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Risk prediction of breast cancer treatment-related cardiotoxicity to guide clinical decision making

乳腺癌治疗相关心脏毒性的风险预测以指导临床决策

基本信息

批准号：
10689025
负责人：
Reina Haque
金额：
$ 36.88万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-07-01 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10689025
关键词：
Acute myocardial infarction Address Adjuvant Adjuvant Chemotherapy Adjuvant Therapy Adoption Adult Affect Aftercare Age Aging Antidiabetic Drugs Antihypertensive Agents Biological Products Body mass index Breast Cancer Risk Factor Breast Cancer Treatment Breast Cancer survivor Breast Cancer therapy California Cancer Control Cardiology Cardiomyopathies Cardiotoxicity Cardiovascular Diseases Cardiovascular system Caring Cause of Death Cessation of life Characteristics Cholesterol Clinical Combined Modality Therapy Communities Data Diabetes Mellitus Diagnosis Early Diagnosis Electronic Health Record Electronics Equation Ethnic Origin Event General Population Guidelines Health Heart failure High Risk Woman Hormonal Hospitals Hyperlipidemia Hypertension Impaired health Individual Intervention Lead Length Life Expectancy Life Style Modification Link Longitudinal cohort study Low income Malignant Neoplasms Managed Care Measures Medicaid Medicare Modeling Monitor Morbidity - disease rate Myocardial Ischemia National Cancer Institute National Heart, Lung, and Blood Institute Newly Diagnosed Oncology Outcome Patient Care Persons Pharmaceutical Preparations Practice Guidelines Prevention Preventive Prognosis Public Health Quality of life Race Radiation Radiation therapy Records Reporting Risk Risk Estimate Risk Factors Smoking Societies Stroke Survivors Toxic effect Transient Ischemic Attack Treatment-Related Cancer Uncertainty Woman Work World Health alternative treatment burden of illness cancer diagnosis cancer therapy cardioprotection cardiovascular disorder prevention cardiovascular disorder risk cardiovascular imaging cardiovascular risk factor cerebrovascular chemotherapy clinical decision-making clinical practice cohort ethnic minority evidence base follow-up health care settings health plan health related quality of life high risk hormone therapy malignant breast neoplasm member mortality predictive modeling premature preservation programs racial minority risk mitigation risk prediction risk prediction model routine imaging socioeconomics standard care treatment planning treatment risk treatment strategy tumor venous thromboembolism

项目摘要

PROJECT SUMMARY Nearly 20% of the 3 million breast cancer survivors in the U.S. have cardiovascular disease (CVD). The National Cancer Institute, NHLBI, and professional oncology and cardiology societies have all endorsed the importance of reducing CVD burden in breast cancer survivors through earlier recognition and intervention. Although women diagnosed with stages I to III breast cancer have an excellent prognosis with 5-year relative survival >90%, specific adjuvant therapies have been reported to lead to cardiovascular (CV) events that impair health-related quality of life and/or lead to premature CVD death. CV events including acute myocardial infarction, stroke, and venous thromboembolism have been reported to be associated with adjuvant chemotherapy, biological agents, radiation therapy, and/or hormonal therapies. These treatment-related CV events pose a significant public health problem because they will affect the increasing number of breast cancer survivors’ health-related quality of life over a long-life expectancy. Currently, no standard risk model exists to predict the risk of CV events associated with multiple adjuvant breast cancer therapies in the presence of established CV risk factors (such as hypertension, hyperlipidemia, smoking) to inform practice guidelines and promote shared clinical decision-making. Such models can inform women before treatment about the potential risks of CVD from alternative treatment strategies while maintaining the best chances for cancer cure. These models can also help to identify women at highest risk of CVD after therapy who would potentially benefit from earlier and more intensive CV monitoring via routine imaging and/or use of preventive medications to mitigate risk of CV events. To address this gap, our study will create risk prediction models by analyzing a large, demographically heterogeneous cohort of adult women (N=40,500) with newly diagnosed stages I to III invasive breast cancer in real-world health care settings. We will study women diagnosed from 2008-2020 and followed up to 15 years using the comprehensive electronic records of one of the largest health plans in the U.S., Kaiser Permanente. In Aim 1, we will assess incident CV events (acute myocardial infarction, stroke, heart failure) following adjuvant breast cancer therapies, adjusting for tumor characteristics and CVD risk factors such as age, race/ethnicity, pre-existing CVD, CVD medications (statins, anti-hypertensives, anti- diabetics), hypertension, diabetes, BMI, and smoking. We will then estimate whether the risk of CV events is greater in the breast cancer cohort versus an age, race- matched cancer-free cohort. In Aim 2, we will create and validate risk prediction models for early (<1 year) and late (up to 15 years) CV events. Our project will be the first to estimate the association of multiple established CVD risk factors with the risk of breast cancer adjuvant treatment-related CV events in a real-world, ethnically and socioeconomically diverse community-based cohort. Our risk prediction models will provide new information to guide evidence-based clinical decision-making concerning adjuvant therapy use for breast cancer and concurrent and post-treatment cardio-oncology care.

项目总结