Commonly Used Medications and Risk of Colorectal Cancer Recurrence

描述(申请人提供)：目前，美国有超过120万人是结直肠癌(CRC)幸存者；每年又有14万美国人被诊断出患有这种疾病。因此，找到具有成本效益的方法来预防结直肠癌复发是一个重要的公共卫生目标。我们研究的长期目标是改善现实世界中癌症幸存者的健康，在现实世界中，人们患有慢性病，他们会服用处方药和非处方药。我们的目标与国家癌症研究所2012财年的年度计划和预算提案一致，该提案强调了对癌症患者多种慢性病进行研究的重要性。确诊时的中位年龄为70岁，结直肠癌往往发生在患有合并症的年龄段。在实验室、动物和流行病学研究中，针对这些疾病的药物治疗与结直肠癌风险有关。然而，令人惊讶的是，人们对常用的治疗糖尿病和高血压等慢性病的药物如何影响CRC复发风险知之甚少。因此，我们试图评估常用药物对结直肠癌复发的影响。我们的假设是，药物是可改变的危险因素，其中一些显示出作为化疗预防药物的前景，一些与CRC幸存者复发风险的增加有关。我们将通过两个集成的医疗保健提供系统中基于人群的回溯性队列研究来验证我们的假设。我们将确定1995-2014年间确诊的约3300例I-IIIA期结直肠癌。癌症复发--肿瘤登记中没有记录--将通过有针对性的病历审查来确定。通过依赖所有处方药物的数据库和审查非处方药的病历，这项研究将避免选择和回忆偏见。关于可能混淆分析的因素的高质量信息将从有针对性的图表审查、完整的自动化医疗计划数据和对最近诊断的患者的调查中有效地收集。将使用各种成熟的方法来控制生存分析中的混淆，以产生与普通药物相关的复发相对风险的估计。二次分析将侧重于无病存活率和全因死亡率。这项具有临床相关性的高影响研究的结果将帮助CRC幸存者及其提供者做出关于如何管理慢性病的循证决策。

DESCRIPTION (provided by applicant): Currently, more than 1,200,000 people in the United States are colorectal cancer (CRC) survivors; each year, 140,000 more Americans are diagnosed with the disease. Finding cost-effective ways to prevent CRC recurrence is therefore an important public health goal. The long-term objective of our research is to improve the health of cancer survivors in the real world, where people have chronic conditions for which they take prescription and over-the-counter medications. Our objective aligns with the National Cancer Institute's Annual Plan and Budget Proposal for Fiscal Year 2012, which highlights the importance of research on multiple chronic conditions in cancer patients. With a median age at diagnosis of 70 years, CRC tends to occur in an age group burdened with comorbidities. Medications for these conditions are linked to CRC risk in laboratory, animal, and epidemiologic studies. However, surprisingly little is known about how medications commonly used to treat prevalent chronic conditions, such as diabetes and hypertension, affect CRC recurrence risk. Therefore, we seek to evaluate the influence of commonly used medications on CRC recurrence. Our hypothesis is that medications are modifiable risk factors, with some showing promise as chemo preventive agents and some associated with an increased risk of recurrence in CRC survivors. We will test our hypotheses through a retrospective population-based cohort study in two integrated healthcare delivery systems. We will identify approximately 3300 incident stage I-IIIA colorectal cancers diagnosed from 1995- 2014. Cancer recurrence-which is not documented in tumor registries-will be ascertained from targeted medical chart review. By relying on a database of all dispensed medications and reviewing medical charts for over-the-counter medications, the study will avoid selection and recall bias. High-quality information on factors that might confound analyses will be efficiently collected from targeted chart review, complete automated health plan data, and surveys of recently diagnosed patients. A variety of well-established methods will be used to control for confounding in survival analysis to produce estimates of the relative risk of recurrence associated with common medications. Secondary analyses will focus on disease-free survival and all-cause mortality. The results from this clinically relevant, high-impact study will help CRC survivors and their providers make evidence-based decisions about how to manage chronic conditions.