Treatment Modifications, Outcomes and Provider Decision Making in the Management of Subsequent Breast Cancers Among Survivors of Childhood Cancer

儿童癌症幸存者后续乳腺癌管理的治疗修改、结果和提供者决策

• 批准号: 10004603
• 负责人: Lucie Marie Turcotte
• 金额: $ 17.81万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-17 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10004603
• 关键词: Address; Adult; Age; Alkylating Agents; Anthracycline; Attention; Breast Cancer Patient; Breast Cancer Risk Factor; Breast Cancer Treatment; Breast Cancer therapy; Cancer Survivor; Cardiovascular system; Caring; Characteristics; Chest; Childhood Cancer Survivor Study; Childhood Cancer Treatment; Childhood Hodgkin' s Lymphoma; Complex; Consequentialism; Data; Decision Making; Diagnosis; Disease; Disease-Free Survival; Educational Intervention; Ethnic Origin; Exposure to; Face; Female; Geography; Goals; Health; Hodgkin Disease; Hodgkin Lymphoma survivors; Incidence; Individual; Inferior; Institution; Interview; Knowledge; Late Effects; Leadership; Life; Long-Term Survivors; Malignant Childhood Neoplasm; Malignant Neoplasms; Mastectomy; Medical; Medical Oncologist; Mentors; Methodological Studies; Methods; Modification; Morbidity - disease rate; National Comprehensive Cancer Network; Neoplasms; Outcome; Participant; Physicians; Population; Provider; Race; Radiation; Radiation Oncologist; Radiation therapy; Recording of previous events; Reporting; Research Design; Research Personnel; Risk; Risk Factors; Scientist; Second Primary Cancers; Secondary to; Skin Carcinoma; Structure; Surveys; Survivors; Toxic effect; Treatment-related toxicity; United States; Vulnerable Populations; Woman; cancer diagnosis; cancer therapy; chemotherapy; childhood cancer survivor; cohort; comorbidity; epidemiology study; experience; follow-up; high risk; high risk population; improved; improved outcome; leukemia; malignant breast neoplasm; mortality; mortality risk; novel; practice setting; response; sarcoma; skills; standard of care; survivorship; therapy development; treatment comparison; treatment guidelines

Project Summary Survivors of childhood cancers face multiple late effects of their initial cancer therapy. One of the most difficult and consequential is the occurrence of a subsequent neoplasm. Subsequent breast cancers are the second most frequently observed subsequent neoplasm, exceeded only by non-melanoma skin cancers. Although much attention has been given to subsequent breast cancer risk and risk factors among survivors, there are limited data on treatment, treatment-related toxicities, survival and physician decision making for these challenging subsequent neoplasms. Survivors of childhood cancer have previously been exposed to therapies, including radiation and/or anthracycline chemotherapies, which may limit their ability to safely receive standard-of-care breast cancer therapy. The overall goals of this study will be: 1) to quantify how overall and event-free survival among long-term survivors of childhood cancer who develop a subsequent breast cancer compare to a geographically diverse, age-, race and ethnicity-,breast cancer stage-, and treatment era- matched cohort of women with similar breast cancer characteristics, and how their overall survival compares to SEER survival estimates; 2) to describe how survivors of childhood cancer who develop a subsequent breast cancer are medically managed and how treatment compares to a contemporarily-treated, age-, race and ethnicity-, breast cancer stage-, and treatment era-matched matched comparison cohort and to contemporary National Comprehensive Cancer Network treatment guidelines, and to describe treatment-related toxicities among survivors with subsequent breast cancer and compare the toxicity profile with a matched comparison cohort of women with primary breast cancer; and 3) to describe how breast cancer treatment decisions are made, through semi-structured interviews and surveys, among medical and radiation oncologists. This project will provide data necessary to improve health outcomes in this growing high-risk and vulnerable population of survivors of childhood cancer. Understanding the drivers of decision-making, the way women with subsequent breast cancers are treated, and how their outcomes compare to other women with breast cancer will guide educational interventions and the development of treatment guidelines for women with subsequent breast cancer. The skills developed through the completion of the aims in this proposal, in complex epidemiological study design, qualitative and mixed methods study methodology, and study leadership, will lay the groundwork for leading novel and high-impact survivorship studies. This project will serve as a transition point from working as a mentored physician scientist to an independent investigator, as demonstrated by a planned R01 submission during the final year of this study.

项目摘要 儿童期癌症的幸存者面临其最初的癌症治疗的多个晚期影响。最困难的 因此，随后的肿瘤发生。随后的乳腺癌是第二种 最常观察到的随后的肿瘤，仅由非黑色素瘤皮肤癌超过。虽然 人们对随后的乳腺癌风险和幸存者的危险因素非常关注， 有关治疗，与治疗相关的毒性，生存和医师决策的数据有限 随后的肿瘤挑战。儿童癌症的幸存者以前已经接触过疗法， 包括辐射和/或蒽环类化疗，这可能会限制其安全接收的能力 护理标准乳腺癌治疗。这项研究的总体目标是：1）量化整体和 儿童癌症的长期幸存者之间的无事件生存，他们发展了随后的乳腺癌 与地理，年龄，种族和种族，乳腺癌阶段和治疗时代相比 匹配具有相似乳腺癌特征的女性队列，其总体生存方式与 先知生存估计； 2）描述如何发展随后乳房的儿童癌症幸存者 癌症是通过医学管理的，治疗与当代治疗，年龄，种族和 种族，乳腺癌阶段和治疗时代匹配的比较队列和与现代 国家综合癌症网络治疗指南，并描述与治疗相关的毒性 在随后的乳腺癌的幸存者中，并将毒性特征与匹配的比较进行了比较 妇女的原发性乳腺癌队列； 3）描述乳腺癌治疗的决定是如何的 通过半结构化的访谈和调查，在医学和放射肿瘤学家中进行。这个项目 将提供必要的数据，以改善这种日益增长的高风险和脆弱人群的健康结果 儿童癌的幸存者。了解决策的驱动力，以后的女性 对乳腺癌进行治疗，以及与其他乳腺癌女性相比的结果 教育干预措施以及针对随后乳房的妇女的治疗指南的制定 癌症。在复杂的流行病学中，通过完成该提案的目标而发展的技能 研究设计，定性和混合方法研究方法以及研究领导将奠定基础 用于领先的小说和高影响的生存研究。该项目将成为工作的过渡点 作为一名受过指导的医师科学家对独立研究者的科学家，如计划的R01所证明 在本研究的最后一年提交。