Improving treatment of cardiovascular risk factors in childhood cancer survivors

改善儿童癌症幸存者心血管危险因素的治疗

• 批准号: 10603027
• 负责人: Eric Jessen Chow
• 金额: $ 48.79万
• 依托单位: FRED HUTCHINSON CANCER CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-03-01 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10603027
• 关键词: Improving; treatment; cardiovascular; risk; factors

ABSTRACT Children and adolescents diagnosed with cancer now have on average >80% 5-year survival. However, premature cardiovascular (CV) disease has become the leading non-cancer cause of late mortality among childhood cancer survivors. Our existing work has shown that traditional CV risk factors such as hypertension, dyslipidemia, insulin resistance/diabetes remain very important, by increasing (in synergistic fashion) the risk of major CV events such as ischemic heart disease and heart failure. However, the existing research has been limited by misclassification of CV risk factor status (i.e., when defined by self-report or medication usage alone), including issues with both underdiagnosis (i.e., people with these risk factors present but who are unaware) and uncertainty of disease control (i.e., potential undertreatment). This proposal will utilize the largest, best characterized childhood cancer survivor cohort in the world, the Childhood Cancer Survivor Study (CCSS; n=24,466), a NCI-funded resource. We will use CCSS-derived validated risk prediction algorithms to select survivors at high risk of serious heart disease (n=800) based on past cancer treatment exposures. Among these 800 survivors, we propose to determine the magnitude of underdiagnosis and undertreatment of hypertension, dyslipidemia, and diabetes via in-person (home-based) measurements supplemented by medical record review. We predict that around 60% of survivors (n~480) will be underdiagnosed or undertreated with respect to one of these three CV risk factors. Survivors who are underdiagnosed or undertreated will then be eligible to participate in a 1-year long randomized controlled trial, where we will measure the efficacy of an Institute of Medicine (IOM) recommended personalized survivorship care plan (SCP) emphasizing CV risk, supplemented by a remotely delivered clinician-led self-management counseling intervention, to improve control of these three CV risk factors (i.e., reduce rates of undertreated hypertension, dyslipidemia, and diabetes). Survivors randomized to the control arm can receive the intervention on a delayed basis. Finally, our proposal seeks to better understand barriers among survivors and their primary healthcare providers that contribute to CV risk factor undertreatment. Knowledge derived from this study will improve the assessment and treatment of important CV risk factors in this high risk population. The proposed intervention, if successful, will be disseminable and low cost, and will have the potential to improve health and reduce mortality in these younger adults who live the majority of their lives as cancer survivors at increased risk of serious CV disease.

摘要 被诊断患有癌症的儿童和青少年现在平均有>80%的5年生存率。然而，在这方面， 早发心血管（CV）疾病已成为晚期死亡的主要非癌症原因， 儿童癌症幸存者。我们现有的工作表明，传统的心血管风险因素，如高血压， 血脂异常，胰岛素抵抗/糖尿病仍然非常重要，通过增加（以协同方式） 严重CV事件，如缺血性心脏病和心力衰竭。然而，现有的研究 受CV风险因素状态错误分类的限制（即，当通过自我报告或药物使用定义时 单独），包括诊断不足（即，存在这些风险因素但 不知道）和疾病控制的不确定性（即，潜在的治疗不足）。该提案将利用 儿童癌症幸存者研究是世界上规模最大、特征最突出的儿童癌症幸存者队列研究， (CCSS; n= 24，466），NCI资助的资源。我们将使用CCSS衍生的经验证的风险预测算法， 基于既往癌症治疗暴露，选择严重心脏病高风险的幸存者（n=800）。 在这800名幸存者中，我们建议确定诊断不足和治疗不足的程度， 高血压、血脂异常和糖尿病，通过现场（基于家庭）测量，辅以医疗 记录审查。我们预测，大约60%的幸存者（n~480）将被诊断不足或治疗不足， 这三个CV风险因素之一。未得到充分诊断或治疗的幸存者将被 有资格参加一项为期1年的随机对照试验，在该试验中，我们将测量 医学研究所（IOM）建议强调CV风险的个性化生存护理计划（SCP）， 辅以远程提供的临床医生主导的自我管理咨询干预，以改善 控制这三种CV风险因素（即，降低治疗不足的高血压、血脂异常的发生率， 糖尿病）。随机分配到对照组的幸存者可以延迟接受干预。最后我们 该提案旨在更好地了解幸存者及其初级保健提供者之间的障碍， 导致CV风险因素治疗不足。从本研究中获得的知识将改善评估 以及在该高风险人群中治疗重要的CV风险因素。拟议的干预如果成功， 将是可传播的和低成本的，并将有可能改善健康和降低死亡率，在这些 年轻的成年人，大部分时间都是癌症幸存者，严重CV疾病的风险增加。