Symptom progress and adverse health outcomes in adult childhood cancer survivors

 描述(由申请人提供)：儿童癌症幸存者容易受到与治疗相关的后遗症的影响，包括生理和心理社会发病率、随后的恶性肿瘤和过早死亡。代表一个人感知的身体、情绪或心身状态异常的症状是儿童癌症幸存者常见的后遗症。幸存者通常会出现多个同时出现的症状，称为症状群。尽管儿童癌症幸存者的症状存在与生活质量差之间的关系已有报道，但尚不确定单个症状域和簇是否会随着时间的推移而变化，以及单个症状域和簇的变化是否与包括慢性病和过早死亡在内的不良健康后果有关。此外，很少有研究考察特定的癌症治疗暴露(例如，头颅照射、蒽环类药物和烷化剂)是否起作用。 随着时间的推移，个体症状和症状群的变化。我们癌症幸存者护理的长期目标是识别重要的症状，以早期指示不良健康事件(例如，心脏骤停和过早死亡)，并设计针对症状的干预措施，以促进癌症幸存者的健康老龄化。为了实现这一目标，本研究提出了两个具体目标：1)调查成年儿童癌症幸存者在25年多个时间点上的个体症状域(感觉异常、运动/运动问题、心脏症状、肺部症状、疼痛、焦虑、抑郁和躯体化)和症状群的存在，以及症状群随时间的变化；2)调查个体症状域和症状群对儿童癌症成年幸存者慢性病和过早死亡的预后价值。这项拟议的研究将克服先前研究的局限性，利用从儿童癌症幸存者研究参与者那里收集的重复症状数据，阐明症状进展与死亡率和圣裘德儿童研究医院圣裘德终身队列研究(N&GT；700)基于风险的综合医学评估中确定的慢性病之间的关联程度。我们将根据八个器官系统对慢性疾病进行分组：心血管、内分泌/生殖、肝脏、神经认知、神经感觉、骨骼、肺和尿液类别。此外，我们将开发一种分类方法，基于八个单独的症状域来识别症状簇，并使用变迁分析方法来捕捉症状簇随时间的变化。我们的团队包括在患者报告结果、症状测量、心理学、儿科/成人生存护理和翻译科学研究方面拥有专业知识的知名研究人员。

 DESCRIPTION (provided by applicant): Childhood cancer survivors are vulnerable to treatment-related late effects, which include physical and psychosocial morbidity, subsequent malignancies, and premature death. Symptoms representing one's perceptive abnormal physical, emotional, or psychosomatic state are common late effects in childhood cancer survivors. Survivors often experience multiple, concurrent symptoms, known as a symptom cluster. Although the association between symptom presence and poor quality of life in childhood cancer survivors has been reported, it is uncertain whether individual symptom domains and clusters change over time, and whether the change in individual symptom domains and clusters are associated with adverse health outcomes, including chronic conditions and premature mortality. In addition, very few studies have examined if specific cancer therapeutic exposures (e.g., cranial irradiation, anthracyclines, and alkylating agents) contribute to the change in individual symptoms and symptom clusters over time. Our long-term goal of cancer survivorship care is to identify important symptoms for early indication of adverse health events (e.g., cardiac arrest and premature mortality), and to design interventions targeting at symptoms for promotion of healthy aging in cancer survivors. To achieve this goal, the current study proposes two specific aims: 1) to investigate the presence of individual symptom domains (sensation abnormality, motor/movement problems, cardiac symptoms, pulmonary symptom, pain, anxiety, depression, and somatization) and symptom clusters across multiple time points spanning 25 years in adult survivors of childhood cancers, and investigate the transition of symptom clusters over time, and 2) to investigate the prognostic value of individual symptom domains and symptom clusters for the development of chronic conditions and premature mortality in adult survivors of childhood cancers. The proposed study will overcome the limitations of previous research by utilizing repeated symptom data collected from participants in the Childhood Cancer Survivor Study to elucidate the extent to which symptom progress is associated with mortality and with chronic conditions identified during risk-based comprehensive medical assessment in the St. Jude Lifetime Cohort Study (N>700) at St. Jude Children's Research Hospital. We will group chronic conditions by eight organ systems: cardiovascular, endocrine/reproductive, hepatic, neurocognitive, neurosensory, skeletal, pulmonary, and urinary categories. In addition, we will develop a classification methodology to identify symptom clusters based on eight individual symptom domains, and use a transition analytic method to capture the change in symptom cluster over time. Our team includes renowned researchers with expertise in patient-reported outcomes, symptom measurement, psychology, pediatric/adult survivorship care, and translational science research.