Long-Term Breast Cancer Treatment Effects: Limb Volume Changes

描述(由申请人提供)：关于乳腺癌治疗和康复过程中后期出现的常见的生理、功能和心理影响的信息有限。这项拟议的研究将首先描述在一个以中西部农村为主的州，被诊断为乳腺癌的患者中早发和晚发淋巴水肿(LE)的发生率、患病率和相关症状，并在治疗前和治疗后3至7年内进行跟踪。我们建议在确诊后3至7年检查治疗后淋巴水肿对心理社会适应和功能健康状况的长期影响。这项前瞻性纵向研究的样本包括在手术前已经积累起来的乳腺癌幸存者(300人中的N=290人，即将完成早期的RO1研究)，他们将在确诊后再进行3到7年的跟踪调查。这项研究有一个主要目标(目标1)和三个次要目标(目标2.1、2.2和2.3)。这些包括：第一，(目标1)探索乳腺癌幸存者随时间(从基线到确诊后3至7年)：(A)肢体体积和肢体体积变化(LVC)，(B)与LE相关的症状，(C)解决问题和社会支持；(D)感知的应对有效性水平和管理LE症状的方法；以及(E)心理社会适应和功能健康状况的结果变量。此外，作为次要目标，我们建议探讨：(目标2.1)(A)感知应对有效性和管理LE症状的方式与(B)LVC及相关LE相关症状之间的关系；(目标2.2)上述治疗后变化(LVC、症状、感知应对有效性和管理症状的方式)与心理社会适应和功能健康状况的关系；(目标2.3)这些易感、中介和调节变量随时间对心理社会适应和功能健康状态的复杂交互作用。根据NIH的奖励，内部资金将支持招募和保留另外100名乳腺癌幸存者，并在确诊后3至7年内对其进行跟踪调查，使我们能够增加少数族裔的招募，并进行更复杂的亚组分析。这项纵向调查的结果将提供有关淋巴水肿的发生和发展及其在较长时间内对心理社会适应和功能健康状况的影响的开创性新信息。这些发现将成为针对乳腺癌幸存者的后续干预措施的设计和时间安排的基础，这些干预措施旨在降低LE风险，改善症状管理和总体生存生活质量。如果没有进一步的资金，在2006年4月30日之后，将失去这种长期后续行动的机会。

DESCRIPTION (provided by applicant): Limited information exists regarding the common physical, functional, and psychological effects that arise late in the course of breast cancer treatment and recovery. The proposed study will first describe the incidence, prevalence, and related symptoms of early- and late-onset Iymphedema (LE) among persons diagnosed with breast cancer and followed from pre- and post-op baseline through 3 to 7years after treatment in a predominantly rural Midwestern state. We propose to then examine the long-term effects of post-treatment lymphedema at 3 to 7 years after diagnosis on psychosocial adjustment and functional health status. The sample for this prospective longitudinal study includes breast cancer survivors, already accrued at pre-op (N=290 of 300, soon to be completing an earlier RO1 study), who will be followed an additional 3 to 7 years post-diagnosis. The study has one primary (Aim 1) and three secondary aims (Aims 2.1, 2.2, and 2.3). These include: First, (Aim 1) To explore in breast cancer survivors over time (from baseline through 3 to 7 yrs after diagnosis): (a) limb volume and limb volume changes (LVC), (b) associated LE-related symptoms, (c) problem solving and social support; (d) levels of perceived coping effectiveness and ways of managing LE symptoms; and (e) the outcome variables of psychosocial adjustment and functional health status. Further, as secondary aims, we propose to explore: (Aim 2.1) associations among (a) perceived coping effectiveness and ways of managing LE symptoms with (b) LVC and associated LE-related symptoms; (Aim 2.2) associations of the above-mentioned post-treatment changes (LVC, symptoms, perceived coping effectiveness, and ways of managing symptoms) on psychosocial adjustment and functional health status; and (Aim 2.3) the complex interactions of these predisposing, mediating, and moderating variables on psychosocial adjustment and functional health status over time. Internal funding, contingent upon the NIH award, will support the recruitment and retention of an additional 100 breast cancer survivors to be followed 3 to 7 years post-diagnosis, enabling us to increase minority recruitment and to carry out more sophisticated subgroup analysis. Results of this longitudinal investigation will provide ground-breaking new information about the onset and progression of lymphedema and their impact on psychosocial adjustment and functional health status over an extended time. These findings will form the basis for design and timing of subsequent interventions with breast cancer survivors aimed at reducing LE risk and improving symptom management and overall survivorship quality of life. Without further funding, after April 30, 2006, this opportunity for long-term follow-up will be lost.