Treatment Modifications, Outcomes and Provider Decision Making in the Management of Subsequent Breast Cancers Among Survivors of Childhood Cancer

项目摘要 儿童癌症的幸存者面临着最初癌症治疗的多种后遗症。最难的一件事 随之而来的是后续肿瘤的发生。继发性乳腺癌是第二大癌症。 最常见的是继发性肿瘤，仅次于非黑色素瘤皮肤癌。虽然 幸存者中继发乳腺癌的风险和风险因素已经得到了很大的关注，有 关于这些疾病的治疗、治疗相关毒性、存活率和医生决策的数据有限 挑战后续的肿瘤。儿童癌症的幸存者此前曾接受过治疗， 包括放射和/或蒽环类化疗，这可能会限制他们安全接受 标准护理乳腺癌治疗。这项研究的总体目标将是：1)量化总体和 继发乳腺癌的儿童癌症长期幸存者的无事件生存率 与地理上不同、年龄、种族和民族、乳腺癌分期和治疗时代相比- 具有相似乳腺癌特征的匹配女性队列，以及她们的总存活率与 SEER生存估计；2)描述儿童癌症幸存者如何发展为随后的乳房 癌症是医学管理的，治疗如何与同期治疗的、年龄、种族和 种族、乳腺癌分期和治疗时代匹配的匹配比较队列和当代 国家癌症综合网络治疗指南，并描述与治疗相关的毒性 对继发乳腺癌的幸存者进行比较，并与匹配的比较进行毒性比较 3)描述乳腺癌的治疗决定是如何 通过半结构化访谈和调查，在内科和放射肿瘤学家中进行了调查。这个项目 将提供必要的数据，以改善这一日益增长的高危和脆弱人口的健康结果 儿童癌症的幸存者。了解决策的驱动因素，了解女性在决策过程中 乳腺癌得到了治疗，她们的预后如何与其他患有乳腺癌的女性进行比较将起到指导作用 教育干预和为患有后继乳房的妇女制定治疗指南 癌症。通过完成本提案中的目标而发展起来的复杂流行病学方面的技能 研究设计、定性方法和混合方法研究方法，以及研究领导力，将奠定基础。 用于领先的新颖和高影响力的生存研究。该项目将作为一个过渡点，从工作 作为一名独立研究人员的指导内科科学家，如计划中的R01所示 在本研究的最后一年提交。

Project Summary Survivors of childhood cancers face multiple late effects of their initial cancer therapy. One of the most difficult and consequential is the occurrence of a subsequent neoplasm. Subsequent breast cancers are the second most frequently observed subsequent neoplasm, exceeded only by non-melanoma skin cancers. Although much attention has been given to subsequent breast cancer risk and risk factors among survivors, there are limited data on treatment, treatment-related toxicities, survival and physician decision making for these challenging subsequent neoplasms. Survivors of childhood cancer have previously been exposed to therapies, including radiation and/or anthracycline chemotherapies, which may limit their ability to safely receive standard-of-care breast cancer therapy. The overall goals of this study will be: 1) to quantify how overall and event-free survival among long-term survivors of childhood cancer who develop a subsequent breast cancer compare to a geographically diverse, age-, race and ethnicity-,breast cancer stage-, and treatment era- matched cohort of women with similar breast cancer characteristics, and how their overall survival compares to SEER survival estimates; 2) to describe how survivors of childhood cancer who develop a subsequent breast cancer are medically managed and how treatment compares to a contemporarily-treated, age-, race and ethnicity-, breast cancer stage-, and treatment era-matched matched comparison cohort and to contemporary National Comprehensive Cancer Network treatment guidelines, and to describe treatment-related toxicities among survivors with subsequent breast cancer and compare the toxicity profile with a matched comparison cohort of women with primary breast cancer; and 3) to describe how breast cancer treatment decisions are made, through semi-structured interviews and surveys, among medical and radiation oncologists. This project will provide data necessary to improve health outcomes in this growing high-risk and vulnerable population of survivors of childhood cancer. Understanding the drivers of decision-making, the way women with subsequent breast cancers are treated, and how their outcomes compare to other women with breast cancer will guide educational interventions and the development of treatment guidelines for women with subsequent breast cancer. The skills developed through the completion of the aims in this proposal, in complex epidemiological study design, qualitative and mixed methods study methodology, and study leadership, will lay the groundwork for leading novel and high-impact survivorship studies. This project will serve as a transition point from working as a mentored physician scientist to an independent investigator, as demonstrated by a planned R01 submission during the final year of this study.