Symptom progress and adverse health outcomes in adult childhood cancer survivors

成年儿童癌症幸存者的症状进展和不良健康结果

• 批准号: 9024265
• 负责人: I-Chan Huang
• 金额: $ 23.31万
• 依托单位: ST. JUDE CHILDREN'S RESEARCH HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-12-01 至 2017-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9024265
• 关键词: Address; Adult; Affect; Age; Alkylating Agents; Anthracyclines; Anxiety; Back; Cancer Patient; Cancer Survivor; Cancer Survivorship; Cardiac; Cardiovascular system; Caring; Categories; Cessation of life; Child Psychology; Childhood Cancer Survivor Study; Chronic; Classification; Cohort Studies; Cranial Irradiation; Data; Development; Diagnosis; Emotional; Endocrine; Enrollment; Esthesia; Event; Foundations; Future; Goals; Head; Head and neck structure; Health; Heart Arrest; Hepatic; Incidence; Individual; Intervention; Knowledge; Late Effects; Lead; Life; Lung; Malignant Childhood Neoplasm; Malignant Neoplasms; Measurement; Medical; Mental Depression; Methodology; Methods; Morbidity - disease rate; Motor; Movement; Nature; Neck; Neurocognitive; Operative Surgical Procedures; Outcome; Pain; Participant; Patient Outcomes Assessments; Patient Self-Report; Play; Premature Mortality; Prevalence; Psychophysiologic Disorders; Quality of life; Radiation therapy; Reporting; Research; Research Personnel; Respiratory Signs and Symptoms; Risk; Role; Saint Jude Children' s Research Hospital; Sentinel; Severities; Siblings; Site; Survival Rate; Survivors; Symptoms; Therapeutic; Time; Translational Research; adverse outcome; associated symptom; base; cancer diagnosis; cancer therapy; chemotherapy; childhood cancer survivor; cohort; design; experience; follow-up; healthy aging; high risk; improved; mortality; neurosensory; persistent symptom; premature; prevent; prognostic value; psychosocial; public health relevance; reproductive; screening; skeletal; success; survivorship; symptom cluster; therapy design; urinary

 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.

 描述（由申请人提供）：儿童癌症幸存者容易受到治疗相关的晚期效应，包括身体和心理疾病，随后的恶性肿瘤和过早死亡。症状代表一个人的感知异常的身体，情绪，或心身状态是常见的晚期影响儿童癌症幸存者。幸存者通常会经历多种并发症状，称为症状群。虽然已经报道了儿童癌症幸存者的症状存在和生活质量差之间的关联，但尚不确定个体症状领域和集群是否随时间变化，以及个体症状领域和集群的变化是否与不良健康结果相关，包括慢性病和过早死亡。此外，很少有研究检查特定癌症治疗暴露（例如，颅照射、蒽环类药物和烷化剂）有助于 个体症状和症状群随时间的变化。 我们癌症生存护理的长期目标是识别重要症状，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。为实现这一目标，本研究提出了两个具体目标：1）调查个体症状域的存在（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）和儿童癌症成年幸存者中跨越25年的多个时间点的症状群，并研究症状群随时间的转变，和2）研究单个症状域和症状群对儿童癌症成年幸存者慢性疾病发展和过早死亡的预后价值。 拟议的研究将通过利用从儿童癌症幸存者研究参与者中收集的重复症状数据来克服先前研究的局限性，以阐明症状进展与死亡率和在圣裘德儿童研究医院的圣裘德终身队列研究（N>700）中基于风险的综合医学评估期间确定的慢性疾病相关的程度。我们将根据八个器官系统对慢性疾病进行分类：心血管、内分泌/生殖、肝脏、神经认知、神经感觉、骨骼、肺和泌尿系统。此外，我们将开发一种分类方法来识别基于八个单独症状域的症状群，并使用过渡分析方法来捕获症状群随时间的变化。我们的团队包括在患者报告的结果，症状测量，心理学，儿科/成人生存护理和转化科学研究方面具有专业知识的著名研究人员。