PREDICTION AND OUTCOME MEASUREMENT IN CHILDHOOD CANCER

旨在解决临床问题的研究往往是有限的， 那些理解医学问题的人缺乏定量技能， 这是达成可衡量的解决方案所必需的。在本申请中，我 我建议利用我在卫生服务研究方面的博士培训， 以及我在儿科肿瘤学方面的知识， 儿童癌症的长期幸存者。患者结局测量 有关护理质量，经济理论和建模，统计学和 健康经济学是我博士课程的一部分， 用于改善和完善儿科肿瘤治疗。工作 本建议所述的三个连续步骤：（1） 预测：开发新的多变量模型并改进 其他的用来预测第二种癌症，心力衰竭，肺衰竭， 生长异常和生存率;（2）结果测量：发育和 改善量化健康状况（生活质量）的措施， 将生存作为儿童的合理目标， 恶性肿瘤，其中高“治愈”率现在已经实现;和93） 决策模型：具有改进的预测和测量;并利用 经济学和运筹学的数学工具， 优化治疗方案，最大限度地提高患者效用。 我计划开始一个学术生涯在儿科肿瘤学助理 加拿大多伦多大学医学院儿科教授 宾夕法尼亚州，一个理想的情况下，联合收割机我的训练， 临床肿瘤学与卫生服务研究。的成员 儿科肿瘤科一直是研究延迟 儿童癌症治疗的后果和庞大的患者人群 为研究多个变量提供了极好的资源。 其他特定项目的患者可从 儿童癌症研究小组，国家威尔姆斯;肿瘤研究和 迟效研究小组，因为这些合作小组的领导人是 教职员工。伦纳德戴维斯卫生经济研究所 与儿童医院保持密切联系，并将提供 一流的技术支持基础，以及一群激励人心的同行 对经济和统计模型感兴趣。

Research aimed at solving clinical problems often is limited because those who understand the medical questions lack the quantitative skills necessary to arrive at measurable solutions. In this application, i propose to utilize my doctoral training in health services research as well as my knowledge of pediatric oncology to solve problems related to long-term survivors of childhood cancer. Patient outcome measurement relating to quality of care, economic theory and modeling, statistics and health economics have been studied as part of my PH.D program and will be utilized to improve and refine pediatric oncology therapy. The work described in this proposal involves three sequential steps; (1) Prediction: develop new multivariate models and improve on those of others to predict second cancers, heart failure, pulmonary failure, growth abnormalities, and survival; (2)Outcome Measurement: develop and improve measures which quantify health status (quality of life) in order to supplement survival as a reasonable objective of children with malignancies in which high "cure" rates are now achieved; and 93) Decision Models: with improved prediction and measurement; and utilizing the mathematical tools of economics and operations research, to suggest refined therapeutic regimens which maximize patient utility. I plan to begin an academic career in Pediatric Oncology as an Assistant Professor of Pediatrics in the School of Medicine of the University of Pennsylvania, an ideal situation in which to combine my training in clinical oncology with health services research. The members of the Division of Pediatric Oncology have been pioneers in the study of delayed consequences of childhood cancer therapy and the large patient population provides an excellent resource for the study of multiple variables. Additional patients for specific projects are available from the children's Cancer Study Group, the National Wilms; tumor Study and the Late Effects Study Group, as leaders of these cooperative groups are faculty members. The Leonard Davis Institute of health Economics maintains very close ties with the Children;s Hospital and will provide a superb base of technical support as well as a stimulating group of peers interested in economic and statistical modelling.