Baseline Symptoms and Adherence to Oral Breast Cancer Therapy among Older Women

老年女性的基线症状和口腔乳腺癌治疗的依从性

• 批准号: 10261485
• 负责人: Kathryn E Flynn
• 金额: $ 19.5万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10261485
• 关键词: Accounting; Address; Adherence; Age; Aromatase Inhibitors; Arthralgia; Attention; Breast Cancer Patient; Breast Cancer Treatment; Breast Cancer therapy; Cancer Center; Caring; Chronic; Clinical Trials; Complex; Data; Degenerative polyarthritis; Development; Diagnosis; Distress; Early Intervention; Education; Electronic Health Record; Estrogens; Event; Fatigue; Informatics; Intervention; Interview; Machine Learning; Measures; Modeling; Morbidity - disease rate; National Comprehensive Cancer Network; Observational Study; Oral; Outcome; Outcome Measure; Pain; Patient Outcomes Assessments; Patients; Pharmaceutical Preparations; Play; Population; Postmenopause; Randomized Controlled Clinical Trials; Recurrence; Relative Risks; Reporting; Research; Research Design; Role; Sampling; Sleep; Statistical Models; Symptoms; Tamoxifen; Therapy Clinical Trials; Thermometers; Time; Treatment Effectiveness; Treatment Protocols; United States; Vasomotor; Woman; adjuvant endocrine therapy; aggressive therapy; base; clinical care; clinical practice; cohort; comorbidity; cost effective; electronic data; experience; high risk; hormone receptor-positive; improved; innovation; malignant breast neoplasm; mortality; multidisciplinary; older patient; older women; pill; poor sleep; prevent; randomized trial; regression trees; secondary analysis; side effect; symptom cluster; theories; therapy adherence; treatment as usual; tumor; Accounting; Address; Adherence; Age; Aromatase Inhibitors; Arthralgia; Attention; Breast Cancer Patient; Breast Cancer Treatment; Breast Cancer therapy; Cancer Center; Caring; Chronic; Clinical Trials; Complex; Data; Degenerative polyarthritis; Development; Diagnosis; Distress; Early Intervention; Education; Electronic Health Record; Estrogens; Event; Fatigue; Informatics; Intervention; Interview; Machine Learning; Measures; Modeling; Morbidity - disease rate; National Comprehensive Cancer Network; Observational Study; Oral; Outcome; Outcome Measure; Pain; Patient Outcomes Assessments; Patients; Pharmaceutical Preparations; Play; Population; Postmenopause; Randomized Controlled Clinical Trials; Recurrence; Relative Risks; Reporting; Research; Research Design; Role; Sampling; Sleep; Statistical Models; Symptoms; Tamoxifen; Therapy Clinical Trials; Thermometers; Time; Treatment Effectiveness; Treatment Protocols; United States; Vasomotor; Woman; adjuvant endocrine therapy; aggressive therapy; base; clinical care; clinical practice; cohort; comorbidity; cost effective; electronic data; experience; high risk; hormone receptor-positive; improved; innovation; malignant breast neoplasm; mortality; multidisciplinary; older patient; older women; pill; poor sleep; prevent; randomized trial; regression trees; secondary analysis; side effect; symptom cluster; theories; therapy adherence; treatment as usual; tumor

For the >200,000 older women who develop hormone receptor positive breast cancer yearly, adjuvant endocrine therapy (AET) for at least five years increases overall survival. Yet almost half of patients prescribed AET fail to take all their pills. Education- and reminder-based studies in this and a number of other settings have had disappointingly small effects on adherence, and more complex interventions have proven difficult to sustain. In this proposal we seek a better understanding of the symptoms that women describe as major barriers to AET adherence. We draw on prior research suggesting that preexisting symptoms may play an important role in patients’ experience with AET. Our proposal fills crucial gaps in our understanding by examining older and less selected subjects treated in a usual care practice, and by using a measure that is already routinely collected across the United States. Specifically, we will use the National Comprehensive Cancer Network’s Distress Thermometer (DT) and its accompanying problem list, which have previously been shown to reveal a high burden of symptoms among older women with breast cancer but have not been examined in association with AET or while accounting for the wide spectrum of comorbid conditions of older women. Most cancer centers administer the DT and problem list at diagnosis or earlier in care, increasing their value for informing early intervention to help women continue their AET. We will investigate whether the DT and problem list are predictive of AET discontinuation among older women, with specific aims as follows: Aim 1 To examine the association of patient-reported distress at diagnosis with early discontinuation of AET. We will utilize electronic health record data from a cohort of incident postmenopausal hormone receptor positive breast cancer patients to examine the association of the DT (scored 0 to 10) measured at diagnosis with AET discontinuation in time-to-event analyses, accounting for age, osteoarthritis, and other comorbidities, and other breast cancer treatments. Aim 2. To explore the association of patient-reported symptoms at diagnosis with discontinuation of AET. In the same cohort and using the same general approach, we will explore AET discontinuation and a) patient-reported overall symptom count based on DT problem list) and b) symptom clusters (e.g., fatigue, sleep, concentration). We will use both standard regression and an innovative application of machine learning using Bayesian Additive Regression Trees. With this approach, we will produce immediately actionable findings to improve adherence outcomes, by providing a means of identifying high-risk patients who are the primary targets for the development of new interventions. It could also be an important model for other conditions that are treated with aggressive treatment regimens in older patients, informing care for a large number of older patients.

对于> 200,000名年龄较高的妇女，每年都会患上骑马受体阳性乳腺癌，调整 内分泌疗法（AET）至少五年增加了总体生存。然而几乎一半的患者处方了 AET无法服用所有药丸。在此以及许多其他环境中的基于教育和提醒的研究 对依从性产生了令人失望的小影响，事实证明，更复杂的干预措施很难 维持。在此提案中，我们寻求更好地理解女性所说的症状 AET依从性的障碍。我们借鉴了先前的研究，表明先前存在的症状可能会发挥 在患者的AET经验中的重要作用。我们的提议填补了我们理解的关键差距 检查在通常的护理实践中接受治疗的老年人和较少选择的受试者，并使用一种措施 已经在美国经常收集。具体来说，我们将使用国家综合 癌症网络的遇险温度计（DT）及其参与问题清单，以前是 显示出乳腺癌老年女性的症状高度燃烧，但尚未 与AET相关或在考虑较大的较旧条件的同时检查 女性。大多数癌症中心在诊断或更早的护理中管理DT和问题清单，增加了其 通知早期干预以帮助妇女继续其AET的价值。我们将调查DT是否 问题清单可预测老年妇女中止AET，其特定目的如下：目标 1检查患者报告的困扰在诊断时与早期中断 AET。我们将利用一系列绝经后激素接收器的电子健康记录数据 乳腺癌阳性患者检查在诊断时测量的DT的关联（得分为0到10） 在活动时间分析中停用AET，对年龄，骨关节炎和其他合并症的核算进行了解释， 和其他乳腺癌治疗。目标2。探索患者报告的症状的关联 诊断AET停用。在同一队列和使用相同的一般方法中，我们将 根据DT问题列表探索AET中断和A）患者报告的总体症状计数）和B） 症状簇（例如，疲劳，睡眠，浓度）。我们将同时使用标准回归和创新性 使用贝叶斯添加剂回归树应用机器学习。通过这种方法，我们将生产 立即采取可行的发现，通过提供一种识别高风险的方法来改善依从性结果 是开发新干预措施的主要目标的患者。这也可能很重要 在老年患者中接受侵略性治疗方案治疗的其他疾病的模型，告知护理 对于大量的老年患者。