Perioperative mental health intervention for older adults undergoing cancer surgery

摘要/项目摘要-项目2 在患有癌症的老年人中，抑郁和焦虑没有得到充分的认识和治疗。100多万 今年，老年人将被诊断出患有癌症。这些人中的每一个都面临着更大的风险 抑郁症/焦虑症比一般老年人群更严重。围手术期是一个特别脆弱的时期， 因为患者同时面临着改变生活的诊断以及功能和身体上的 伴随着大手术而来的变化。大多数同时患有癌症和抑郁/焦虑的老年人并不 接受适当的心理健康治疗，如果他们接受了，那通常只是药物治疗，而且 加剧了本已猖獗的多药交易。在这个提案中，我们将优化和测试一个量身定做的 为接受癌症手术的老年患者提供的药物和行为干预捆绑包， 临床上有明显的抑郁和焦虑症状。我们将建立围手术期精神卫生保健制度 干预捆绑包包括：(1)应用经过验证的行为干预，即行为激活(BA)， 基于患者偏好和需求的策略；以及(2)药物优化和停药(MOD)， 有针对性地优化抗抑郁药物的剂量，停止有害或无效的药物。 目标1(适应)：在协作规划方法的指导下，我们将适应、制定和实施 接受计划中的癌症手术的老年人的最佳围手术期心理健康干预捆绑。 通过利益相关者的输入，我们将开发并迭代地调整行为和药物优化 在这一人群中实施的干预捆绑。在最初的协议开发之后，通过 治疗开发试验，我们将通过来自以下方面的互动反馈反复优化干预 65岁以上接受癌症大手术的患者和其他利益相关者，注意到障碍和 促进者完成计划。目标2(试验)：采用混合型1型随机对照试验设计， 我们将比较干预捆绑和常规护理在减少症状方面的有效性 接受肿瘤手术的老年癌症患者的抑郁和焦虑。为此，100名患者 将有抑郁和焦虑症状的患者随机分配到药理学和行为学 干预捆绑或常规护理。术前抑郁和焦虑与许多不良反应有关 手术后的结果，包括医疗并发症、跌倒、精神错乱和死亡率。因此，药物治疗 行为激活治疗抑郁症的干预捆绑疗法中的优化和停药 老年癌症患者的焦虑，不仅有望改善抑郁和焦虑的症状 而且还有其他重要的术后结果。

Abstract/Project Summary – PROJECT 2 Depression and anxiety are under-recognized and undertreated in older adults with cancer. More than a million older adults will be diagnosed with cancer this year. Each of these individuals are at greater risk for depression/anxiety than the general older population. The perioperative period is a particularly vulnerable time, as the patient is concurrently confronted with a life-changing diagnosis as well as functional and physical changes that accompany a major surgery. Most older adults with both cancer and depression/anxiety do not receive appropriate mental health treatment, and if they do, it is typically pharmacologic treatment only, further exacerbating already rampant polypharmacy. In this proposal, we will optimize and test a tailored pharmacological and behavioral intervention bundle for older patients undergoing surgery for cancer, with clinically significant depressive and anxiety symptoms. We will institute a perioperative mental healthcare intervention bundle including: (1) applying a proven behavioral intervention, behavioral activation (BA), with strategies based on patient preferences and needs; and (2) medication optimization and deprescribing (MOD), targeting to optimize dosages of anti-depressant medications, and stopping harmful or ineffective medications. Aim 1 (Adaptation): Informed by a collaborative planning approach, we will adapt, develop and implement an optimal perioperative mental health intervention bundle for older adults undergoing planned cancer surgery. Through stakeholder input, we will develop and iteratively adapt a behavioral and medication optimization intervention bundle for implementation in this population. Following initial protocol development, through treatment development trials, we will iteratively optimize the intervention through interactive feedback from patients over the age of 65 undergoing major surgery for cancer, and other stakeholders, noting barriers and facilitators to program completion. Aim 2 (Testing): Using a hybrid Type 1 randomized controlled trial design, we will compare the effectiveness of the intervention bundle with usual care in reducing symptoms of depression and anxiety in older patients with cancer undergoing oncologic surgery. For this aim, 100 patients with symptoms of depression and anxiety will be randomly assigned to the pharmacological and behavioral intervention bundle or usual care. Pre-operative depression and anxiety are associated with a host of adverse outcomes after surgery, including medical complications, falls, delirium, and mortality. Thus, medication optimization and deprescribing, in an intervention bundle with behavioral activation treatment of depression and anxiety in older adults with cancer, is expected to improve not only symptoms of depression and anxiety but also other important post-operative outcomes.