Survivorship: Mentoring and Bridging Primary Care and Oncology

生存：初级保健和肿瘤学的指导和桥梁

• 批准号: 8165534
• 负责人: Kevin Charles Oeffinger
• 金额: $ 16.43万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-05 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8165534
• 关键词: Adherence; Adult; African American; Age; Age-Years; Area; Asians; Cancer Center; Cancer Control; Cancer Survivor; Cancer Survivorship; Cardiovascular Diseases; Caring; Chest; Childhood; Childhood Cancer Survivor Study; Chronic; Cisplatin; Client satisfaction; Clinical; Collaborations; Colorectal Cancer; Communication; Communities; Consensus; Data; Data Set; Disadvantaged; Education; Enrollment; Face; Feasibility Studies; Female; Focus Groups; Functional disorder; Funding; Future; Goals; Grant; Group Interviews; Guidelines; Health; Healthcare; Hodgkin Disease; Immigrant; Incidence; Institute of Medicine (U.S.); Insulin Resistance; Intervention; Intervention Trial; Interview; Late Effects; Latina; Life; Long-Term Survivors; Malignant Childhood Neoplasm; Malignant Neoplasms; Measurement; Mediastinal; Medical; Memorial Sloan-Kettering Cancer Center; Mentors; Methods; Minority Groups; Modeling; Morbidity - disease rate; New York City; Oncologist; Outcome; Outcome Measure; Outpatients; Participant; Patient Care Planning; Physicians; Population; Premature Mortality; Primary Care Physician; Primary Health Care; Primary Nursing Care; Radiation; Recording of previous events; Relative (related person); Reporting; Research; Research Personnel; Resources; Risk; Risk Reduction; Sampling; Services; Severities; Societies; Staging; Strategic Planning; Study models; Survival Rate; Survivors; Target Populations; Testing; United States; Update; Woman; Work; base; cancer health disparity; cancer risk; cancer therapy; career; childhood cancer survivor; cohort; design; ethnic minority population; experience; follow-up; health disparity; improved; irradiation; leukemia/lymphoma; malignant breast neoplasm; meetings; oncology; research study; socioeconomics; survivorship; usability; young adult

DESCRIPTION (provided by applicant): Five-year survival rates for pediatric and adult cancer are 81.5% and 66%, respectively. Currently in the United States, there are over 12 million cancer survivors, representing about 3.8% of the population. Importantly, many of these survivors face a significantly increased risk of late occurring serious morbidity or premature mortality. Fortunately, the incidence and severity of many late effects of therapy can be reduced with cancer control strategies. Based upon the evidence of the long-term health risks of cancer survivors and the potential to modify these outcomes, the authors of the two survivorship-focused Institute of Medicine reports recommend lifelong medical care for all cancer survivors. The goals of my research are to reduce premature mortality and serious morbidity associated with common late effects, in particular radiation-induced breast cancer, and to improve the quality of risk-based survivorship health care. Two studies are proposed. Study 1. Promoting breast cancer surveillance and reducing health disparities among female Hodgkin lymphoma survivors treated for a pediatric or young adult cancer with chest radiation. Project 1 - Characterizing Risk Using the updated 2008 Childhood Cancer Survivor Study (CCSS) second malignant neoplasm dataset, we aim to 1) estimate the standardized incidence ratio (SIR) and the absolute excess risk (AER) of breast cancer in women who were treated with chest radiation for a pediatric malignancy relative to the general US population and 2) describe the cumulative incidence of breast cancer in this population as a function of the number of years post radiation exposure and of attained age. Project 2 - Communicating Risk Among female Hodgkin lymphoma survivors, ages 25-49 years, with a history of chest radiation, and seen in the MSKCC outpatient setting, we will conduct in-depth interviews (N=20 or saturation of themes) to evaluate the usability and acceptability of the EMPOWER Education Toolkit for communicating breast cancer risk in the clinical setting. Project 3 - Barriers to Risk Reduction Among Ethnic Minorities Identify potentially eligible, ethnic minority female Hodgkin lymphoma survivors living in the New York City area for a future intervention trial aimed at increasing breast cancer surveillance rates. We will work with cancer centers, community-based oncologists in the New York City area, the local chapter of the Leukemia & Lymphoma Society and through collaboration with the MSKCC Immigrant Health and Cancer Disparities Service. From a sample of women in this eligible pool, characterize the barriers and facilitators to breast cancer surveillance through qualitative study using in-depth interviews (N=10) followed by focus group interviews (N=3 groups: African American, Latina, and Asian). Study 2. Bridging Primary Care and Oncology and the Shared Care Model Project 4 - Predicting Risk Using CCSS data, develop and validate a risk-prediction model to predict the likelihood of serious health condition by treatment exposure among long-term survivors of childhood cancer. Project 5 - Risk-Based Transition of Care Conduct a 12-month feasibility study to (1) determine the proportion of eligible survivors and PCPs who will: (a) enroll and (b) complete the baseline and 12-month measurements; (2) estimate resources needed by MSKCC to conduct the study; (3) test usability and refine outcome measurements. The target populations are early stage breast cancer survivors (N=341) at MSKCC being transitioned to PCPs (N=20) at two community-based groups. Outcome measures will include adherence to follow-up guidelines, participant satisfaction (patient, PCP), and understanding/clarity/utility of the MSKCC Survivorship Care Plan (patient, PCP). Project 6 Consensus-Building on Survivorship Care The three aims of this project are to: (1) obtain funding for a 2-day summit meeting of key stakeholders focused on the delivery of survivorship care; (2) convene the meeting; and (3) develop a strategic plan for transitioning survivors to primary care physicians. The key stakeholders will be national and community leaders in oncology, primary care, nursing, payers, and cancer survivors. Mentoring Plan: In addition, in the proposed K05 grant, I will mentor five early career investigators who are investigating: methods to reduce health disparities of socioeconomically disadvantaged ethnic minority women who have breast cancer and subsequently experience delays in returning to work; cisplatin-related endothelial dysfunction; cardiovascular disease following mediastinal irradiation; colorectal and breast cancer survivorship care plans; and mechanisms leading to insulin resistance following cancer therapy. PUBLIC HEALTH RELEVANCE: This study is focused on improving outcomes of cancer survivors. The goals are to systematically mentor early career investigators studying survivorship outcomes and conduct two research studies aimed at: (1) promoting breast cancer surveillance and reducing health disparities among female Hodgkin lymphoma survivors treated for a pediatric or young adult cancer with chest radiation; and (2) bridging primary care and oncology and promoting the shared care model.

描述（由申请人提供）：儿童和成人癌症的五年生存率分别为81.5%和66%。目前在美国，有超过1200万癌症幸存者，约占人口的3.8%。重要的是，这些幸存者中的许多人面临着后期发生严重发病或过早死亡的显著增加的风险。幸运的是，癌症控制策略可以降低许多治疗晚期效应的发生率和严重程度。基于癌症幸存者长期健康风险的证据以及改变这些结果的可能性，两份以生存为重点的医学研究所报告的作者建议为所有癌症幸存者提供终身医疗保健。我的研究的目标是减少过早死亡率和严重的发病率与常见的晚期效应，特别是辐射引起的乳腺癌，并提高基于风险的生存保健的质量。提出了两项研究。 研究1.促进乳腺癌监测和减少女性霍奇金淋巴瘤幸存者接受胸部放射治疗的儿童或年轻成人癌症的健康差异。 项目1 -风险特征 使用更新的2008年儿童癌症幸存者研究（CCSS）第二个恶性肿瘤数据集，我们的目标是：1）估计相对于美国普通人群，接受胸部放疗治疗儿童恶性肿瘤的女性乳腺癌的标准化发病率比（SIR）和绝对超额风险（AER）; 2）描述这一人群中乳腺癌的累积发病率与辐射照射后年数和达到的年龄之间的函数关系。 项目2 -沟通风险 在女性霍奇金淋巴瘤幸存者中，年龄25-49岁，有胸部放疗史，在MSKCC门诊环境中看到，我们将进行深入访谈（N=20或主题饱和），以评估EMPOWER教育工具包在临床环境中传达乳腺癌风险的可用性和可接受性。 项目3 -减少少数族裔风险的障碍 确定潜在的合格，少数民族女性霍奇金淋巴瘤幸存者生活在纽约市地区的未来干预试验，旨在提高乳腺癌的监测率。我们将与癌症中心、纽约市地区的社区肿瘤学家、白血病和淋巴瘤协会的当地分会合作，并与MSKCC移民健康和癌症差异服务合作。从这个合格的池中的妇女样本，通过定性研究，使用深入访谈（N=10），然后焦点小组访谈（N=3组：非洲裔美国人，拉丁裔和亚洲人）的障碍和促进因素，以乳腺癌监测的特点。 研究2.连接初级保健和肿瘤学以及共享护理模式 项目4 -预测风险 使用CCSS数据，开发并验证风险预测模型，以预测儿童癌症长期幸存者因治疗暴露而出现严重健康状况的可能性。 项目5 -基于风险的护理过渡 进行为期12个月的可行性研究，以（1）确定符合条件的幸存者和PCP的比例，他们将：（a）入组并（B）完成基线和12个月的测量;（2）估计MSKCC进行研究所需的资源;（3）测试可用性并完善结局测量。目标人群是MSKCC的早期乳腺癌幸存者（N=341），在两个基于社区的组中过渡到PCP（N=20）。结局指标将包括对随访指南的依从性、参与者满意度（患者，PCP）和对MSKCC生存护理计划的理解/清晰度/实用性（患者，PCP）。 项目6：建立幸存者护理 该项目的三个目标是：（1）为为期两天的主要利益攸关方首脑会议筹集资金，重点是提供幸存者护理;（2）召开会议;（3）制定将幸存者过渡到初级保健医生的战略计划。主要利益相关者将是肿瘤学、初级保健、护理、支付者和癌症幸存者方面的国家和社区领导人。 指导计划：此外，在拟议的K 05补助金，我将指导五个早期职业调查谁正在调查：方法，以减少健康差距的社会经济地位不利的少数民族妇女谁有乳腺癌，随后经历延迟返回工作;顺铂相关的内皮功能障碍;心血管疾病后纵隔照射;结直肠癌和乳腺癌生存护理计划;以及癌症治疗后导致胰岛素抵抗的机制。 公共卫生相关性：这项研究的重点是改善癌症幸存者的预后。其目标是系统地指导研究生存结果的早期职业研究人员，并进行两项研究，旨在：（1）促进乳腺癌监测并减少接受胸部放射治疗的儿科或年轻成人癌症女性霍奇金淋巴瘤幸存者的健康差异;和（2）连接初级保健和肿瘤学并促进共享护理模式。