The Challenge of Individualizing Treatments for Patients with Breast Cancer

描述（由申请人提供）：癌症治疗带来了巨大的负担和发病率，但不同策略的净生存效益往往很小，而且几乎总是不确定的。因此，如果治疗过于激进，临床医生可能弊大于利。有一些乳腺癌的管理策略，旨在减少不必要的发病率和对有利的疾病患者的负担。推进这些举措的一个关键障碍是需要更好地了解个体化癌症治疗的挑战。该计划的目标是通过帮助临床医生和他们的患者应对乳腺癌个体化治疗的挑战来改善人群健康，从而获得良好的预后。目的1：探讨女性乳腺癌个体化治疗的挑战。两个项目将分别对新诊断为乳腺癌的患者（包括其主治医生）进行一项观察性研究，这些患者在18个月期间向佐治亚州和新泽西州的SEER登记处报告，以检查与关键评估测试、治疗和患者对决策质量的评估相关的患者和临床医生因素。项目1将重点关注外科医生及其患者在局部治疗方面面临的挑战。项目2将重点关注肿瘤内科医生及其患者在系统治疗方面面临的挑战。目的2：提高治疗决策质量。项目3将对底特律和亚特兰大SEER地区新诊断为乳腺癌的患者进行基于实践的在线决策工具的随机对照试验，旨在提高决策质量。目的3：通过实施和评估针对P1和P2患者样本的所有外科医生和内科肿瘤学家的定制在线门户网站，加速基于seer的研究成果的传播，以评估我们的研究成果是否可以更直接、更及时地告知临床医生关于个体化治疗的知识和态度。目的4：推进以癌症护理质量为重点的SEER人群转化研究方法。我们提出了四个共享资源核心，将支持项目活动，推进肿瘤人口科学的创新方法，推进团队使命和长期战略规划。

DESCRIPTION (provided by applicant): Treatments for cancer impose substantial burden and morbidity but net survival benefit of different strategies is often small and virtually always uncertain. Thus, clinicians may do more harm than good if treatment is too aggressive. There are a number of management strategies for breast cancer aimed at reducing unnecessary morbidity and burden on patients with favorable disease. A key barrier to advancing these initiatives is the need for a better understanding of the challenges of individualizing cancer care The goal of this program is to improve population health by helping clinicians and their patients address the challenges of individualizing treatment of breast cancer for patients with favorable prognosis. Objective 1: To examine the challenges of individualizing treatment for women with breast cancer. Two projects will each undertake an observational study of patients newly diagnosed with breast cancer (including their attending clinicians) who were reported to the SEER registries of Georgia and New Jersey during an 18 month period to examine patient and clinician factors associated with key evaluative tests, treatments, and patient appraisal of decision quality. Project 1 will focus on challenges for surgeons and their patients with regard to locoregional therapy. Project 2 will focus on challenges for medical oncologists and their patients with regard to systemic therapy. Objective 2: To improve treatment decision quality. Project 3 will perform a randomized controlled trial of a practice based online decision tool for patients newly diagnosed with breast cancer in the Detroit and Atlanta SEER regions intended to improve decision quality. Objective 3: To accelerate the dissemination of SEER-based research findings by implementing and evaluating a tailored online portal aimed at all surgeons and medical oncologists who treated the patient samples in P1 and P2 to evaluate whether our research findings can more directly and promptly inform clinicians knowledge and attitudes about individualizing treatment. Objective 4: To advance methods in SEER population translational research focused on quality of cancer care. We propose four shared resource cores that will support program project activities, advance innovative methods in oncology population sciences, and advance team mission and long-term strategic planning.