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: 8554994
• 负责人: Reshma Jagsi
• 金额: $ 29.01万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/8554994
• 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-making process.

对于患者及其临床医生而言，对乳腺癌的局部区域管理的个性化都是有挑战性的。引入和采用评估测试以告知乳腺癌管理的加速速度可能有助于个性化，但是这些测试的使用和影响模式尚未充分了解。标准治疗方法包括保存乳房的手术（BCS），具有全乳腺辐射与乳房切除术，在成熟的随机试验中已证明可以产生同等的临床结果。然而，现在患者还可以接受更具侵略性的方法，包括对侧预防性乳房切除术，或较低的侵略性方法，例如部分乳腺照射的BCS（PBI）或腋窝淋巴结清除术（ALND）的暂时性淋巴结清除术（ALND），用于有限的哨兵淋巴结活检。如果没有正在进行的基于人群的研究以跟踪和评估如何使用这些测试和治疗方法来更好地个性化的护理，则无法最大化乳腺癌局部区域管理方法的健康益处。当1）在临床适当的患者中排序评估测试时，可以在这种情况下实现个性化护理，2）治疗收据在很大程度上是由证据基于证据的临床指示驱动的，这些临床指示可以解决预期的无疾病和整体存活方面的预期益处，3）患者对这一过程感到满意，并将其偏好和价值观纳入决策。此处提出的项目是一项基于人群的研究，对新诊断为乳腺癌的患者，并向新泽西州和佐治亚州的SEER登记处报告。 AIM 1是检查诊断为乳腺癌的患者以及患者和临床医生的测试相关性的新评估测试（BRCA1/2突变的乳腺MRI和基因测试）。 AIM 2是检查对侧预防性乳房切除术，ALND和PBI的遗漏，以及这些新兴方法的摄取患者和临床医生的相关性，用于乳腺癌的局部区域管理。作为此目标的一部分，我们将评估新的评估测试对接收治疗的影响。 AIM 3是通过评估患者的测试信息的程度来探索决策的个性化。 和治疗，并对决策过程感到满意。