A Prospective Study of the Impact of Breast Cancer on Symptoms and Functioning

 描述（由申请人提供）：乳腺癌是美国女性中最常见的癌症。主要由于筛查和治疗的改善，自1975年以来，美国乳腺癌死亡率显著下降。再加上人口老龄化，乳腺癌幸存者的数量已经增加，预计将继续增加。目前，美国估计有270万乳腺癌幸存者，今年估计有232，340名乳腺癌患者中有近90%将在诊断后存活5年。乳腺癌幸存者可能会经历短期和长期的不良影响，包括生活质量下降，性和认知功能;以及疲劳，抑郁和血管扩张症状（VMS）增加。现有的研究已经研究了癌症诊断后的这些结果，但据我们所知，没有一个将癌症幸存者与适当的对照进行比较，有冗长的诊断前和诊断后数据，并在一个具有纵向数据的队列中检查多个相关结果。这项拟议的研究利用了来自3302名妇女的多种族/种族队列的现有数据，这些妇女在基线时处于绝经前和早期围绝经期，并在全国妇女健康研究（SWAN）中进行了15次近20年的绝经过渡期随访。这项拟议中的研究将使用创新的统计技术，全面了解乳腺癌对一系列结果的影响，并开始探索炎症在这些结果中的作用。具体而言，我们的目标是：1）比较SWAN队列中发生乳腺癌的女性与未发生癌症的女性，以确定乳腺癌诊断和治疗对症状的影响（疲劳、抑郁、VMS、睡眠问题）、功能（性、认知）和生活质量; 2）仅在乳腺癌妇女中，检查癌症治疗的影响（化疗、放疗）、诊断时的年龄、诊断后的时间、诊断时的绝经阶段和心理社会因素对上述结果的影响，以及对新获得的疲劳、疾病侵入性、和癌症相关的生活质量，并共同考虑结果，以确定不同的“状态”或妇女的概况;和3）作为探索性目标， 我们将比较乳腺癌幸存者和年龄匹配的对照组，以检查癌症和/或治疗对hs-CRP的影响，检查两组之间炎症的时间进程，以及这种炎症标志物是否与癌症对疲劳、抑郁、睡眠和/或认知的影响有关。拟议的研究利用了SWAN队列中现有的比较组，SWAN中已有的详细诊断前和诊断后信息，以及使用分析方法，如潜在增长分析，以确定不同的结果轨迹。我们的研究结果也将进一步推进我们对炎症与疲劳，抑郁，睡眠和认知症状之间关系的认识。拟议的工作将有助于改善风险状况，以加速针对癌症幸存者的干预措施。

 DESCRIPTION (provided by applicant): Breast cancer is the most frequently occurring cancer among US women. Largely due to improvements in screening and treatment, breast cancer mortality rates in the US have declined significantly since 1975. In combination with an aging population, the number of breast cancer survivors has grown and is projected to continue increasing. Currently, an estimated 2.7 million breast cancer survivors are alive in the US, and nearly 90% of the estimated 232,340 women diagnosed with breast cancer this year will be alive 5 years after diagnosis. Breast cancer survivors may experience short- and long-term adverse effects, including reduced quality of life, sexual, and cognitive functioning; and increased fatigue, depression, and vasomotor symptoms (VMS). Existing research has studied these outcomes following a cancer diagnosis, but to our knowledge, none has compared cancer survivors to appropriate controls, had lengthy pre-and post-diagnosis data, and examined multiple relevant outcomes over time in a single cohort with longitudinal data. The proposed research capitalizes on existing data from a multiethnic/racial cohort of 3302 women who were pre- and early peri-menopausal at baseline and have been followed through the menopausal transition in the Study of Women's Health Across the Nation (SWAN) with 15 visits over nearly 20 years. The proposed research will use innovative statistical techniques to provide a comprehensive view of the impact of breast cancer on a range of outcomes and begin to explore the role that inflammation plays in these outcomes. Specifically, we aim to: 1) compare women who develop incident breast cancer in the SWAN cohort to those who have not developed cancer to determine the impact of breast cancer diagnosis and treatment on symptoms (fatigue, depression, VMS, sleep problems), functioning (sexual, cognitive), and quality of life; 2) among women with breast cancer only, examine the impact of cancer treatment (chemotherapy, radiation), age at diagnosis, time since diagnosis, menopausal stage at diagnosis, and psychosocial factors on the above outcomes, as well as on newly acquired in-depth measures of fatigue, illness intrusiveness, and cancer-related quality of life, and consider outcomes jointly to identify different "states" or profiles of women; and 3) as an exploratory aim, we will compare breast cancer survivors and age-matched controls to examine the impact of cancer and/or treatment on hs-CRP, examining the time course of inflammation between the two groups and whether this inflammatory marker is associated with the impact of cancer on fatigue, depression, sleep, and/or cognition. The proposed research capitalizes on an existing comparison group within the SWAN cohort, detailed pre-and post-diagnostic information already available in SWAN, and use of analytic approaches, such as latent growth analysis to identify different trajectories of outcomes. Our results will also further advance our knowledge of the relationships between inflammation and symptoms of fatigue, depression, sleep, and cognition. The proposed work will allow for improved risk profiles to accelerate interventions specific to cancer survivors.