Unpacking the Multi-level Drivers of Cardiotoxicity Disparities in Breast Cancer Survivors

揭示乳腺癌幸存者心脏毒性差异的多层次驱动因素

• 批准号: 10682651
• 负责人: Arnethea La'Shaun Sutton
• 金额: $ 21.48万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-16 至 2025-08-15
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10682651
• 关键词: Address; Adjuvant Therapy; Adrenergic beta-Antagonists; Advisory Committees; Age; Anthracycline; Anxiety; Attention; Award; Behavioral; Black race; Breast Cancer Patient; Breast Cancer Treatment; Breast Cancer survivor; Cardiac; Cardiac health; Cardiology; Cardiotoxicity; Cardiovascular Diseases; Cardiovascular system; Caring; Cause of Death; Chronology; Clinical; Computerized Medical Record; Coupled; Data; Demographic Factors; Development; Diagnosis; Doxorubicin; Ensure; Environment; Epidermal Growth Factor Receptor; Female; Goals; Healthcare; Heart; Heart Diseases; Heart failure; High Prevalence; Hospitals; Human; Intervention; Interview; Left Ventricular Dysfunction; Life; Light; Literature; Maintenance; Malignant Neoplasms; Measures; Mediating; Medical; Medical Records; Mentors; Modeling; Myocardial dysfunction; National Cancer Institute; Oncology; Pathway interactions; Patients; Pattern; Phase; Prevalence; Prospective cohort study; Race; Reporting; Research; Research Methodology; Research Project Grants; Resources; Risk; Risk Factors; Role; Smoking; Strategic Planning; Surveys; Survivors; Training; Treatment-Related Cancer; Woman; black women; breast cancer survival; cancer care; cancer health disparity; care delivery; care outcomes; chemotherapy; comorbidity; early onset; experience; high body mass index; improved outcome; insight; malignant breast neoplasm; mortality; novel; perceived discrimination; prevent; primary outcome; programs; psychological distress; psychosocial; racial difference; racial disparity; receptor; recruit; secondary outcome; side effect; social; social culture; sociodemographics; success; survivorship; targeted treatment; therapy development

Abstract The improvement in breast cancer survival is partially due to improvements in treatments. However, these treatments are not without mild to life-threatening side effects. For example, anthracycline chemotherapies (e.g. doxorubicin) and human epidermal growth factor receptor-2 (HER-2) targeted therapies have been shown to cause cardiotoxicity (CTX), or damage to the heart. This side effect is of great concern as survivors are more likely to die of heart disease than any other diagnosis and racial disparities exist with regard to prevalence of CTX and risk of heart-related mortality. Factors that have been shown to contribute to cardiotoxicity include Black race and the presence of comorbidities. While the cardiovascular disease literature includes the roles of psychosocial and sociocultural factors in its prevalence and the racial disparity in its manifestation and progression, these factors are unexplored in the context CTX. Additionally, cancer care delivery factors, including maintenance of CTX, deserves attention as there may be opportunities to address gaps or differences in care that may exacerbate the CTX disparity. Addressing psychosocial and sociocultural factors may provide intervention targets to mitigate CTX disparities. Guided by the Social Ecological Model, I will conduct retrospective analyses and a historical-prospective cohort study to identify factors related to the racial disparity in CTX. During the K99 mentored phase, I will abstract electronic hospital data on breast cancer survivors treated with anthracycline chemotherapy or Her-2 targeted therapies to elucidate sociodemographic, clinical, and maintenance factors that relate to onset of and racial differences in CTX (Aim 1). In Aim 2, I will conduct in-depth interviews with Black and White survivors (n=20) with and without CTX to understand psychosocial and sociocultural experiences that may contribute to CTX. During the R00 phase (Aim 3), I will use the information learned from the in-depth interviews to inform a survey that will be distributed to n=150 Black and White breast cancer survivors who were treated with adjuvant therapies. This survey, coupled with medical record data, will be used to assess relationships between psychosocial and socio-cultural factors and racial differences in CTX. In order to successfully execute these aims the candidate will receive strategic planning in cancer care delivery, cardio-oncology, and mixed methods research. These training aims will ensure the candidate's goal of successfully transitioning to independence and establishing a research program involving the development of interventions that will address racial disparities in cancer care delivery and outcomes. The expertise and guidance of the mentoring and advisory teams in addition to the wealth of resources and commitment to training provided through the institutional environment will ensure the success of the candidate's research project and transition to independence.

抽象的 乳腺癌生存率的提高部分归功于治疗方法的改进。然而，这些 治疗并非没有轻微甚至危及生命的副作用。例如，蒽环类化疗（例如 阿霉素）和人表皮生长因子受体-2（HER-2）靶向治疗已被证明可以 引起心脏毒性（CTX）或心脏损伤。这种副作用值得高度关注，因为幸存者更多 死于心脏病的可能性高于任何其他诊断，并且在患病率方面存在种族差异 CTX 和心脏相关死亡的风险。已被证明会导致心脏毒性的因素包括黑色 种族和合并症的存在。虽然心血管疾病文献包括以下作用： 其流行的心理社会和社会文化因素以及其表现形式和种族差异 在 CTX 的背景下，这些因素尚未被探索。此外，癌症护理提供因素包括 CTX 的维持值得关注，因为可能有机会解决护理方面的差距或差异 这可能会加剧 CTX 差异。解决心理社会和社会文化因素可能会提供 旨在缩小 CTX 差异的干预目标。以社会生态模型为指导，我将进行 回顾性分析和历史前瞻性队列研究以确定与种族差异相关的因素 在CTX中。在 K99 指导阶段，我将提取有关接受治疗的乳腺癌幸存者的电子医院数据 使用蒽环类化疗或 Her-2 靶向治疗来阐明社会人口统计学、临床和 与 CTX 发病和种族差异相关的维持因素（目标 1）。在目标2中，我将深入进行 对使用和不使用 CTX 的黑人和白人幸存者 (n=20) 进行访谈，以了解社会心理和 可能有助于 CTX 的社会文化经历。在 R00 阶段（目标 3），我将使用这些信息 从深度访谈中了解到，将开展一项调查，该调查将分发给 n=150 名黑人和白人乳房 接受辅助疗法治疗的癌症幸存者。这项调查与医疗记录数据相结合，将 用于评估心理社会和社会文化因素与 CTX 种族差异之间的关系。 为了成功实现这些目标，候选人将获得癌症护理提供的战略规划， 心脏肿瘤学和混合方法研究。这些培训目标将确保候选人的目标 成功过渡到独立并建立了一个涉及开发的研究计划 旨在解决癌症护理服务和结果方面的种族差异的干预措施。专业知识和 除了丰富的资源和对培训的承诺之外，指导和咨询团队的指导 通过制度环境提供的将确保候选人的研究项目的成功和 向独立过渡。