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

 描述(申请人提供)：乳腺癌是美国女性中最常见的癌症。自1975年以来，美国的乳腺癌死亡率显著下降，这在很大程度上是由于筛查和治疗的改进。再加上人口老龄化，乳腺癌幸存者的数量已经增长，预计还会继续增加。目前，美国估计有270万乳腺癌幸存者活着，今年被诊断为乳腺癌的232340名女性中，近90%的人将在确诊后5年内存活。乳腺癌幸存者可能会经历短期和长期的不良反应，包括生活质量、性功能和认知功能的下降；以及疲劳、抑郁和血管舒缩症状(VMS)的增加。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，没有一项研究将癌症幸存者与适当的对照进行比较，没有一项研究拥有冗长的诊断前和诊断后数据，并在一组纵向数据中检查了随着时间推移的多个相关结果。这项拟议的研究利用了3302名绝经前和围绝经期早期妇女的现有数据，这些妇女在基线水平上处于绝经前和围绝经期早期，并在全国妇女健康研究(SWAN)中进行了更年期过渡，在近20年中进行了15次访问。拟议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所起的作用。具体地说，我们的目标是：1)将天鹅队列中发生乳腺癌的女性与未患癌症的女性进行比较，以确定乳腺癌诊断和治疗对症状(疲劳、抑郁、VMS、睡眠问题)、功能(性、认知)和生活质量的影响；2)在仅患有乳腺癌的妇女中，检查癌症治疗(化疗、放射治疗)、确诊年龄、确诊时间、绝经阶段和心理社会因素对上述结果的影响，以及对疲劳感、疾病侵入性和癌症相关生活质量的新获得的深入测量，并联合考虑结果以确定妇女的不同“状态”或特征；以及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队列中现有的一个比较小组、SWAN中已有的详细的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。我们的结果还将进一步促进我们对炎症与疲劳、抑郁、睡眠和认知症状之间关系的了解。拟议的工作将允许改善风险状况，以加快针对癌症幸存者的干预。

 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.