，以改善这一不断增长的高风险和弱势群体的健康结果 儿童癌症的幸存者。了解决策的驱动因素以及女性做出后续决策的方式 乳腺癌的治疗方法以及其结果与其他乳腺癌女性的比较将如何指导 对患有乳腺癌的妇女进行教育干预并制定治疗指南 癌症。通过完成本提案中的目标而开发的技能，在复杂的流行病学方面 研究设计、定性和混合方法研究方法以及研究领导力将为奠定基础 领先的新颖和高影响力的生存研究。该项目将作为工作的过渡点 作为独立研究者的指导医师科学家，正如计划的 R01 所证明的那样 在本研究的最后一年提交。

项目成果

How to Treat Breast Cancer After Childhood Cancer: Management of Oncologic and Cardiovascular Concerns.

• DOI: 10.1016/j.jaccao.2021.12.003
• 发表时间: 2022-03
• 期刊: JACC: CARDIOONCOLOGY
• 影响因子: 11.1
• 作者: Blaes, Anne H.;Konety, Suma;Hui, Jane;Dusenbery, Kathryn;Yuan, Jianling;Dent, Susan;Oeffinger, Kevin C.;Turcotte, Lucie M.
• 通讯作者: Turcotte, Lucie M.

RE: "RACIAL AND ETHNIC DIFFERENCES IN SOCIOECONOMIC POSITION AND RISK OF CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA".

回复：“社会经济地位和儿童急性淋巴细胞白血病风险的种族和民族差异”。

• DOI: 10.1093/aje/kwz075
• 发表时间: 2019
• 期刊: American journal of epidemiology
• 影响因子: 5
• 作者: Spector,LoganG;DeWan,AndrewT;Pankratz,NathanD;Turcotte,LucieM;Yang,JunJ;Scheurer,MichaelE
• 通讯作者: Scheurer,MichaelE

Cancer survivors exercise at higher intensity in outdoor settings: The GECCOS trial.

癌症幸存者在户外环境中进行更高强度的锻炼：GECCOS 试验。

• DOI: 10.1002/pbc.28850
• 发表时间: 2021
• 期刊: Pediatric blood & cancer
• 影响因子: 3.2
• 作者: Miller,JonathanM;Sadak,KarimT;Shahriar,ArmanA;Wilson,NatalieJ;Hampton,Maree;Bhattacharya,Manami;Towle,Ali;Turcotte,LucieM
• 通讯作者: Turcotte,LucieM

Germline Genetic Risk Stratification in ALL? GATA Get More Information.

ALL 的种系遗传风险分层？

• DOI: 10.1093/jnci/djaa139
• 发表时间: 2021
• 期刊: Journal of the National Cancer Institute
• 作者: Spector,LoganG;Turcotte,LucieM
• 通讯作者: Turcotte,LucieM

Clinical Features and Risk Factors Associated With Multisystem Inflammatory Syndrome in Children With Cancer and COVID-19.

与癌症和 COVID-19 儿童多系统炎症综合征相关的临床特征和危险因素。

• DOI: 10.1001/jamaoncol.2023.0525
• 发表时间: 2023
• 期刊: JAMA oncology
• 影响因子: 28.4
• 作者: Martin,SamanthaD;Davis,ElizabethS;Dai,Chen;Boal,LaurenH;Araya,Brook;Brackett,Julienne;Dickens,David;Kahn,Alissa;Martinez,Isaac;Sharma,Archana;Schwalm,Carla;Aguayo-Hiraldo,Paibel;Bhatia,Smita;Levine,JenniferM;Johnston,Emily
• 通讯作者: Johnston,Emily