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Grant Details

Grant Number: 5R01CA134722-07 Interpret this number
Primary Investigator: Oeffinger, Kevin
Organization: Duke University
Project Title: Empower Study: Promoting Bc Screening in Women Who Survived Childhood Cancer
Fiscal Year: 2019
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PROJECT SUMMARY By age 50, almost one in three women, treated with chest radiation for a childhood cancer, will be diagnosed with breast cancer. Early detection of breast cancer is strongly associated with survival, and surveillance with annual breast MRI and mammography is recommended, starting at age 25. Unfortunately, the vast majority of these women are not adherent to the recommended surveillance. Magnifying this problem, most childhood cancer survivors are no longer followed at a cancer center, are unaware of their risks, and are being followed by primary care providers (PCPs) who are not informed about the recommended follow-up care. Based upon our prior findings in EMPOWER-I, we now propose EMPOWER-II, a 3-arm randomized controlled trial that extends the core component of the EMPOWER-I intervention (mailed educational materials) to evaluate the utility of patient activation with and without added PCP activation to increase breast cancer surveillance. We propose to randomize 291 women, who are at least 25 years of age, with a history of chest radiation for a childhood cancer, without a history of breast cancer, and without both a breast MRI and mammogram in the previous two years. The primary outcome is obtaining a breast MRI and mammogram during the 12-month study period. We will determine the comparative effectiveness of (1) a smartphone-based patient activation intervention and (2) patient activation plus PCP activation, compared to control. Secondary aims include exploring moderating and mediating factors that predict surveillance completion, timing of the obtained surveillance, and estimating the intervention replication costs and costs resulting from the intervention. The proposed EMPOWER-II study brings together a research team with the necessary expertise and experience in both survivorship research, smart-phone delivered interventions, and the unique resource of the 31-insitution Childhood Cancer Survivors Study (CCSS). Notably, the CCSS represents the single largest cohort of women in the target population and the infrastructure to conduct the proposed study. Results from this intervention will have important implications for all high-risk women treated with chest radiation at a young age.

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Radiation-associated breast cancer and gonadal hormone exposure: a report from the Childhood Cancer Survivor Study.
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Breast Cancer Risk in Childhood Cancer Survivors Without a History of Chest Radiotherapy: A Report From the Childhood Cancer Survivor Study.
Authors: Henderson T.O. , Moskowitz C.S. , Chou J.F. , Bradbury A.R. , Neglia J.P. , Dang C.T. , Onel K. , Novetsky Friedman D. , Bhatia S. , Strong L.C. , et al. .
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Specialty care for adult survivors of childhood cancer.
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PMID: 26407076
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Enhancing Health Care of Survivors of Childhood Cancer With Tailored Education.
Authors: Henderson T.O. , Oeffinger K.C. .
Source: Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015-11-20; 33(33), p. 3849-50.
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Breast cancer following spinal irradiation for a childhood cancer: A report from the Childhood Cancer Survivor Study.
Authors: Moskowitz C.S. , Malhotra J. , Chou J.F. , Wolden S.L. , Weathers R.E. , Stovall M. , Armstrong G.T. , Leisenring W.M. , Neglia J.P. , Robison L.L. , et al. .
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Health care utilization, lifestyle, and emotional factors and mammography practices in the Childhood Cancer Survivor Study.
Authors: Rosenberg S.M. , Moskowitz C.S. , Ford J.S. , Henderson T.O. , Frazier A.L. , Diller L.R. , Hudson M.M. , Stanton A.L. , Chou J.F. , Smith S. , et al. .
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PMID: 26304504
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Predicting Adverse Health Outcomes in Long-Term Survivors of a Childhood Cancer.
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Source: Children (Basel, Switzerland), 2014 Sep; 1(2), p. 63-73.
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Breast cancer after chest radiation therapy for childhood cancer.
Authors: Moskowitz C.S. , Chou J.F. , Wolden S.L. , Bernstein J.L. , Malhotra J. , Novetsky Friedman D. , Mubdi N.Z. , Leisenring W.M. , Stovall M. , Hammond S. , et al. .
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Recommendations for breast cancer surveillance for female survivors of childhood, adolescent, and young adult cancer given chest radiation: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group.
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Survivor profiles predict health behavior intent: the Childhood Cancer Survivor Study.
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Screening and surveillance for second malignant neoplasms in adult survivors of childhood cancer: a report from the childhood cancer survivor study.
Authors: Nathan P.C. , Ness K.K. , Mahoney M.C. , Li Z. , Hudson M.M. , Ford J.S. , Landier W. , Stovall M. , Armstrong G.T. , Henderson T.O. , et al. .
Source: Annals of internal medicine, 2010-10-05; 153(7), p. 442-51.
PMID: 20921543
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Inconsistent mammography perceptions and practices among women at risk of breast cancer following a pediatric malignancy: a report from the Childhood Cancer Survivor Study.
Authors: Smith S.M. , Ford J.S. , Rakowski W. , Moskowitz C.S. , Diller L. , Hudson M.M. , Mertens A.C. , Stanton A.L. , Henderson T.O. , Leisenring W.M. , et al. .
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Systematic review: surveillance for breast cancer in women treated with chest radiation for childhood, adolescent, or young adult cancer.
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PMID: 20368650
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