Optimizing Treatment of Rectal Cancer Using a Markov Decision Model

描述（由申请人提供）：本项目提出了一个指导研究计划，以开发乔治J.张，医学博士。成为一个独立的临床医生，科学家专门从事癌症相关的卫生服务研究，汇集癌症流行病学，结果评估和临床决策分析，以改善结肠癌和直肠癌的治疗，并预防和控制癌症治疗相关的发病率。Chang博士是一名外科医生，拥有普通外科和结肠直肠外科的双重认证，并在本提案主题方面具有临床专业知识。职业发展计划包括教学教育，包括临床研究理学硕士学位，基础广泛的体验式学习计划和指导研究经验，指导研究将在由Scott B组成的导师委员会的指导下进行。康托博士，生物统计学教授M。D.安德森癌症中心和医疗决策协会的前任主席;泰森医学博士M.P.H.德克萨斯大学健康科学中心儿科教授兼临床研究和循证医学中心主任;和J. Robert Beck，医学博士，福克斯大通癌症中心高级副总裁兼首席学术官将担任场外导师和委员会成员。拟议的研究重点是通过开发用于治疗直肠癌患者的毒性最小化和生活质量保护策略来应用癌症控制。直肠癌是一种常见的疾病，目前的治疗非常有效，但可能与治疗相关毒性的高发生率相关，患者的生活质量和社会成本显着。不幸的是，最近所有基于美国调查的传统临床试验的尝试都失败了。这项研究将使用成熟的先进建模技术和患者偏好研究来进行虚拟随机对照临床试验，以确定毒性最小，临床上最有效的治疗策略或每年受这种常见癌症影响的数万名患者。相关性：目前的直肠癌治疗策略没有考虑到诊断和治疗的进展，也没有考虑到影响结果的各种患者相关差异。该提案将有助于改善直肠癌患者术前放化疗的选择，以减少患者的慢性毒性，医生将有证据作为治疗建议的基础，社会将负担更少的治疗和毒性相关费用。

DESCRIPTION (provided by applicant): This project proposes a mentored research program to develop George J. Chang, M.D. into an independent clinician-scientist specializing in cancer-related health services research that brings together cancer epidemiology, outcomes evaluation, and clinical decision analysis in order to improve the treatment of colon and rectal cancer and to prevent and control cancer treatment related morbidities. Dr. Chang is a surgeon with dual board certifications in General Surgery and Colon and Rectal Surgery and a clinical expertise in the subject of this proposal. The career development plan consists of didactic education including a Master of Science degree in Clinical Research, a broad-based experiential learning program, and a mentored research experience, Mentored research will be conducted under the direction of the mentorship committee composed of Scott B. Cantor, Ph.D., Professor of Biostatistics at M. D. Anderson Cancer Center and past-president of the Society for Medical Decision Making; Jon E. Tyson, M.D., M.P.H., Professor of Pediatrics and Director of the Center for Clinical Research and Evidence-Based Medicine, University of Texas Health Sciences Center; and J. Robert Beck, M.D., Senior Vice President and Chief Academic Officer, Fox Chase Cancer Center will serve as an off-site mentor and committee member. The proposed research focuses on applied cancer control by developing toxicity minimized and quality-of-life preserving strategies for the treatment of patients with rectal cancer. Rectal cancer is a common disease for which the current treatment is highly effective but can be associated with high rates of treatment-related toxicity with significant patient quality-of-life and societal costs. Unfortunately, all recent attempts at traditional clinical trials based on investigation within the United States have; failed. The proposed research will use well-established advanced modeling techniques and patient preferences research to perform a virtual randomized controlled clinical trial to determine the least toxic and most clinically effective treatment strategies or the tens of thousands of patients affected by this common cancer each year. RELEVANCE: Current treatment strategies for rectal cancer do not account for advances in diagnosis and treatment or for the wide variety of patient related differences that affect outcomes. This proposal will help improve the selection of patients with rectal cancer for preoperative chemoradiotherapy in order that patients will experience less chronic toxicity, physicians will have evidence on which to base treatment recommendations, and society will encumber fewer treatment and toxicity related costs.