Social networks, breast cancer treatment, and survival

社交网络、乳腺癌治疗和生存

• 批准号: 9314444
• 负责人: CANDYCE H KROENKE
• 金额: $ 18.69万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-14 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9314444
• 关键词: Adherence; Adjuvant; Advanced Malignant Neoplasm; Affect; Award; Behavior Therapy; Breast Cancer Patient; Breast Cancer Treatment; Breast Cancer survivor; Cancer Prognosis; Cancer Survivor; Characteristics; Clinical; Clinical Treatment; Computerized Medical Record; Conflict (Psychology); Data; Data Collection; Data Set; Development; Diagnosis; Documentation; Environment; Epidemiologist; Epidemiology; Evaluation; Exercise; Foundations; Funding; Goals; Health; Healthcare Systems; Healthy People 2020; Individual; Internet; Intervention; K-Series Research Career Programs; Knowledge; Life Style; Linear Regressions; Literature; Longitudinal cohort; Malignant Neoplasms; Measurement; Measures; Medical center; Mentors; Methodology; Methods; Newly Diagnosed; Outcome; Pathway Analysis; Pathway interactions; Patients; Physical activity; Physicians; Positive Lymph Node; Psychosocial Factor; Questionnaires; Research; Research Personnel; Resources; Risk; Role; Smoking; Social Environment; Social Network; Social Psychology; Social support; Spouses; Structure; System; Testing; Time; Training; Translating; Treatment outcome; Variant; Woman; Women' s Health; Work; behavior change; behavioral outcome; breast cancer survival; cancer care; cancer recurrence; cancer survival; cancer therapy; career; career development; chemotherapy; clinical care; clinical development; clinical practice; clinically relevant; cohort; density; diabetic; hormone therapy; improved; improved outcome; individual patient; insight; interest; lifestyle factors; malignant breast neoplasm; meetings; member; mortality; multidisciplinary; multilevel analysis; outcome forecast; practical application; public health relevance; skill acquisition; skills; social; success; survival outcome; survival prediction; symposium; theories; treatment adherence; tumor

 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.

 描述（由申请人提供）：每年，超过 200,000 名女性被诊断患有乳腺癌 (BC)，近 40,000 名女性死于乳腺癌 (BC)。先前的文献表明，社会决定因素，例如社交网络，即围绕个人的社会关系网，在BC生存中发挥着重要作用。然而，社交网络影响预后的机制，特别是对 BC 治疗的影响，尚不清楚。此外，目前临床护理中还没有系统的方法来识别社会孤立的 BC 患者以促进干预。 Kroenke 博士的职业目标是成为社会环境和癌症结果方面的多学科、独立资助的学术研究员，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（包括社交网络理论、测量和分析）； 2）进行社交网络行为干预； 3）临床BC治疗和电子病历（EMR）在研究中的使用； 4）专业的研究技能。目标将通过与优秀导师团队的合作来实现；正式的教学法；研讨会；会议；和会议。具体目标 (SA) 包括： 1) 在 Pathways 研究中，由 4,505 名 BC 幸存者组成的大型 KPNC 队列拥有有关社会因素和癌症治疗的广泛数据，评估社交网络和 BC 治疗之间的关联； 2) 评估社交网络、乳腺癌复发和死亡率的关联，以及与社交网络相关的治疗变异在多大程度上解释了与生存的关联； 3) 开发、试点、评估和完善一项简短的“社交网络作为生命体征”(SVS) 措施，收集 KP 奥克兰医疗中心的 BC 患者数据，以便进入 EMR。线性回归和生存方法将用于分析与 BC 治疗的关联，包括接受治疗、治疗时间、辅助激素治疗的依从性以及生存结果。我们预计，具有更大程度的支持性关系以及更大的关系密度、强度和多样性的女性将更早、更好地坚持治疗，并且治疗的变化将有助于解释与生存的关系。 SA 1-2 的结果和拟议的培训将为 SA 3 中开发 SVS 测量提供基础。拟议的研究是第一个研究社交网络结构如何影响 BC 治疗和生存的研究。 KPNC 是获得这一职业发展奖的理想环境，因为它拥有强有力的导师、机构承诺、有关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。这项研究的结果将用于识别大型管理医疗保健系统中社交网络受损的个体患者，并开发个体和系统级 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 可以改善每年在 KP 诊断的 10,000 例 BC 病例中高达 20% 的 BC 患者的预后。