Individualization of Locoregional Management for Early-Stage Breast Cancer

早期乳腺癌局部区域管理的个体化

• 批准号: 8374168
• 负责人: Reshma Jagsi
• 金额: $ 32.97万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8374168
• 关键词: Address; Adoption; Age; Attitude; Axillary Lymph Node Dissection; BRCA1 gene; Breast; Breast Cancer Treatment; Breast-Conserving Surgery; Cancer Patient; Caring; Characteristics; Clinical; Communication; Contralateral; Data; Decision Making; Diagnosis; Disease; Ethnic Origin; Evaluation; Extranodal; Face; Family; Family history of; Genetic screening method; Health Benefit; Histology; Instruction; Intervention; Knowledge; Magnetic Resonance Imaging; Malignant Neoplasms; Mastectomy; Modeling; Mutation; Neoplasm Metastasis; New Jersey; Newly Diagnosed; Nodal; Operative Surgical Procedures; Outcome; Patients; Pattern; Process; Public Health; Quality of life; Radiation; Radiation therapy; Recording of previous events; Recurrence; Registries; Reporting; Research; Research Personnel; Role; Sentinel Lymph Node; Sentinel Lymph Node Biopsy; Socioeconomic Status; Staging; Surgeon; Surveys; Testing; cancer care; cancer type; clinical practice; evidence base; improved; irradiation; malignant breast neoplasm; population based; preference; prophylactic; randomized trial; satisfaction; standard care; treatment effect; uptake

Individualizing the locoregional management of breast cancer is challenging for both patients and their clinicians. The acceleratetd pace of introduction and adoption of evaluative tests to inform management of breast cancer may facilitate individualization, but the patterns of use and impact of these tests is not sufficiently understood. Standard treatments include breast conserving surgery (BCS) with whole breast radiation vs mastectomy, which have been shown to yield equivalent clinical outcomes in mature randomized trials. However, patients may now also receive more aggressive approaches, including contralateral prophylactic mastectomy, or less aggressive approaches, such as BCS with partial breast irradiation (PBI) or omission of axillary lymph node dissection (ALND) for limited metastases on sentinel node biopsy. The health benefits of the rapidly evolving approaches for breast cancer locoregional management cannot be maximized without ongoing population-based research to track and evaluate how these tests and treatments are used to better individualize care. Individualized care in this context is achieved when 1) evaluative tests are ordered in clinically appropriate patients, 2) treatment receipt is largely driven by evidence-based clinical indications that address expected benefit in terms of disease-free and overall survival, and 3) patients are informed, satisfied with the process, and their preferences and values are incorporated into decisions. The project proposed here is a population-based study of patients newly diagnosed with breast cancer and reported to the SEER registries of New Jersey and Georgia, as well as their surgeons. Aim 1 is to examine the use of newer evaluative tests (breast MRI and genetic testing for BRCA1/2 mutation) for patients diagnosed with breast cancer and the patient and clinician correlates of testing. Aim 2 is to examine the receipt of contralateral prophylactic mastectomy, omission of ALND, and PBI, and the patient and clinician correlates of uptake of these emerging approaches for locoregional management of breast cancer. As part of this aim, we will evaluate the effects of newer evaluative tests on receipt of treatments. Aim 3 is to explore the individualization of decision-making by evaluating the extent to which patients are informed about tests and treatments and are satisfied with the decision-makino process.

对患者及其临床医生来说，乳腺癌的个体化局部区域管理都是一项挑战。加快引入和采用评估测试以告知乳腺癌管理可能会促进个体化，但这些测试的使用模式和影响尚未得到充分了解。标准治疗包括保乳手术（BCS）加全乳放疗与乳房切除术，成熟的随机试验已证明这两种方法可产生相同的临床结果。然而，患者现在也可能接受更积极的方法，包括对侧预防性乳房切除术，或不太积极的方法，例如BCS联合部分乳房照射（PBI）或省略腋窝淋巴结清扫（ALND）以治疗前哨淋巴结活检中的有限转移。如果没有持续的基于人群的研究来跟踪和评估如何使用这些测试和治疗来更好地进行个体化护理，那么快速发展的乳腺癌局部区域管理方法的健康益处就无法最大化。在这种情况下，实现个体化护理的条件是：1) 在临床上适当的患者中进行评估测试，2) 治疗接受很大程度上是由基于证据的临床适应症驱动的，这些适应症解决了无病生存率和总生存率方面的预期益处，以及 3) 患者他们了解情况，对流程感到满意，并且他们的偏好和价值观被纳入决策中。这里提出的项目是一项基于人群的研究，对象是新诊断出的乳腺癌患者，并向新泽西州和佐治亚州的 SEER 登记处及其外科医生报告。目标 1 是检查新的评估测试（乳腺 MRI 和 BRCA1/2 突变基因测试）对诊断为乳腺癌的患者的使用情况，以及测试的患者和临床医生的相关性。目标 2 是检查对侧预防性乳房切除术、省略 ALND 和 PBI 的接受情况，以及患者和临床医生采用这些新兴乳腺癌局部区域管理方法的相关性。作为这一目标的一部分，我们将评估新的评估测试对接受治疗的影响。目标 3 是通过评估患者了解测试的程度来探索决策的个体化 和治疗并对决策过程感到满意。