Life and Longevity After Cancer (LILAC): The Women's Health Initiative Cancer Survivor Cohort

总结/摘要 美国有1600万癌症幸存者，其中约60%年龄在65岁及以上。 据估计，到2040年，癌症幸存者的数量将增长到2600万，其中73%的年龄在65岁及以上。 将近50%的人年龄在75岁以上。尽管有所谓的老年癌症幸存者的银海啸， 关于癌症和癌症治疗如何影响衰老过程的重大知识差距。有 由于老年人癌症的流行， 合并症、功能丧失、认知障碍和虚弱，尤其是年龄≥ 75岁的患者， 实际上没有任何数据。需要进行研究以更好地了解癌症及其治疗如何与 潜在的脆弱性，这反过来又影响了干预措施的可行性，安全性和有效性， 人口癌症后的生活和长寿（LILAC）项目是一个癌症幸存者队列， 妇女健康倡议，以支持老年人癌症生存率的研究。在初始 在资助期间，我们开发了13，453名WHI癌症幸存者的LILAC队列，他们被诊断患有一种 八种LILAC指定的癌症：浸润性乳腺癌、结直肠癌、子宫内膜癌、黑色素瘤、白血病、肺癌， 淋巴瘤黑色素瘤或卵巢癌我们收集了第一个疗程的信息，临床和患者 报告的结果，以及来自4351个实体瘤的存档组织。至少有20年的数据 这些妇女和目前的年龄范围为70至101岁，LILAC人口准备提供关键的 关于癌症和衰老的信息，以推进我们的癌症和衰老研究议程。为了实现这一目标，我们 建议通过若干机制加强LILAC资源，以支持对 新出现的问题。具体来说，我们建议：1）填补关于自我报告的知识的关键空白 老年女性癌症幸存者的身体、心理和社会健康，继续招募新诊断的癌症患者， 幸存者（N=2685），并遵循LILAC队列; 2）制定分析框架，以评估 老化，包括WHI/LILAC数据库中的加速老化表型; 3）建立年龄组- 将WHI参与者与保持无癌症的类似数据相匹配，以帮助我们了解 癌症的诊断和治疗对衰老的轨迹，加速老化表型和年龄， 相关合并症; 4）获得基于性能的身体功能和新的后治疗措施 血液样本，以评估加速老化的潜在生物标志物;和5）最大限度地利用和影响 这个资源。鉴于美国人口老龄化，癌症幸存者人数的增加和 癌症和衰老之间的联系，这些对LILAC基础设施的战略性和及时的投资将 帮助填补了许多关键的研究空白。

SUMMARY/ABSTRACT There are 16 million cancer survivors in the United States, and approximately 60% are age 65 years and over. By 2040, it is estimated that the number of cancer survivors will grow to 26 million with 73% age 65 and older and almost 50% age 75 and older. Despite this so-called silver tsunami of older cancer survivors, there are significant knowledge gaps regarding how cancer and cancer treatment impacts the aging process. There is also a growing consensus regarding the need for studies of cancer in older adults because of the prevalence of comorbidities, functional losses, cognitive impairment, and frailty, and particularly for those age ≥ 75 for whom there are virtually no data. Studies are needed to better understand how cancer and its treatment interact with underlying vulnerabilities, which in turn impacts the feasibility, safety, and efficacy of interventions in this population. The Life and Longevity After Cancer (LILAC) project is a cancer survivor cohort embedded within the Women’s Health Initiative to support studies of cancer survivorship in an aging population. During the initial funding period, we developed the LILAC cohort of 13,453 WHI cancer survivors who were diagnosed with one of eight LILAC designated cancers: invasive breast, colorectal, endometrial, melanoma, leukemia, lung, lymphoma, melanoma, or ovarian. We collected information on first course of treatment, clinical and patient reported outcomes, as well as archival tissue from 4351 solid tumors. With a minimum of 20 years of data on these women and a current age-range of 70 to101 years, the LILAC population is poised to provide key information on cancer and aging to advance our cancer and aging research agenda. To accomplish this we propose to enhance the LILAC resource through several mechanisms designed to support analyses of emerging questions. Specifically, we propose: 1) To fill critical gaps in knowledge regarding the self-reported physical, mental and social health of older female cancer survivors by continuing to enroll newly diagnosed survivors (N=2685) and follow the LILAC cohort; 2) To develop the analytic framework to assess trajectories of aging, including an accelerated aging phenotype in the WHI/LILAC database; 3) To establish cohorts of age- matched WHI participants with similar data who have remained cancer free, to help us understand the diagnosis of cancer and its treatment on the trajectories of aging, the accelerated aging phenotype and age- related comorbidities; 4) To obtain performance-based measures of physical function and new post-treatment blood samples to assess potential biomarkers of accelerated aging; and 5) To maximize the use and impact of this resource. Given the aging of the US population, the increase in the number of cancer survivors and the association between cancer and aging, these strategic and timely investments in the LILAC infrastructure will help to fill many of these critical research gaps.