Survivorship: Mentoring and Bridging Primary Care and Oncology

生存：初级保健和肿瘤学的指导和桥梁

基本信息

批准号：
8296531
负责人：
Kevin Charles Oeffinger
金额：
$ 16.43万
依托单位：
SLOAN-KETTERING INST CAN RESEARCH
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-07-05 至 2016-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8296531
关键词：
Adherence Adult African American Age Age-Years Area Asians Cancer Center Cancer Control Cancer Survivor Cancer Survivorship Cardiovascular Diseases Caring Chest Childhood Childhood Cancer Survivor Study Chronic Cisplatin Client satisfaction Clinical Collaborations Colorectal Cancer Communication Communities Consensus Data Data Set Disadvantaged Education Enrollment Face Feasibility Studies Female Focus Groups Functional disorder Funding Future Goals Grant Group Interviews Guidelines Health Healthcare Hodgkin Disease Immigrant Incidence Institute of Medicine (U.S.)Insulin Resistance Intervention Intervention Trial Interview Late Effects Latina Life Long-Term Survivors Malignant Childhood Neoplasm Malignant Neoplasms Measurement Mediastinal Medical Memorial Sloan-Kettering Cancer Center Mentors Methods Minority Groups Modeling Morbidity - disease rate New York City Oncologist Outcome Outcome Measure Outpatients Participant Patient Care Planning Physicians Population Premature Mortality Primary Care Physician Primary Health Care Primary Nursing Care Radiation Recording of previous events Relative (related person)Reporting Research Research Personnel Resources Risk Risk Reduction Sampling Services Severities Societies Staging Strategic Planning Study models Survival Rate Survivors Target Populations Testing United States Update Woman Work base cancer health disparity cancer risk cancer therapy career childhood cancer survivor cohort design ethnic minority population experience follow-up health disparity improved irradiation leukemia/lymphoma malignant breast neoplasm meetings oncology research study socioeconomics survivorship usability young adult

项目摘要

DESCRIPTION (provided by applicant): Five-year survival rates for pediatric and adult cancer are 81.5% and 66%, respectively. Currently in the United States, there are over 12 million cancer survivors, representing about 3.8% of the population. Importantly, many of these survivors face a significantly increased risk of late occurring serious morbidity or premature mortality. Fortunately, the incidence and severity of many late effects of therapy can be reduced with cancer control strategies. Based upon the evidence of the long-term health risks of cancer survivors and the potential to modify these outcomes, the authors of the two survivorship-focused Institute of Medicine reports recommend lifelong medical care for all cancer survivors. The goals of my research are to reduce premature mortality and serious morbidity associated with common late effects, in particular radiation-induced breast cancer, and to improve the quality of risk-based survivorship health care. Two studies are proposed. Study 1. Promoting breast cancer surveillance and reducing health disparities among female Hodgkin lymphoma survivors treated for a pediatric or young adult cancer with chest radiation. Project 1 - Characterizing Risk Using the updated 2008 Childhood Cancer Survivor Study (CCSS) second malignant neoplasm dataset, we aim to 1) estimate the standardized incidence ratio (SIR) and the absolute excess risk (AER) of breast cancer in women who were treated with chest radiation for a pediatric malignancy relative to the general US population and 2) describe the cumulative incidence of breast cancer in this population as a function of the number of years post radiation exposure and of attained age. Project 2 - Communicating Risk Among female Hodgkin lymphoma survivors, ages 25-49 years, with a history of chest radiation, and seen in the MSKCC outpatient setting, we will conduct in-depth interviews (N=20 or saturation of themes) to evaluate the usability and acceptability of the EMPOWER Education Toolkit for communicating breast cancer risk in the clinical setting. Project 3 - Barriers to Risk Reduction Among Ethnic Minorities Identify potentially eligible, ethnic minority female Hodgkin lymphoma survivors living in the New York City area for a future intervention trial aimed at increasing breast cancer surveillance rates. We will work with cancer centers, community-based oncologists in the New York City area, the local chapter of the Leukemia & Lymphoma Society and through collaboration with the MSKCC Immigrant Health and Cancer Disparities Service. From a sample of women in this eligible pool, characterize the barriers and facilitators to breast cancer surveillance through qualitative study using in-depth interviews (N=10) followed by focus group interviews (N=3 groups: African American, Latina, and Asian). Study 2. Bridging Primary Care and Oncology and the Shared Care Model Project 4 - Predicting Risk Using CCSS data, develop and validate a risk-prediction model to predict the likelihood of serious health condition by treatment exposure among long-term survivors of childhood cancer. Project 5 - Risk-Based Transition of Care Conduct a 12-month feasibility study to (1) determine the proportion of eligible survivors and PCPs who will: (a) enroll and (b) complete the baseline and 12-month measurements; (2) estimate resources needed by MSKCC to conduct the study; (3) test usability and refine outcome measurements. The target populations are early stage breast cancer survivors (N=341) at MSKCC being transitioned to PCPs (N=20) at two community-based groups. Outcome measures will include adherence to follow-up guidelines, participant satisfaction (patient, PCP), and understanding/clarity/utility of the MSKCC Survivorship Care Plan (patient, PCP). Project 6 Consensus-Building on Survivorship Care The three aims of this project are to: (1) obtain funding for a 2-day summit meeting of key stakeholders focused on the delivery of survivorship care; (2) convene the meeting; and (3) develop a strategic plan for transitioning survivors to primary care physicians. The key stakeholders will be national and community leaders in oncology, primary care, nursing, payers, and cancer survivors. Mentoring Plan: In addition, in the proposed K05 grant, I will mentor five early career investigators who are investigating: methods to reduce health disparities of socioeconomically disadvantaged ethnic minority women who have breast cancer and subsequently experience delays in returning to work; cisplatin-related endothelial dysfunction; cardiovascular disease following mediastinal irradiation; colorectal and breast cancer survivorship care plans; and mechanisms leading to insulin resistance following cancer therapy.

描述（由申请人提供）：儿童和成人癌症的五年生存率分别为 81.5% 和 66%。目前在美国，有超过1200万癌症幸存者，约占总人口的3.8%。重要的是，许多幸存者面临晚期严重发病或过早死亡的风险显着增加。幸运的是，通过癌症控制策略可以降低许多治疗晚期效应的发生率和严重程度。基于癌症幸存者长期健康风险的证据以及改变这些结果的潜力，两份以生存为重点的医学研究所报告的作者建议对所有癌症幸存者进行终身医疗护理。我的研究目标是减少与常见迟发效应（特别是辐射诱发的乳腺癌）相关的过早死亡和严重发病率，并提高基于风险的生存医疗保健的质量。提出了两项研究。研究 1. 促进乳腺癌监测并减少接受胸部放射治疗的儿童或青年癌症女性霍奇金淋巴瘤幸存者的健康差异。项目 1 - 描述风险使用更新的 2008 年儿童癌症幸存者研究 (CCSS) 第二个恶性肿瘤数据集，我们的目标是 1) 估计接受胸部放射治疗的女性乳腺癌的标准化发病率 (SIR) 和绝对超额风险 (AER)相对于美国普通人群的儿科恶性肿瘤，2) 描述了该人群中乳腺癌的累积发病率，作为辐射暴露后年数和达到年龄的函数。项目 2 - 沟通风险在女性霍奇金淋巴瘤幸存者中，年龄 25-49 岁，有胸部放射史，并在 MSKCC 门诊就诊，我们将进行深度访谈（N = 20 或主题饱和），以评估其可用性和可接受性用于在临床环境中传达乳腺癌风险的 EMPOWER 教育工具包。项目 3 - 减少少数民族风险的障碍确定居住在纽约市地区的潜在合格少数民族女性霍奇金淋巴瘤幸存者，进行未来旨在提高乳腺癌监测率的干预试验。我们将与纽约市地区的癌症中心、社区肿瘤学家、白血病和淋巴瘤协会当地分会合作，并与 MSKCC 移民健康和癌症差异服务机构合作。从符合资格的女性样本中，通过定性研究，使用深入访谈 (N=10) 和焦点小组访谈（N=3 组：非洲裔美国人、拉丁裔和亚洲人）来描述乳腺癌监测的障碍和促进因素）。研究 2：连接初级保健和肿瘤学以及共享护理模式项目 4 - 预测风险使用 CCSS 数据，开发并验证风险预测模型，以预测儿童癌症长期幸存者因接受治疗而出现严重健康状况的可能性。项目 5 - 基于风险的护理过渡进行为期 12 个月的可行性研究，以 (1) 确定符合资格的幸存者和 PCP 的比例，他们将：(a) 登记并 (b) 完成基线和 12 个月的测量； (2) 估计 MSKCC 开展研究所需的资源； (3) 测试可用性并完善结果测量。目标人群是 MSKCC 的早期乳腺癌幸存者 (N=341)，正在两个社区团体过渡到 PCP (N=20)。结果衡量标准包括遵守随访指南、参与者满意度（患者、PCP）以及对 MSKCC 幸存者护理计划的理解/清晰度/实用性（患者、PCP）。项目6 幸存者护理共识该项目的三个目标是：(1) 为主要利益相关者举行为期 2 天的峰会获得资金，重点关注提供幸存者护理；（二）召集会议； (3) 制定将幸存者转为初级保健医生的战略计划。主要利益相关者将是肿瘤学、初级保健、护理、付款人和癌症幸存者方面的国家和社区领导者。指导计划：此外，在拟议的 K05 拨款中，我将指导五名早期职业调查员，他们正在调查：减少患有乳腺癌并随后延迟重返工作岗位的社会经济弱势少数民族妇女的健康差距的方法；顺铂相关的内皮功能障碍；纵隔照射后的心血管疾病；结直肠癌和乳腺癌生存护理计划；以及癌症治疗后导致胰岛素抵抗的机制。