The Fibrosis-Lymphedema Continuum in Head and Neck Cancer

头颈癌的纤维化-淋巴水肿连续体

• 批准号: 8098131
• 负责人: Barbara A. Murphy
• 金额: $ 60.81万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8098131
• 关键词: Activities of Daily Living; Acute; Address; Adverse effects; Advocate; Affect; Aftercare; Age; Alcohols; Anti-Inflammatory Agents; Area; Biologic Characteristic; Biological; Breast; Cancer Patient; Cancer Survivor; Characteristics; Chronic; Clinical; Codon Nucleotides; Collection; Combined Modality Therapy; Consensus; Data; Data Collection; Deglutition; Development; Diagnosis; Disease; Dose; Economic Burden; Edema; Electromagnetic Energy; Evaluation; Fibrosis; Future; Gelatinase A; Gelatinase B; Gender; Genetic Polymorphism; Goals; Hardness; Head and Neck Cancer; Head and neck structure; Health Personnel; Health Professional; Healthcare Systems; Impairment; Incidence; Inflammation; Inflammatory; Inflammatory Response; Intervention; Late Effects; Life; Liquid substance; Long-Term Survivors; Lymphedema; Malignant Neoplasms; Malignant neoplasm of prostate; Measures; Mental Depression; Methods; Modeling; National Cancer Institute; Nature; Neck; Operative Surgical Procedures; Ovarian; Pathway interactions; Patients; Pattern; Physicians; Physiological; Plague; Play; Population; Predictive Factor; Prevalence; Preventive; Process; Proteins; Quality of life; Radiation; Radiosurgery; Recommendation; Recording of previous events; Recovery; Research; Research Personnel; Research Support; Risk; Risk Factors; Role; Secondary to; Severities; Shoulder; Site; Speech; Strategic Planning; Structure; Survival Rate; Swelling; Symptoms; TNF gene; Time; Tissues; Tobacco use; Toxic effect; Treatment Efficacy; Treatment Factor; Treatment Protocols; Treatment outcome; Withdrawal; base; cancer therapy; chemotherapy; cytokine; experience; functional outcomes; head and neck cancer patient; high risk; improved; interstitial; melanoma; psychologic; psychosocial; public health relevance; response; social; stressor; survivorship; therapy design; tumor

DESCRIPTION (provided by applicant): Aggressive treatment for head and neck cancer (HNC) has improved survival rates. This improvement comes with a marked increase in acute and late-effects of treatment. [Late-effects may be secondary to treatment] (surgery, radiation, and chemotherapy) or effects of the tumor itself. They have a profound impact on [survivor's long-term symptom burden, functionality, and overall quality of life (QOL). Under- standing the mechanisms and manifestations of late-effects is critical to the design of interventions for improvement of quality of survivorship in HNC patients.] Fibrosis and lymphedema secondary to the stromal response to [tissue damage from tumor or treatment are understudied and poorly understood mechanisms that contribute to late-effects of therapy.] We hypothesize [that late-effect fibrosis and lymphedema represent inter-related processes that exist on biological and clinical continuums. Further- more, recent data indicates that both] fibrosis and lymphedema may be associated [with chronic] inflammation resulting in [an active, ongoing process. Thus, lymphedema and fibrosis may: develop after treatment is completed; progress over time; and be self perpetuating]. The National Cancer Institute's strategic plan addresses the need to "expand efforts to understand biologic, physical, psychological, and social mechanisms and their interactions that affect a cancer patient's response to disease, treatment, and recovery," and to "support research on the biologic and physiological mechanisms involved in adverse chronic and late-effects of both current and new cancer treatment." The objective of this longitudinal, descriptive study is to investigate the fibrosis/ lymphedema continuum [in HNC patients]. Specific Aims are to: 1) determine prevalence and nature of late-effect (e 3 months post-treatment) fibrosis and/or lymphe- dema in HNC patients; 2) explore relationships among biological mechanisms of inflammatory response, genetic polymorphisms, [treatment factors], and late-effect fibrosis and/or lymphedema in HNC patients; and 3) [explore relationships among late-effect fibrosis and/or lymphedema and psychosocial stressors (depression and social withdrawal) in HNC patients. Data collection, using select repeated measures, will take place at end of treatment, six week intervals after treatment through 48 weeks post-treatment, and 15 and 18 month intervals post-treatment.] Nagin's group-based trajectory modeling will be used to evaluate our findings. If the aims are achieved and information is disseminated, important new information will be available to: 1) [serve as underpinnings for future studies in other cancer populations at high risk for development of fibrosis and/or lymphedema, such as those with breast, ovarian, prostate cancers, and melanoma; 2) aid in development of predictive risk models; 3) stimulate new avenues of preventive. interventional research (e.g. anti-inflammatory agents);] and 4) assist physicians and other healthcare professionals to better diagnose, reduce risk for, and treat late-effect fibrosis and/or lymphedema. PUBLIC HEALTH RELEVANCE: Head and neck cancer patients are living longer, and many suffer hardness and swelling in the head and neck post-treatment. We do not know why some experience these problems and others do not. This study will provide information so healthcare providers can better treat these patients.

描述（由申请人提供）：针对头颈癌（HNC）的积极治疗提高了存活率。这种改进是急性和晚期治疗的明显增加。 [晚期作用可能是治疗的继发性]（手术，放射和化学疗法）或肿瘤本身的作用。他们对[幸存者的长期症状负担，功能和整体生活质量（QOL）产生了深远的影响。未经理解晚期作用的机制和表现对于改善HNC患者的生存质量的设计至关重要。在生物和临床连续体上存在的相关过程。更重要的是，最近的数据表明，纤维化和淋巴水肿可能与[慢性]炎症相关，从而导致[一个积极的，正在进行的过程。因此，淋巴水肿和纤维化可能：治疗完成后发展；随着时间的推移；并保持持久性]。国家癌症研究所的战略计划解决了“扩大努力，了解生物学，身体，心理和社会机制及其相互作用，影响癌症患者对疾病，治疗和康复的反应”，并“支持对涉及生物学和生理机制的研究，涉及涉及的生物学和生理机制，这些机制涉及当前和新癌症治疗的不良慢性和晚期治疗。”这项纵向，描述性研究的目的是研究纤维化/淋巴水肿连续体[HNC患者]。具体目的是：1）确定HNC患者的纤维化（治疗后3个月）纤维化和/或淋巴DEMA的患病率和性质； 2）探索HNC患者的炎症反应，遗传多态性，治疗因子]和晚期纤维化和/或淋巴水肿的生物学机制之间的关系；和3）[探索HNC患者的晚期效应纤维化和/或淋巴水肿和社会心理压力源（抑郁和社交戒断）之间的关系。数据收集（使用精选的重复措施）将在治疗结束时进行，治疗后48周后进行六周的间隔以及治疗后的15和18个月间隔。] Nagin的基于组的轨迹建模将用于评估我们的发现。如果实现了目标并传播信息，则可以使用重要的新信息：1）[作为对其他癌症人群的未来研究的基础，该研究具有纤维化和/或淋巴水肿的高风险，例如患有乳腺癌，卵巢癌，前列腺癌和黑色素瘤的基础； 2）帮助开发预测风险模型； 3）刺激预防性的新途径。介入研究（例如，抗炎药）；]和4）协助医师和其他医疗保健专业人员更好地诊断，降低患有晚期效应纤维化的风险和/或淋巴水肿。 公共卫生相关性：头颈癌患者的寿命更长，许多人在治疗后头和颈部遭受硬度和肿胀。我们不知道为什么有些人遇到这些问题，而另一些则没有。这项研究将提供信息，以便医疗保健提供者可以更好地治疗这些患者。