Elucidating the Prevalence, Etiology, and Trajectories of Symptom Clusters in Early Cancer Survivors

阐明早期癌症幸存者症状群的患病率、病因和轨迹

• 批准号: 10355546
• 负责人: Arnold L Potosky
• 金额: $ 27.43万
• 依托单位: GEORGETOWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-03-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10355546
• 关键词: Acute; Address; Adult; Adverse effects; Age; Age-Years; Anxiety; Basic Science; Cancer Survivor; Caring; Characteristics; Chronic; Clinical; Clinical Treatment; Cohort Studies; Data; Diagnosis; Economics; Education; Educational workshop; Ethnic Origin; Etiology; Fatigue; Financial Hardship; Foundations; Future; Health; Health behavior; Healthcare; Healthcare Systems; Impaired cognition; Income; Information Systems; Insurance Coverage; Intervention; Intervention Studies; Joints; Knowledge; Link; Long-Term Effects; Malignant Neoplasms; Measurement; Measures; Medicare claim; Memory; Mental Depression; Mental Health; Methods; Modality; NIH Program Announcements; National Institute of Nursing Research; Oncology; Pain; Patient Outcomes Assessments; Patient Self-Report; Patients; Pattern; Phase; Physical Function; Population; Prevalence; Psychometrics; Quality of life; Race; Rare Diseases; Recording of previous events; Research; Role; SEER Program; Severities; Sleep disturbances; Social Functioning; Social support; Statistical Methods; Subgroup; Surveys; Survivors; Symptoms; Technical Expertise; Time; United States; anxiety symptoms; associated symptom; biomedical referral center; cancer diagnosis; cancer therapy; cancer type; clinical care; cognitive function; cohort; common symptom; comorbidity; data registry; ethnic minority; evidence base; experience; follow-up; functional disability; functional status; health related quality of life; human old age (65+); innovation; negative affect; neoplasm registry; palliative; persistent symptom; population based; racial and ethnic; recruit; response; sex; sociodemographic variables; sociodemographics; survivorship; symptom cluster; symptom management; symptom science

Basic science discoveries and cancer treatment innovations have led to 15.5 million cancer survivors currently in the United States, and the number of survivors is estimated to reach 20 million by 2026. Cancer and its treatment often cause long-term effects, including both persistent symptoms and functional deficits that negatively impact survivors’ quality of life. Cancer survivors are an ideal population in which to examine multiple co-occurring symptoms, termed “symptom clusters.” A 2017 panel of experts in symptom science convened by the National Institute of Nursing Research (NINR) and the Office of Rare Diseases noted that patients with chronic conditions such as cancer experience an array of symptom clusters that have a negative impact on health-related quality of life (HRQOL). This panel called for advancing symptom science through symptom cluster research to build the evidence base for effective symptom management. Our proposal is in response to an NINR/NCI joint program announcement that emerged from this workshop. Most prior research on symptom clusters in cancer has focused on patients undergoing the acute phase of cancer treatment for specific common cancers often treated in academic referral centers. Our study will address these limitations by focusing on early stage, sociodemographically diverse adult cancer survivors treated in general US oncology practices. We will investigate symptom clusters using data from a previously surveyed cohort of 5,506 adult cancer survivors initially diagnosed between 21-84 years of age with 1 of 7 distinct cancer types who were recruited in partnership with 4 population-based Surveillance, Epidemiology, and Ends Results (SEER) cancer registries in 3 states (CA, NJ, LA). This cohort was first surveyed at a median of 9 months after initial cancer diagnosis with a follow-up survey conducted 6 months later. The SEER registry data include detailed clinical and treatment data, and the survey collected information on 8 domains of symptoms and functional status common and highly impactful in cancer survivors, and numerous other sociodemographic and economic variables. In Aim 1, we will identify the prevalence of symptom clusters and subgroup profiles using innovative psychometric and statistical methods. We will evaluate sociodemographic (e.g., age, sex, race-ethnicity, income, education) and clinical characteristics (e.g., cancer type, stage, treatment, and comorbidity) associated with each symptom cluster and survivor subgroup. In Aim 2 we will investigate the temporal patterns of symptom clusters using state-of-the-art latent transition analysis. In both aims, we will evaluate the role of several mutable factors at the patient and healthcare system levels to inform future interventional research. In Aim 3 we will investigate the association of evidence-based symptom and comorbidity care with the prevalence and trajectory of symptom clusters using linked Medicare claims data for the subgroup of survivors ages 65 and over. Our results will enable a richer understanding of the phenomenon of symptom clusters and will provide a new foundation of knowledge that will help inform future interventions to mitigate the adverse effects of symptom clusters.

基础科学发现和癌症治疗创新已导致 1550 万癌症幸存者 目前在美国，预计到 2026 年幸存者人数将达到 2000 万。癌症和 它的治疗通常会造成长期影响，包括持续的症状和功能缺陷， 对幸存者生活质量的负面影响 癌症幸存者是进行多项检查的理想人群。 共同出现的症状，称为“症状群”。 2017 年症状科学专家小组由 美国国家护理研究所 (NINR) 和罕见病办公室指出，患有以下疾病的患者 癌症等慢性疾病会经历一系列症状群，对健康产生负面影响 该小组呼吁通过症状群推进症状科学。 我们的建议是为了建立有效症状管理的证据基础的研究。 本次研讨会上公布的 NINR/NCI 联合计划公告是关于症状的大多数先前研究。 癌症集群集中于接受特定常见癌症治疗急性期的患者 我们的研究将通过关注早期治疗来解决这些局限性。 阶段，社会人口统计学多样化的成年癌症幸存者接受美国一般肿瘤学实践的治疗。 我们将使用先前调查的 5,506 名成人癌症队列的数据来调查症状群 幸存者最初被诊断为 21-84 岁，患有 7 种不同癌症类型中的一种，他们被招募到 与 3 个国家的 4 个基于人群的监测、流行病学和最终结果 (SEER) 癌症登记处建立伙伴关系 州（加利福尼亚州、新泽西州、洛杉矶）首次对这一队列进行了调查，时间中位为初次癌症诊断后 9 个月。 6 个月后进行的跟踪调查 SEER 登记数据包括详细的临床和治疗数据， 调查收集了常见且高度重视的8个症状和功能状态领域的信息 在目标 1 中，我们将影响癌症幸存者以及许多其他社会人口和经济变量。 使用创新的心理测量和统计方法确定症状群和亚组概况的患病率 我们将评估社会人口统计学（例如年龄、性别、种族、收入、教育程度）和临床。 与每个症状群相关的特征（例如癌症类型、分期、治疗和合并症）以及 在目标 2 中，我们将使用最先进的技术研究症状群的时间模式。 在这两个目标中，我们将评估几个可变因素对患者和患者的作用。 为未来的介入研究提供信息的医疗保健系统水平在目标 3 中，我们将调查以下因素之间的关联。 基于证据的症状和合并症护理以及症状群的患病率和轨迹 65 岁及以上幸存者亚组的链接医疗保险索赔数据我们的结果将使数据更加丰富。 了解症状群现象并将提供新的知识基础 有助于为未来的干预措施提供信息，以减轻症状群的不利影响。