A Phase III Randomized Trial Targeting Behavioral Symptoms in Younger Breast Cancer Survivors

项目摘要 乳腺癌是50岁以下女性最常见的癌症，占新发癌症的25%。 乳腺癌病例。乳腺癌诊断后生存率的提高将注意力集中在关键的 需要解决这种疾病及其治疗对年轻妇女长期结果的影响。这 已经成为一个越来越重要的癌症控制优先事项，包括联邦立法，重点是 45岁以下女性的独特需求。研究一直表明，年轻女性拥有更大的 乳腺癌后的心理和身体发病率高于老年妇女和年龄匹配的妇女， 癌症史，包括抑郁水平升高和其他行为症状（即，疲劳，睡眠 紊乱、血管炎症状），导致生活质量显著受损。行为增加 在这一人群中，诊断后10年内都有症状记录，这表明 如果不干预，可能无法补救。年轻的乳腺癌幸存者有长期不良反应的风险 影响，使他们成为特别脆弱的群体，对他们只有少数具体的干预措施， 测试.采用许多行为干预的主要障碍是缺乏转化研究 实施策略，因此这些干预措施未能成为一种标准的护理， 提供并偿还。为了应对这一挑战，我们将进行一项III期、三组、随机临床试验， 在三个地理上分开的NCI指定的综合癌症中心进行的试验，随机分配360名 年轻的治疗后乳腺癌幸存者，两个有前途的干预措施之一（生存教育 或正念意识实践），将每个人与通常的护理/等待名单对照组进行比较。我们假设 这两种干预方案都将有效地减少行为症状（抑郁症-原发性 结果;疲劳、睡眠障碍、血管扩张-次要结果）， 干预期间，与常规护理/等待名单对照组相比。此外，我们将研究 干预相对于对照组对炎症的循环和基因组标志物的功效， 假设正念干预会显著减少炎症标志物。最后我们 将探讨干预组干预效果的潜在调节因素。

PROJECT SUMMARY Breast cancer is the most common cancer in women younger than 50 years, accounting for up to 25% of new breast cancer cases. Improved survival after a breast cancer diagnosis has focused attention on the critical need to address the impact of the disease and its treatments on long-term outcomes in younger women. This has become an increasingly important cancer control priority, including federal legislation focusing on the unique needs of women <45 years old. Studies have consistently shown that younger women have greater psychological and physical morbidity after breast cancer than older women and age-matched women with no cancer history, including elevated levels of depression and other behavioral symptoms (i.e., fatigue, sleep disturbance, vasomotor symptoms) that cause significant impairment in quality of life. Increased behavioral symptoms have been documented up to 10 years after diagnosis in this population, suggesting that effects may not remediate without intervention. Younger breast cancer survivors are at risk for adverse long-term effects, making them a particularly vulnerable population, for whom only a few specific interventions have been tested. A major barrier to adoption of many behavioral interventions is the lack of a translational research implementation strategy, and thus these interventions fail to become a standard of care that is clinically provided and reimbursed. To meet this challenge, we will conduct a phase III, three-group, randomized clinical trial at three geographically separated NCI-designated comprehensive cancer centers, randomly assigning 360 younger post-treatment breast cancer survivors, to one of two promising interventions (survivorship education or mindful awareness practices), comparing each to a usual care/waitlist control group. We hypothesize that both of the intervention programs will be effective in reducing behavioral symptoms (depression - primary outcome; fatigue, sleep disturbance, vasomotor symptoms-secondary outcomes) over a 6 month post- intervention period, in comparison to the usual care/waitlist control group. Additionally, we will examine the efficacy of the interventions relative to the control group on circulating and genomic markers of inflammation, hypothesizing that the mindfulness intervention will significantly reduce markers of inflammation. Finally, we will explore potential moderators of intervention efficacy in the intervention groups.