Unpacking the Multi-level Drivers of Cardiotoxicity Disparities in Breast Cancer Survivors

揭示乳腺癌幸存者心脏毒性差异的多层次驱动因素

• 批准号: 10322753
• 负责人: Arnethea La'Shaun Sutton
• 金额: $ 11.39万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-01 至 2022-08-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10322753
• 关键词: Address; Adjuvant Therapy; Adrenergic beta-Antagonists; Advisory Committees; Age; Anthracycline; Anxiety; Attention; Award; Behavioral; Black race; Breast Cancer Patient; Breast Cancer Treatment; Breast Cancer survivor; Cardiac; Cardiac health; Cardiology; Cardiotoxicity; Cardiovascular Diseases; Cardiovascular system; Caring; Cause of Death; Chronology; Clinical; Computerized Medical Record; Coupled; Data; Demographic Factors; Development; Diagnosis; Doxorubicin; Ensure; Environment; Epidermal Growth Factor Receptor; Female; Goals; Healthcare; Heart; Heart Diseases; Heart failure; High Prevalence; Hospitals; Human; Intervention; Interview; Left Ventricular Dysfunction; Life; Light; Literature; Maintenance; Malignant Neoplasms; Measures; Mediating; Medical; Medical Records; Mentors; Modeling; Myocardial dysfunction; National Cancer Institute; Oncology; Pathway interactions; Patients; Pattern; Phase; Prevalence; Prospective cohort study; Race; Reporting; Research; Research Methodology; Research Project Grants; Resources; Risk; Risk Factors; Role; Smoking; Strategic Planning; Surveys; Survivors; Training; Treatment-Related Cancer; Woman; black women; breast cancer survival; cancer care; cancer health disparity; care delivery; care outcomes; chemotherapy; comorbidity; early onset; experience; high body mass index; improved outcome; insight; malignant breast neoplasm; mortality; novel; perceived discrimination; prevent; primary outcome; programs; psychological distress; psychosocial; racial difference; racial disparity; receptor; recruit; secondary outcome; side effect; social; social culture; sociodemographics; success; survivorship; targeted treatment; therapy development

Abstract The improvement in breast cancer survival is partially due to improvements in treatments. However, these treatments are not without mild to life-threatening side effects. For example, anthracycline chemotherapies (e.g. doxorubicin) and human epidermal growth factor receptor-2 (HER-2) targeted therapies have been shown to cause cardiotoxicity (CTX), or damage to the heart. This side effect is of great concern as survivors are more likely to die of heart disease than any other diagnosis and racial disparities exist with regard to prevalence of CTX and risk of heart-related mortality. Factors that have been shown to contribute to cardiotoxicity include Black race and the presence of comorbidities. While the cardiovascular disease literature includes the roles of psychosocial and sociocultural factors in its prevalence and the racial disparity in its manifestation and progression, these factors are unexplored in the context CTX. Additionally, cancer care delivery factors, including maintenance of CTX, deserves attention as there may be opportunities to address gaps or differences in care that may exacerbate the CTX disparity. Addressing psychosocial and sociocultural factors may provide intervention targets to mitigate CTX disparities. Guided by the Social Ecological Model, I will conduct retrospective analyses and a historical-prospective cohort study to identify factors related to the racial disparity in CTX. During the K99 mentored phase, I will abstract electronic hospital data on breast cancer survivors treated with anthracycline chemotherapy or Her-2 targeted therapies to elucidate sociodemographic, clinical, and maintenance factors that relate to onset of and racial differences in CTX (Aim 1). In Aim 2, I will conduct in-depth interviews with Black and White survivors (n=20) with and without CTX to understand psychosocial and sociocultural experiences that may contribute to CTX. During the R00 phase (Aim 3), I will use the information learned from the in-depth interviews to inform a survey that will be distributed to n=150 Black and White breast cancer survivors who were treated with adjuvant therapies. This survey, coupled with medical record data, will be used to assess relationships between psychosocial and socio-cultural factors and racial differences in CTX. In order to successfully execute these aims the candidate will receive strategic planning in cancer care delivery, cardio-oncology, and mixed methods research. These training aims will ensure the candidate's goal of successfully transitioning to independence and establishing a research program involving the development of interventions that will address racial disparities in cancer care delivery and outcomes. The expertise and guidance of the mentoring and advisory teams in addition to the wealth of resources and commitment to training provided through the institutional environment will ensure the success of the candidate's research project and transition to independence.

抽象的 乳腺癌存活的改善部分是由于治疗的改善。但是，这些 治疗并非没有轻度威胁生命的副作用。例如，蒽环类化学疗法（例如 阿霉素）和人表皮生长因子受体-2（HER-2）靶向疗法已显示为 导致心脏毒性（CTX）或对心脏的损害。这种副作用非常关注，因为幸存者更多 在患病的患病率方面，可能死于心脏病 CTX和与心脏有关的死亡率的风险。已证明有助于心脏毒性的因素包括黑色 种族和合并症的存在。心血管疾病文献包括 其流行率以及其表现形式的种族差异和社会文化因素和社会文化因素 进展，这些因素在上下文CTX中没有探索。此外，癌症护理输送因素，包括 维持CTX，值得关注，因为可能会有机会解决差距或护理差异 这可能会加剧CTX差异。解决社会心理和社会文化因素可能会提供 干预目标可减轻CTX差异。在社会生态模型的指导下，我将进行 回顾性分析和一项历史研究队列研究，以识别与种族差异有关的因素 在CTX中。在K99指导阶段，我将抽象有关治疗的乳腺癌幸存者的电子医院数据 蒽环类化疗或HER-2靶向疗法，以阐明社会人口统计学，临床和 与CTX的​​发作和种族差异有关的维护因素（AIM 1）。在AIM 2中，我将深入进行 在有或没有CTX的情况下，对黑白幸存者（n = 20）的访谈以了解心理社会和 可能有助于CTX的社会文化经验。在R00阶段（AIM 3），我将使用信息 从深入的访谈中学到的，以告知一项将分发给n = 150黑白乳房的调查 接受辅助疗法治疗的癌症幸存者。这项调查，加上病历数据，将 用于评估心理社会和社会文化因素之间的关系以及CTX中的种族差异。 为了成功执行这些目标，候选人将在癌症护理交付中获得战略计划， 心脏肿瘤学和混合方法研究。这些培训目标将确保候选人的目标 成功过渡到独立性并建立涉及发展的研究计划 将解决癌症护理交付和结果的种族差异的干预措施。专业知识和 除了资源丰富和对培训的承诺之外，指导和咨询团队的指导 通过机构环境提供的将确保候选人研究项目的成功 过渡到独立。