Grant Details
Grant Number: |
5R01CA282793-02 Interpret this number |
Primary Investigator: |
Han, Summer |
Organization: |
Stanford University |
Project Title: |
Integrating Multiple Electronic Health Records Systems to Improve Lung Cancer Outcomes |
Fiscal Year: |
2024 |
Abstract
Recent advances in screening and treatment have increased the number of lung cancer (LC) survivors (~571,340
LC survivors as of 2019). However, studies have shown that these survivors have a high risk for developing
second primary lung cancer (SPLC), with the median 10-year SPLC risk of 8.36% after surviving 5 years from
the initial diagnosis. Further, survivors with SPLC have significantly higher mortality vs. those who remain with
single primary LC. Many unaddressed challenges exist: (1) While prior studies identified several risk factors for
SPLC, these are mostly measured and fixed at the time of initial diagnosis, with findings focused on survivors
who have ever smoked. However, SPLC risk is likely to be influenced by dynamic changes of various factors
(e.g., smoking cessation), and our preliminary data show that SPLC risk remains just as high among survivors
who never smoked. (2) Nevertheless, current epidemiologic data mainly used for SPLC do not offer detailed data
measured after initial diagnosis, (3) nor have risk factors or predictions been evaluated for never-smoking
survivors. (4) Further, limited trial evidence exists to address the important clinical question of whether and how
to continue CT screening after IPLC diagnosis among LC survivors, which requires a long-term follow-up that is
often not feasible in clinical trials. (5) Importantly, data on detailed screening for LC survivors are typically lacking
in most population-based data. We plan to address these multiple challenges by leveraging electronic health
records (EHRs) and novel analytical approaches to generate evidence to inform clinical decisions. Our long-term
goal is to improve LC outcomes by focusing on SPLC utilizing large EHR data combined with novel statistical
methods that integrate patient data measured after initial diagnosis. Our Specific Aims are: (AIM 1) to use a
novel 3-way linkage to establish an integrated shared database for LC (i.e., Oncoshare-Lung) using EHRs from
community-based and academic healthcare systems (with an ethnically diverse population with a high proportion
of Asian never smokers) linked to the California Cancer Registry (CCR) ; (AIM 2) to provide a set of clinical
decision tools for efficiently managing LC survivors by developing a novel statistical framework for predicting
dynamic SPLC risks by capturing data measured after IPLC diagnosis; and (AIM 3) to evaluate the feasibility
and utility of a novel causal inference method to assess efficient screening strategies for SPLC in LC survivors
using EHRs. We will apply a new causal inference method that explicitly emulates the target trials (hypothetical
randomized trials to answer the question of interest) in estimating the effects of continuing CT screening in long-
term LC survivors under varying eligibility criteria. We expect that the completion of this research will fill the
critical gaps in SPLC by providing: (1) clinical decision tools to assess individuals’ dynamic SPLC risks to identify
high-risk survivors for tailored surveillance, (2) new analytic pipelines to evaluate efficient screening criteria for
SPLC, and (3) a well-curated database for high-impact translational research for LC outcomes and surveillance
in an ethnically diverse population that provides a unique opportunity to examine critical questions in SPLC.
Publications
Racial and ethnic differences in second primary lung cancer risk among lung cancer survivors.
Authors: Choi E.
, Hua Y.
, Su C.C.
, Wu J.T.
, Neal J.W.
, Leung A.N.
, Backhus L.M.
, Haiman C.
, Le Marchand L.
, Liang S.Y.
, et al.
.
Source: Jnci Cancer Spectrum, 2024-09-02 00:00:00.0; 8(5), .
PMID: 39186009
Related Citations
Risk Model-Based Lung Cancer Screening and Racial and Ethnic Disparities in the US.
Authors: Choi E.
, Ding V.Y.
, Luo S.J.
, Ten Haaf K.
, Wu J.T.
, Aredo J.V.
, Wilkens L.R.
, Freedman N.D.
, Backhus L.M.
, Leung A.N.
, et al.
.
Source: Jama Oncology, 2023-12-01 00:00:00.0; 9(12), p. 1640-1648.
PMID: 37883107
Related Citations
Second Primary Lung Cancer Among Lung Cancer Survivors Who Never Smoked.
Authors: Choi E.
, Su C.C.
, Wu J.T.
, Aredo J.V.
, Neal J.W.
, Leung A.N.
, Backhus L.M.
, Lui N.S.
, Le Marchand L.
, Stram D.O.
, et al.
.
Source: Jama Network Open, 2023-11-01 00:00:00.0; 6(11), p. e2343278.
EPub date: 2023-11-01 00:00:00.0.
PMID: 37966839
Related Citations
Risk model-based management for second primary lung cancer among lung cancer survivors through a validated risk prediction model.
Authors: Choi E.
, Luo S.J.
, Ding V.Y.
, Wu J.T.
, Kumar A.V.
, Wampfler J.
, Tammemägi M.C.
, Wilkens L.R.
, Aredo J.V.
, Backhus L.M.
, et al.
.
Source: Cancer, 2023-10-25 00:00:00.0; , .
EPub date: 2023-10-25 00:00:00.0.
PMID: 37877788
Related Citations
Software Application Profile: dynamicLM-a tool for performing dynamic risk prediction using a landmark supermodel for survival data under competing risks.
Authors: Fries A.H.
, Choi E.
, Wu J.T.
, Lee J.H.
, Ding V.Y.
, Huang R.J.
, Liang S.Y.
, Wakelee H.A.
, Wilkens L.R.
, Cheng I.
, et al.
.
Source: International Journal Of Epidemiology, 2023-09-06 00:00:00.0; , .
EPub date: 2023-09-06 00:00:00.0.
PMID: 37670428
Related Citations
Overall Survival Among Patients With De Novo Stage IV Metastatic and Distant Metastatic Recurrent Non-Small Cell Lung Cancer.
Authors: Su C.C.
, Wu J.T.
, Choi E.
, Myall N.J.
, Neal J.W.
, Kurian A.W.
, Stehr H.
, Wood D.
, Henry S.M.
, Backhus L.M.
, et al.
.
Source: Jama Network Open, 2023-09-05 00:00:00.0; 6(9), p. e2335813.
EPub date: 2023-09-05 00:00:00.0.
PMID: 37751203
Related Citations