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，被诊断出患有癌症的儿童和青少年平均具有5年的5年生存率。然而， 早产心血管（CV）疾病已成为主要的非癌症病因 儿童癌症幸存者。我们现有的工作表明，传统的简历风险因素，例如高血压， 血脂异常，胰岛素抵抗/糖尿病仍然非常重要，通过（以协同方式）增加的风险 主要的简历事件，例如缺血性心脏病和心力衰竭。但是，现有的研究是 受到简历风险因素状态的错误分类（即，在自我报告或药物使用情况下定义时 一个人），包括两个诊断不足的问题（即存在这些风险因素但谁 不知道）和疾病控制的不确定性（即潜在治疗）。该建议将利用 儿童癌症幸存者研究最大，最有特征的儿童癌症幸存者队列 （CCSS; n = 24,466），一种由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 根据过去的癌症治疗暴露，选择患有严重心脏病风险的幸存者（n = 800）。 在这800个幸存者中，我们建议确定诊断不足和治疗不足的幅度 通过亲自（基于家庭的）测量值补充的高血压，血脂血症和糖尿病 记录评论。我们预测，大约60％的幸存者（N〜480）将被诊断或未治疗 尊重这三个简历危险因素之一。那些被诊断或未治疗的幸存者将是 有资格参加一项为期1年的随机对照试验，我们将衡量 医学研究所（IOM）建议的个性化生存护理计划（SCP）强调简历风险， 补充远程交付的临床医生主导的自我管理咨询干预措施，以改善 控制这三个CV风险因素（即降低缺乏治疗的高血压，血脂异常和 糖尿病）。随机分配到控制臂的幸存者可以延迟接受干预。最后，我们的 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CV风险因素不足。从这项研究中得出的知识将改善评估 以及在这个高风险人群中对重要简历危险因素的处理。拟议的干预措施，如果成功， 将是可观的和低成本的，并且有可能改善健康状况并减少死亡率 癌症幸存者的一生中大部分生活的年轻成年人会增加严重的简历疾病风险。