Cancer-related cognitive impairment: Real-time evaluation and assessment of long-term impact of treatment on young adult survivors (CRCI REALITY)

项目概要/摘要 在美国，每年有超过80，000名青少年和年轻人（AYA）被诊断患有癌症，其中85% 在癌症诊断后至少存活五年。青春期和成年早期是一个关键时期 而癌症治疗可能会破坏这种神经发育， 癌症相关认知障碍（CRCI）。其中53%的长期 早期年轻成人（YA）幸存者经历CRCI，干扰他们的工作和教育目标。然而，在这方面， 使用客观神经心理学评估的稀疏研究未检测到YA报告的CRCI 幸存者因此，K99/R 00应用程序的目标是迈出创新计划的第一步， 使用生态有效的方法来描述CRCI在这一脆弱生存人群中的特征的研究 评估。职业发展计划：总体培训目标是为Tometich博士提供额外的 培训和指导，成为一个高素质的独立调查员，在CRCI的专业知识， AYA癌症幸存者的未充分研究人群。Tometich博士的培训目标是：1）提高她的知识 AYAs中的癌症和认知，2）获得认知和行为评估方法的技能，3） 发展实时纵向数据分析的熟练程度，以及4）继续专业发展。期间 在K99阶段，Tometich博士将在Moffitt癌症中心（一个研究中心）的石楠Jim博士的主要指导下工作。 nci指定的综合癌症中心）和布伦特小博士的共同导师。CRCI专家 全国缺乏AYA幸存者;因此，一个指导和咨询小组将提供补充 专业知识，以解决培训和研究内容的各个方面（其他顾问是安德鲁博士 Galligan，Martin Sliwinski，and Dinorah Martinez Tyson）.研究计划：本研究的目的是评估 YA幸存者的长期CRCI和潜在可改变的风险因素（即，年龄18-30岁）使用生态有效的 评估。现有的认知生态瞬时评估（EMA）已被开发和使用， 我们的研究团队在中年乳腺癌幸存者中进行了研究，但尚未应用于YA幸存者。 此外，体动记录仪可以客观地测量CRCI的两个可改变的风险因素（体力活动和 睡眠）。在K99阶段（即，目标1和2），我们将使用迭代混合方法来定制EMA CRCI和情境、行为和背景风险因素（SBCF）对YAs经验的影响， 对20名报告CRCI的YA幸存者进行定性访谈。然后，我们将在25年内试用EMA和活动记录仪 幸存者，并根据需要进行修改。在R 00阶段（即，目标3），我们将招募150名YA幸存者和150名 社区对照组在性别、年龄和教育程度上相匹配，进行横断面研究以评估CRCI， SBCF。影响：合并的培训和研究计划将使Tometich博士过渡到独立 作为为数不多的专门研究CRCI的癌症控制研究人员之一， AYA幸存者

Project Summary/Abstract Of over 80,000 adolescents and young adults (AYA) diagnosed with cancer in the United States each year, 85% live for at least five years after their cancer diagnosis. Adolescence and early young adulthood is a critical period for frontal neurodevelopment, and cancer treatments potentially disrupt this neurodevelopment, leading to cognitive deficits known as cancer-related cognitive impairment (CRCI). An estimated 53% of these long-term early young adult (YA) survivors experience CRCI that interferes with their work and educational goals. However, sparse research using objective neuropsychological assessment does not detect CRCI as reported by YA survivors. Therefore, the goal of this K99/R00 application is to take the first step in an innovative program of research to characterize CRCI among this vulnerable survivorship population using ecologically valid assessments. Career Development Plan: The overall training objective is to provide Dr. Tometich with additional training and mentorship to become a highly qualified independent investigator with expertise in CRCI in the understudied population of AYA cancer survivors. Dr. Tometich’s training goals are to: 1) enhance her knowledge of cancer and cognition in AYAs, 2) acquire skills in cognitive and behavioral assessment methodologies, 3) develop proficiency in real-time longitudinal data analysis, and 4) continue professional development. During the K99 phase, Dr. Tometich will work under the primary mentorship of Dr. Heather Jim at Moffitt Cancer Center (an NCI-designated comprehensive cancer center) and co-mentorship of Dr. Brent Small. Experts in CRCI among AYA survivors are lacking nationally; therefore, a mentorship and advisory team will provide complementary expertise to address each aspect of the training and research content (additional advisors are Drs. Andrew Galligan, Martin Sliwinski, and Dinorah Martinez Tyson). Research Plan: The goal of this study is to evaluate long-term CRCI and potentially modifiable risk factors in YA survivors (i.e., age 18-30) using ecologically valid assessments. An existing cognitive ecological momentary assessment (EMA) has been developed and used by our research team in middle-aged breast cancer survivors, but it has not yet been applied in YA survivors. Furthermore, actigraphy can objectively measure two modifiable risk factors for CRCI (physical activity and sleep). In the K99 phase (i.e., Aims 1 and 2), we will use an iterative mixed-methods approach to tailor an EMA of CRCI and situational, behavioral, and contextual risk factors (SBCF) to the experience of YAs based on qualitative interviews with 20 YA survivors who report CRCI. We will then pilot the EMA and actigraphy in 25 YA survivors and make revisions as needed. In the R00 phase (i.e., Aim 3), we will recruit 150 YA survivors and 150 community controls matched on gender, age, and education for a cross-sectional study to evaluate CRCI and SBCF. Impact: The combined training and research plan will position Dr. Tometich to transition to independence as one of the few cancer control investigators specializing in CRCI in the vulnerable and unique population of AYA survivors.