Cancer Survival in WTC First Responders vs. Comparable Occupational Cohorts

项目摘要 我们最近发现，世界贸易中心（WTC）暴露的救援/恢复工作人员谁参加了 WTC健康计划（WTCHP）与 来自纽约州的人口统计学上相似的癌症患者。在所有患者中均观察到了这种生存获益- 原因死亡率和癌症特异性死亡率。此外，我们记录了这种益处， 与一般人群相比，癌症的发病率有所下降。的一部分 WTCHP，注册者免费接受医疗监测和癌症护理，包括治疗。我们 假设观察到的生存益处是由于这些抢救/恢复的护理水平 作为WTCHP的一部分。然而，我们不能排除救援/恢复的可能性， 在患癌症之前，工人比纽约州癌症患者的参考人群更健康 诊断并因此更可能具有有利的癌症结果（即，由于健康工人的影响）。 然而，未纳入WTCHP的暴露于WTC的补救/恢复未观察到生存获益- a 反对健康工人效应作为唯一因素的事实。现在，我们建议解决这个问题 知识差距，通过确定和量化观察到的生存效益的来源，使用 作为一个比较的职业适当的队列。目前提案的总体目标是调查 癌症存活率和存活率相关因素，如癌症特异性病理学和治疗开始， WTCHP响应者（消防员和警察）和非WTC暴露响应者（即，消防员和警察 谁满足类似的健康标准雇用作为WTC暴露的反应者），相互比较， 占领，以及美国的一般人口。该提案的结果有可能阐明 WTCHP医疗监测和治疗对癌症诊断后生存率的影响， 卫生保健提供系统。此外，虽然该项目的重点是世贸中心的反应，其结果可能有 对因职业原因接触环境污染物的工人产生更广泛的影响。

Project Summary We recently found that World Trade Center (WTC)-exposed rescue/recovery workers who participated in the WTC Health Program (WTCHP) experienced improved survival post-cancer diagnosis compared with demographically similar cancer patients from New York State. This survival benefit was observed in both all- cause mortality and cancer-specific mortality. Further, we documented this benefit both in cancers with elevated incidence and cancers with reduced incidence compared with the general population. As part of the WTCHP, enrollees receive medical monitoring and cancer care, including treatment, at no cost to them. We hypothesized that the observed survival benefit was due to the level of care that these rescue/recovery workers receive as part of the WTCHP. We could not rule out however, the possibility that rescue/recovery workers were healthier than the reference population of New York State cancer patients prior to cancer diagnosis and therefore more likely to have a favorable cancer outcome (i.e., due to the healthy worker effect). However, no survival benefit was observed for WTC-exposed rescue/recovery not enrolled in the WTCHP – a fact that argues against the healthy worker effect as the sole factor. Now, we propose to address this knowledge gap by identifying and quantifying the sources of the observed survival benefit using an occupationally appropriate cohort as a comparison. The overall goal of the current proposal is to investigate cancer survival and survival-related factors such as cancer-specific pathology and treatment initiation in WTCHP responders (firefighters and police) and non-WTC-exposed responders (i.e., firefighters and police who met similar health criteria for hiring as WTC-exposed responders), compared with each other, by occupation, and with the general US population. Results from this proposal have the potential to elucidate the impact of WTCHP medical monitoring and treatment on survival post-cancer diagnoses and to help inform health care delivery systems. Further, while the project is focused on WTC responders, its results could have broader implications for workers occupationally exposed to environmental contaminants.