EMPOWER Study: Promoting BC Screening in Women Who Survived Childhood Cancer

项目总结 到50岁时，几乎三分之一因儿童癌症而接受胸部放射治疗的女性将 被诊断出患有乳腺癌。乳腺癌的早期发现与生存密切相关，而且 建议从25岁开始每年进行乳房核磁共振和乳房X光检查。不幸的是， 这些妇女中的绝大多数没有遵守建议的监测。放大了这个问题， 大多数儿童癌症幸存者不再在癌症中心接受跟踪，他们不知道自己的风险，而且 被初级保健提供者(PCP)跟踪，他们没有被告知建议的后续护理。 基于我们先前在Empower-I中的发现，我们现在提出Empower-II，一种三臂随机 扩展Empower-I干预的核心组成部分的对照试验(邮寄教育材料) 评价患者激活加和不加PCP激活对增加乳腺癌的作用 监视系统。我们建议随机选择291名年龄在25岁以上、有胸部病史的女性。 儿童癌症的放射治疗，没有乳腺癌病史，也没有乳房MRI和 前两年做过乳房X光检查。 主要结果是在12个月的研究期间获得乳房核磁共振和乳房X光检查。 我们将确定(1)基于智能手机的患者激活干预和 (2)与对照组相比，患者激活+PCP激活。次要目标包括探索缓和 以及预测监视完成、获得监视的时间和估计的中介因素 干预复制成本和干预产生的成本。 拟议的EMPOWER-II研究汇集了一个研究小组，具有必要的专业知识和 在生存研究、智能手机提供的干预方面的经验，以及 31-儿童癌症幸存者研究(CCSS)。值得注意的是，CCSS代表着最大的单一 在目标人群和基础设施中的妇女队列进行拟议的研究。结果来自 这一干预措施将对所有在年轻时接受胸部放射治疗的高危女性产生重要影响。 年龄。

PROJECT SUMMARY By age 50, almost one in three women, treated with chest radiation for a childhood cancer, will be diagnosed with breast cancer. Early detection of breast cancer is strongly associated with survival, and surveillance with annual breast MRI and mammography is recommended, starting at age 25. Unfortunately, the vast majority of these women are not adherent to the recommended surveillance. Magnifying this problem, most childhood cancer survivors are no longer followed at a cancer center, are unaware of their risks, and are being followed by primary care providers (PCPs) who are not informed about the recommended follow-up care. Based upon our prior findings in EMPOWER-I, we now propose EMPOWER-II, a 3-arm randomized controlled trial that extends the core component of the EMPOWER-I intervention (mailed educational materials) to evaluate the utility of patient activation with and without added PCP activation to increase breast cancer surveillance. We propose to randomize 291 women, who are at least 25 years of age, with a history of chest radiation for a childhood cancer, without a history of breast cancer, and without both a breast MRI and mammogram in the previous two years. The primary outcome is obtaining a breast MRI and mammogram during the 12-month study period. We will determine the comparative effectiveness of (1) a smartphone-based patient activation intervention and (2) patient activation plus PCP activation, compared to control. Secondary aims include exploring moderating and mediating factors that predict surveillance completion, timing of the obtained surveillance, and estimating the intervention replication costs and costs resulting from the intervention. The proposed EMPOWER-II study brings together a research team with the necessary expertise and experience in both survivorship research, smart-phone delivered interventions, and the unique resource of the 31-insitution Childhood Cancer Survivors Study (CCSS). Notably, the CCSS represents the single largest cohort of women in the target population and the infrastructure to conduct the proposed study. Results from this intervention will have important implications for all high-risk women treated with chest radiation at a young age.