Optimizing Supportive Care for Patients with Metastatic Lung Cancer in the Era of Precision Oncology

项目摘要 肺癌是美国癌症相关死亡的主要原因，但精确肿瘤学 这些发现已经显著地改善了一部分患者的存活率和生活质量。肺癌 具有靶向致癌驱动突变的癌症代表了一个新出现的患有以下疾病的患者群体： 慢性的，限制生命的癌症这样的患者挣扎于不确定性，他们的癌症何时会进展， 如何决定他们的个人生活和医疗保健。他们也很少讨论他们的 与临床医生一起进行临终关怀的预后和偏好。该提案详细介绍了一项五年计划， 制定并试点测试姑息治疗干预措施，其中包括生存护理的要素，以解决 癌基因驱动型肺癌患者未满足的需求。具体而言，该项目的目标是：1） 通过生存护理，完善针对特定人群的姑息治疗干预措施， 癌基因驱动的肺癌与利益相关者的反馈（N=15）和开放试点（N=10）; 2）评估 与常规护理相比，在随机对照试验中干预的可行性和可接受性 （N=80），并估计干预对患者与预后相关的痛苦的初步影响 不确定性、管理慢性病的自我效能、预后意识和关于目标的讨论 和价值观来指导未来的决策。 这份提案还详细说明了候选人劳拉·佩特里罗博士的计划，她是一名姑息治疗医生兼调查员， 获得指导，教学培训和职业发展，以促进她向研究过渡 独立Petrillo博士的长期职业目标是成为肿瘤学支持性护理的领导者， 专门开发和评估针对患者需求的支持性护理干预措施 接受新的治疗。这份建议书包括了佩特里罗博士的计划，他打算在行为学方面获得专业知识， 干预开发; 2）癌症生存研究和实践方法; 3）临床试验设计 和行为。她将通过体验式学习来完成这项培训， 来自导师Jennifer Temel博士和Joseph Greer的指导，他们是姑息治疗研究的领先专家， 科学咨询团队，在癌基因驱动的肺癌，行为心理学，姑息治疗方面具有专业知识 和生存研究她将通过行为研究方法的课程获得额外的技能， 临床试验设计和实施，以及纵向数据分析。这个项目将使Petrillo博士 为R 01级资金，并推出一个独立的职业生涯，领导在接口的研究计划， 支持治疗和肿瘤学。

PROJECT SUMMARY Lung cancer is the leading cause of cancer-related death in the United States, yet precision oncology discoveries have substantially improved survival and quality of life for a subset of patients. Patients with lung cancer with targetable oncogenic driver mutations represent an emerging population of patients living with chronic, life-limiting cancer. Such patients struggle with uncertainty about when their cancer will progress and how to make decisions about their personal lives and medical care. They also infrequently discuss their prognosis and preferences for end-of-life care with their clinicians. This proposal details a five-year plan to develop and pilot test a palliative care intervention that incorporates elements of survivorship care to address the unmet needs of patients with oncogene-driven lung cancer. Specifically, the aims of this project are to 1) refine a population-specific palliative care intervention informed by survivorship care for patients with oncogene-driven lung cancer with feedback from stakeholders (N=15) and an open pilot (N=10); 2) evaluate the feasibility and acceptability of the intervention in a randomized controlled trial compared to usual care (N=80), and estimate the preliminary effects of the intervention on patients’ distress related to prognostic uncertainty, self-efficacy for managing chronic disease, prognostic awareness, and discussions about goals and values to inform future decision making. This proposal also details the plans of the candidate, Dr. Laura Petrillo, a palliative care physician-investigator, to gain mentorship, didactic training, and career development to facilitate her transition to research independence. Dr. Petrillo’s long-term career goal is to become a leader in supportive care in oncology, specializing in developing and evaluating supportive care interventions tailored to the needs of patients receiving novel therapies. This proposal includes Dr. Petrillo’s plans for gaining expertise in 1) behavioral intervention development; 2) approach to cancer survivorship research and practice; and 3) clinical trial design and conduct. She will achieve this training through experiential learning leading the proposed project with guidance from mentors Dr. Jennifer Temel and Joseph Greer, leading experts in palliative care research, and a scientific advisory team with expertise in oncogene-driven lung cancer, behavioral psychology, palliative care and survivorship research. She will gain additional skills through coursework in behavioral research methods, clinical trial design and conduct, and longitudinal data analysis. This project will position Dr. Petrillo to compete for R01-level funding and launch an independent career leading a research program at the interface of supportive care and oncology.