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)接触过的救援/恢复人员参与了 与WTC Health Program(WTCHP)相比，WTCHP在癌症诊断后获得了更高的存活率 来自纽约州的人口统计相似的癌症患者。这一生存益处在所有人中都观察到了- 致死原因和癌症特有的死亡。此外，我们还记录了癌症患者的这种益处。 与普通人群相比，发病率上升和癌症发病率下降。作为该计划的一部分 WTCHP，参与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救援/恢复的护理水平 工人作为WTCHP的一部分获得。然而，我们不能排除救援/恢复的可能性 工作人员比纽约州癌症患者癌症前的参考人群更健康 因此，更有可能产生有利的癌症结果(即，由于健康工作者效应)。 然而，没有在WTCHP-a中登记的WTC暴露的救援/恢复没有观察到生存益处。 这一事实反对将健康工人效应作为唯一因素。现在，我们建议解决这个问题 通过确定和量化观察到的生存益处的来源，使用 作为比较，在职业上合适的队列。目前提案的总体目标是调查 癌症生存和生存相关因素，如癌症特异性病理和治疗启动 WTCHP响应者(消防员和警察)和未接触WTC的响应者(即消防员和警察 符合与WTC暴露的应答者相似的健康标准的人)，通过 占领，和普通的美国人。这项提议的结果有可能阐明 WTCHP医疗监测和治疗对癌症后生存诊断的影响和帮助提供信息 医疗保健提供系统。此外，虽然该项目的重点是世贸中心的响应者，但其结果可能会 对职业暴露于环境污染物的工人的更广泛的影响。

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.