A PILOT STUDY OF PREHABILITATION DURING THE NEOADJUVANT WINDOW OF OPPORTUNITY IN OLDER WOMEN WITH OVARIAN CANCER (FIT4SURGERY)

项目概要/摘要 卵巢癌的治疗开始于复杂的根治性手术，这些手术通常发生在年龄较大的女性中， 虚弱和合并症的症状这导致术后并发症和最高的死亡率 在所有妇科癌症中。术后不良事件，如手术并发症和住院 再入院，可能会延迟术后化疗的开始，导致生存率下降。鉴于 老年卵巢癌患者术后发病风险增加和癌症特异性生存率降低 癌症，需要有针对性的干预措施，以改善其结果。Prehistory指的是增强 在即将到来的压力源（如手术）之前的功能能力，目的是改善术后 成果。具体来说，身体活动已被发现具有无数的健康益处，并且是 许多预防干预措施。然而，预防干预往往使用规定性的静态目标， 由医疗保健专业人员提供的高强度活动可能无法扩展， 适合接受化疗的年老体弱患者人群。为了解决这些问题，本提案 在老年妇女中进行了一项以家庭为基础的、量身定制的身体活动干预（Fit 4Surgery）的试点测试 接受新辅助化疗的卵巢癌患者像这样的干预措施对患者有效 在这项提案中，将在一个新的环境和高风险人群中进行测试。通过 增加卵巢癌老年妇女在手术前几个月的身体活动量， 减积手术，我们的目标是改善功能状态和生活质量，同时减少虚弱，术后 并发症和辅助癌症治疗的时间，最终提高癌症的长期生存率。 作为一名接受过正规流行病学培训的妇科肿瘤学家，我在临床研究方面有着坚实的基础 重点关注手术质量和妇女健康结果。通过我的研究，我发现 卵巢癌妇女作为高危人群和生理老化的机制是普遍的， 患有癌症和正在接受化疗的妇女。为了实现我的职业目标， 生活质量和生存的老年妇女妇科癌症，我需要进一步的培训， 在老龄化、老年评估和虚弱评估方面的指导。这个提议将帮助我填补这些空白 直接通过正式的课程，研讨会，并指导博士麦考伊（老年医学，老年肿瘤学），博士 Simon（妇科恶性肿瘤和衰老），菲利普斯博士（癌症患者的体力活动，老年人的体力活动） 成人）和Kocherginsky博士（行为干预的临床试验）。技能、知识和初步 我获得这个奖项的数据将使我能够检查Fit 4Surgery干预的有效性 在改善卵巢癌老年妇女的手术结果，并将大大有助于我的 过渡到一个独立的外科医生，科学家研究衰老和妇科癌症。

PROJECT SUMMARY/ABSTRACT Treatment for ovarian cancer begins with complex radical surgery in women who often are older with high rates of frailty and comorbid conditions. This results in postoperative complications and the highest mortality amongst all gynecologic cancers. Postoperative adverse events, such as surgical complications and hospital readmissions, can delay the initiation of post-operative chemotherapy, leading to decreased survival. Given the increased risk of postoperative morbidity and inferior cancer-specific survival for older women with ovarian cancer, targeted interventions are needed to improve their outcomes. Prehabilitation refers to enhancing functional capacity prior to an upcoming stressor, such as surgery, with the goal of improving postoperative outcomes. Physical activity, specifically, has been found to have myriad health benefits and is a component of many prehabilitation interventions. However, prehabilitation interventions often use prescriptive static goals of high intensity activity delivered by health care professionals which may not be scalable and may not be appropriate for an older frail patient population receiving chemotherapy. To address these issues, this proposal pilot tests a home-based, symptom-tailored, physical activity intervention (Fit4Surgery) among older women with ovarian cancer undergoing neoadjuvant chemotherapy. Interventions such as this are effective in patients with chronic diseases and in this proposal will be tested in a novel setting and a high-risk population. By increasing the amount of physical activity older women with ovarian cancer perform in the months prior to debulking surgery, we aim to improve functional status and quality of life while decreasing frailty, postoperative complications, and time to adjuvant cancer therapy, ultimately improving long-term cancer survival. As a gynecologic oncologist with formal epidemiology training, I have a solid foundation in clinical research with a focus on surgical quality and outcomes in women’s health. Through my research, I have identified older women with ovarian cancer as a high-risk population and the mechanisms of physiologic aging are prevalent in women with cancer and those undergoing chemotherapy. In order to fulfill my career goal to improve the quality of life and survival of older women with gynecologic cancers, I am in need of further training and mentorship in aging, geriatric assessment, and frailty assessment. This proposal will help me fill these gaps directly through formal coursework, seminars, and mentorship by Dr McKoy (geriatrics, geriatric oncology), Dr Simon (gynecologic malignancies and aging), Dr Phillips (physical activity in cancer, physical activity in older adults) and Dr Kocherginsky (clinical trials of behavioral interventions). The skills, knowledge and preliminary data, that I acquire as a result of this award will allow me examine the efficacy of the Fit4Surgery intervention in improving surgical outcomes for older women with ovarian cancer and will substantively contribute to my transition to an independent surgeon-scientist studying aging and gynecologic cancers.