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.
This study is focused on improving outcomes of cancer survivors. The goals are to systematically mentor early career investigators studying survivorship outcomes and conduct two research studies aimed at: (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; and (2) bridging primary care and oncology and promoting the shared care model.
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