Prognostic value of quantitative HPV viral load in determining cervical cancer treatment response and recurrence

定量 HPV 病毒载量在确定宫颈癌治疗反应和复发方面的预后价值

• 批准号: 10380979
• 负责人: Surbhi Grover
• 金额: $ 13.5万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10380979
• 关键词: Acquired Immunodeficiency Syndrome; African; Awareness; Botswana; COVID-19 pandemic; Cancer Control; Caring; Cessation of life; Characteristics; Clinic; Clinical; Complex; Consolidated Framework for Implementation Research; Country; Data; Developing Countries; Diagnostic tests; Ensure; Female; Fright; Future; Geography; Goals; Gynecologic Oncology; HIV; HIV Seronegativity; HIV Seropositivity; Healthcare; Hospitals; Human Papillomavirus; Incidence; Infection; Intervention; Interview; Knowledge; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Methods; Outcome; Pathway interactions; Patient-Focused Outcomes; Patients; Pattern; Policies; Prevalence; Private Hospitals; Public Health; Radiation therapy; Recommendation; Recurrence; Research; Resources; Shapes; Social Distance; Stage at Diagnosis; Structure; Surveys; Telemedicine; Testing; Time; Treatment outcome; Viral Load result; Woman; Work; cancer care; cancer diagnosis; cancer therapy; care delivery; care outcomes; clinical practice; cohort; comparative; contextual factors; demographics; design; digital health; effective intervention; experience; implementation study; implementation trial; improved; interest; low and middle-income countries; mortality; multidisciplinary; novel; pandemic disease; parent grant; prognostic value; response; telehealth; therapy design; treatment response; tumor

PROJECT SUMMARY This application is being submitted in response to the Notice of Special Interest (NOSI) identified as NOT-CA- 21-033. The COVID-19 pandemic dramatically and rapidly altered the delivery of cancer care globally, providing a compelling opportunity to empirically study how the pandemic and subsequent practice changes impacted patients and treatment pathways. Cervical cancer is one of the most common female cancers worldwide with over 600,000 new cases and 340,000 deaths estimated in 2020. The vast majority of incident cases and deaths occur in low- and middle-income countries (LMICs), particularly those with high rates of human immunodeficiency virus (HIV) as cervical cancer is an HIV-associated and acquired immunodeficiency syndrome (AIDS)-defining malignancy. In Botswana, a Sub-Saharan African country that is burdened with high rates of cervical cancer (incidence rate of 34.4 per 100,000) and HIV (18.5% prevalence), advanced stage at diagnosis and poor treatment completion contribute to high rates of mortality (20.1 per 100,000) in both HIV-positive and HIV-negative women. Despite this substantial burden, very few studies have focused on understanding modifiable drivers of treatment delays in Botswana. Furthermore, little is known regarding which interventions may be most impactful and sustainable to improve timeliness of care in LMICs before, during, or after the pandemic. As such, there is a critical need to identify effective strategies to ensure timely initiation and completion of treatment, and to understand contextual factors that may shape response to interventions. Prior to the COVID- 19 pandemic, our quantitative and qualitative data from an existing cohort of over 1,000 women receiving treatment for advanced cervical cancer in Botswana documented substantial delays in diagnostic testing and treatment initiation, driven by myriad challenges including patient knowledge and awareness, geographic and structural barriers, and limited healthcare resources. Expanding upon this prior work, the objective of this project is to: 1) quantitatively evaluate patterns of treatment initiation and completion for cervical cancer during the COVID-19 pandemic using an existing cohort of patients receiving care for advanced cervical cancer at Princess Marina Hospital in Gaborone, Botswana; and 2) qualitatively assess contextual determinants (e.g., patient fear, social distancing policies, shifts to telemedicine) contributing to experiences and timeliness of care and identify intervention strategies to target contextual determinants using the Expert Recommendations for Implementing Change (ERIC) framework. The results of this project will provide empirical data on how the COVID-19 pandemic impacted cervical cancer care and provide scientific knowledge on how different delivery approaches may have shaped outcomes for patients in Botswana. This project will also identify contextually-aligned interventions to be tested in a future implementation trial and generate fundamental evidence needed to mitigate impact of future pandemics on cancer control. The long-term goal of this project is to decrease cervical cancer mortality in LMICs by developing effective interventions that can be feasibly implemented and sustained in low-resource settings.

项目摘要 本申请是为了响应被标识为NOT-CA的特别利益通知（NOSI）而提交的- 21-033. 2019冠状病毒病大流行急剧而迅速地改变了全球癌症护理的提供， 这是一个从经验上研究大流行和随后的做法变化如何影响 患者和治疗途径。宫颈癌是世界上最常见的女性癌症之一， 2020年估计有超过60万新病例和34万死亡病例。绝大多数事件和死亡 低收入和中等收入国家（LMIC），特别是人口死亡率高的国家， 子宫颈癌是一种与艾滋病毒相关的获得性免疫缺陷综合征， （艾滋病）定义恶性肿瘤。在博茨瓦纳，一个撒哈拉以南的非洲国家， 宫颈癌（发病率为每100 000人34.4例）和艾滋病毒（流行率为18.5%），诊断时为晚期 和治疗完成情况不佳导致艾滋病毒阳性和 艾滋病毒呈阴性的妇女。尽管有如此沉重的负担，很少有研究关注理解 博茨瓦纳治疗延误的可改变驱动因素。此外，人们对哪些干预措施知之甚少， 可能是最有影响力和可持续的，以提高护理的及时性在中低收入国家之前，期间，或之后， 流行病因此，迫切需要确定有效的战略，以确保及时启动和完成 的治疗，并了解可能影响对干预措施的反应的背景因素。在COVID之前- 19大流行病，我们从现有的1,000多名接受大流行病治疗的妇女中获得的定量和定性数据 博茨瓦纳晚期宫颈癌的治疗记录了诊断检测的严重延误， 治疗启动，由无数挑战驱动，包括患者知识和意识，地理和 结构性障碍和有限的医疗资源。在此基础上，本项目的目标 是：1）定量评估治疗期间宫颈癌治疗开始和完成的模式， 2019冠状病毒病大流行使用公主医院接受晚期宫颈癌护理的现有患者队列 博茨瓦纳哈博罗内的滨海医院;以及2）定性评估背景决定因素（例如，耐心的恐惧， 社会距离政策，转向远程医疗）有助于护理的经验和及时性， 使用专家建议实施针对背景决定因素的干预策略 变革框架。该项目的结果将提供有关COVID-19大流行如何 影响宫颈癌护理并提供有关不同分娩方式可能如何影响宫颈癌护理的科学知识 为博茨瓦纳的患者带来了良好的治疗效果。该项目还将确定与具体情况相一致的干预措施， 在未来的实施试验中进行测试，并产生减轻未来影响所需的基本证据。 对癌症控制的影响。该项目的长期目标是降低中低收入国家的宫颈癌死亡率 制定有效的干预措施，在资源匮乏的环境中切实可行地实施和维持。