Risk stratified survivorship care pathways for early-onset colorectal cancer

早发性结直肠癌的风险分层生存护理途径

• 批准号: 10560031
• 负责人: Pasithorn Suwanabol
• 金额: $ 67.86万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-21 至 2028-02-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10560031
• 关键词: Address; Adult; Affect; Age; Age Years; Cancer Survivor; Caregivers; Caring; Characteristics; Clinical; Colorectal Cancer; Complex; Consensus; County; Data; Data Reporting; Diagnosis; Disease; Electronics; Endoscopy; Face; Family; Family Planning; Goals; Guidelines; Image; Incidence; Individual; Kentucky; Knowledge; Life; Long-Term Effects; Los Angeles; Malignant Neoplasms; Medically Underinsured; Medically Uninsured; Methodology; Methods; Modeling; Pathology Report; Pathway interactions; Patient Care; Patient Self-Report; Patients; Pattern; Population; Preventive care; Process; Provider; Psychosocial Assessment and Care; Quality of Care; Recurrence; Registries; Reporting; Risk; Risk Estimate; Sampling; Science; Site; Structure; Surveys; Survivors; Symptoms; Testing; Veterans Health Administration; Work; care burden; care delivery; care systems; cohort; design; early onset; early onset colorectal cancer; ethnic minority; evidence based guidelines; experience; follow-up; improved; innovation; low socioeconomic status; mortality; multidisciplinary; novel; older patient; patient engagement; patient oriented; patient population; personalized approach; physical symptom; population based; prognostic; psychosocial; racial minority; reproductive; response; risk stratification; service delivery; sociodemographic factors; sociodemographics; stakeholder perspectives; survivorship; tumor; young adult

Abstract: Over the past two decades, the incidence of colorectal cancer among adults < 50 years of age (i.e., early-onset CRC) has been alarmingly and steadily increasing. Despite these increases, survivorship care has evolved slowly and remains poorly informed and of suboptimal quality. Patients with early-onset CRC are particularly vulnerable to suboptimal care, given that the disease is more often diagnosed in racial and ethnic minorities and at a stage in life when financial instability and being medically underinsured or uninsured are more common. Thus, there is a critical need to design a model of survivorship care that aligns: 1) the intensity of surveillance with actual risk of recurrence; and 2) the provision of care services with need. Stratified survivorship care pathways provide an opportunity to deliver patient-centered, high-quality care that is appropriately tailored to individual needs. However, these pathways currently do not exist for patients with early-onset CRC, which is in part due to the lack of population-based estimates of recurrence that can guide surveillance approaches and the dearth of knowledge regarding these patients’ unique survivorship care burdens and needs. In this proposal, we will partner with three SEER registries in Georgia, Kentucky, and Los Angeles County to apply a new methodology to identify patterns of recurrence among patients with stage I-III early-onset CRC, generate population-level estimates of risk of recurrence, and examine clinical and sociodemographic factors associated with recurrence risk (Aim 1). We will then survey a contemporary and diverse SEER-based cohort of patients diagnosed with early-onset CRC to assess patients’ receipt of surveillance and self-reported survivorship care needs across multiple domains (e.g., physical symptoms, financial issues, family planning) (Aim 2). Finally, informed by findings from Aims 1 and 2, we will develop a stratified survivorship care framework and care pathways with a multi-disciplinary Advisory Panel (Aim 3). We will engage patients, caregivers, and clinician stakeholders in a consensus panel using the RAND/UCLA Appropriateness Method to refine and finalize the stratified survivorship care framework and care pathways. We will then assess the acceptability, appropriateness, and feasibility among the stakeholders. This study will yield much-needed population-based estimates of recurrence risk, surveillance intensity, and survivorship care needs and generate stratified survivorship care pathways for this rapidly growing population of cancer survivors. The findings have the potential to meaningfully improve the quality of survivorship care for patients with early-onset CRC and advance the science of stratified survivorship care delivery for other cancers more broadly.

摘要：在过去的二十年中，成年人少于50岁的大肠癌事件（即 早发的CRC）令人震惊，安静地增加。尽管有这些增加，但生存护理有 进化缓慢，知识渊博，质量不佳。早发CRC的患者是 鉴于这种疾病在种族和种族中更常见，特别容易受到次优护理的影响 少数民族和生活阶段，财务不稳定和医疗不足或没有保险的人是 更常见。这是一个迫切需要设计生存护理模型的迫切需要：1）强度 进行实际复发风险的监视； 2）需要提供护理服务。分层 生存护理途径为提供以患者为中心的高质量护理提供了机会 适当根据个人需求量身定制。但是，这些途径目前不存在 早期发作的CRC，部分是由于缺乏基于人群的复发估计值，可以指导 监视方法和有关这些患者独特的生存护理的知识死亡 伯伦斯和需求。在此提案中，我们将与佐治亚州，肯塔基州和洛杉矶的三个SEER登记处合作 安吉尔斯县采用新方法来识别I-III期患者的复发模式 早期发作的CRC，产生人口级复发风险的估计，并检查临床和 与复发风险相关的社会人口统计学因素（AIM 1）。然后，我们将调查当代和 基于潜水员的基于诊断为早发CRC的患者的同类群体评估患者的收到 跨多个领域的监视和自我报告的生存护理需求（例如，身体症状， 财务问题，计划生育）（目标2）。最后，在目标1和2的发现中，我们将开发一个 由多学科咨询小组（AIM 3）分层生存护理框架和护理途径。我们 将使用RAND/UCLA参与共识面板中的患者，看护人和临床利益相关者 适当的方法来完善和最终确定分层的生存护理框架和护理途径。 然后，我们将评估利益相关者之间的可接受性，适当性和可行性。这项研究会 产生急需的基于人群的复发风险，监视强度和 生存护理需求并为这种迅速增长的生存护理途径产生分层 癌症存活人群。这些发现有可能有意义地提高 针对早发CRC患者的生存护理，并推进分层生存护理的科学 为其他癌症提供更广泛的癌症。