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.

抽象的 现在，被诊断患有癌症的儿童和青少年的五年生存率平均>80%。然而， 早发心血管（CV）疾病已成为导致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，传统的心血管危险因素，如高血压、 血脂异常、胰岛素抵抗/糖尿病仍然非常重要，因为（以协同方式）增加了以下风险： 主要心血管事件，如缺血性心脏病和心力衰竭。然而，现有的研究已 受到心血管危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来定义时） 单独），包括诊断不足的问题（即存在这些危险因素但未确诊的人） 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 世界上规模最大、特征最鲜明的儿童癌症幸存者队列——儿童癌症幸存者研究 （CCSS；n=24,466），NCI 资助的资源。我们将使用 CCSS 衍生的经过验证的风险预测算法来 根据过去的癌症治疗经历选择患有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 通过亲自（家庭）测量并辅以医疗手段来测量高血压、血脂异常和糖尿病 记录审核。我们预测大约 60% 的幸存者 (n~480) 将被诊断不足或治疗不足 关于这三个心血管风险因素之一。诊断不足或治疗不足的幸存者将被 有资格参加一项为期 1 年的随机对照试验，我们将在其中衡量一项药物的功效 医学研究所 (IOM) 推荐的个性化生存护理计划 (SCP) 强调心血管风险， 辅之以远程提供的临床医生主导的自我管理咨询干预，以改善 控制这三个心血管危险因素（即降低高血压、血脂异常和高血压治疗不足的发生率） 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，我们的 该提案旨在更好地了解幸存者及其主要医疗保健提供者之间的障碍 导致心血管危险因素治疗不足。从这项研究中获得的知识将改善评估 以及对这一高危人群中重要的心血管危险因素的治疗。拟议的干预措施如果成功的话 将可传播且成本低廉，并将有可能改善这些地区的健康状况并降低死亡率 大部分时间作为癌症幸存者的年轻人患严重心血管疾病的风险增加。