Resiliency among Older Adults Receiving Lung Cancer Treatment: A Supportive Care Intervention Study

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PROJECT ABSTRACT/SUMMARY. Lung cancer is a disease of older adults, who make up the least studied population of patients in cancer research. Evidence gaps persist in understanding the impact of newer treatments such as immunotherapy on functional status, the ability to recover from disability (resiliency), and clinical outcomes (e.g. symptom burden and treatment toxicity) among older adults. Current evidence indicates that the majority of older adults with cancer prioritize maintaining functional independence (i.e. no disability) over survival. Despite this common desire among older adults, disability in basic activities of daily living (ADLs), instrumental activities of daily living (IADLs), and mobility is a common consequence of cancer treatment. Functional status in terms of ADLs, IADLs, and mobility is often unmonitored throughout the treatment course. Among older adults with lung cancer, poor physical capability and psychological symptoms such as anxiety and depression are common and represent potentially modifiable risk factors to achieve resiliency rather than disability. Interventions that focus on helping older adults enhance resiliency and prevent functional decline during treatment are urgently needed. Therefore, the objective of this application is to test a novel supportive care intervention specifically designed to enhance resiliency among older adults with advanced lung cancer. This supportive care intervention, called Resiliency among Older Adults Receiving Lung Cancer Treatment (ROAR-LCT), is designed to help patients engage in behavior change to preserve functional status, by optimizing a resilience response to cancer treatment, and is delivered virtually to decrease treatment burden for older adults. The first aim of this proposal is to conduct the ROAR-LCT pilot randomized clinical trial, comprising physical therapy plus relaxation versus standard-of-care, to evaluate a) feasibility and b) the preliminary effect on functional status (primary outcome). The second and third aims are to compare secondary outcome differences (physical capability and psychological symptoms) and exploratory outcome differences (symptom burden and treatment toxicity) between the two study groups. As a geriatric thoracic oncologist, my overall career goal is to become an independent physician-scientist conducting research to understand the problem of disability following a lung cancer diagnosis and developing empirically supported strategies to improve a resilience response and prevent disability among older adults. This award and training proposal will provide the support to advance my knowledge of patient-reported functional outcomes for older adults, implement this knowledge in the design of behavioral clinical trials, and share this knowledge in new leadership roles. To help ensure the success of this application, I have developed relationships with a distinguished mentorship team having expertise in behavioral interventions, cancer control, lung cancer, and geriatrics. This award will provide me with the additional training and career development I need to become an independent physician-scientist focused on cancer and aging and to achieve my long-term goal of becoming an international leader in geriatric oncology and a role model and mentor for women in academic medicine.