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

项目摘要/总结。肺癌是一种老年人的疾病， 癌症研究中的患者群体。在理解新疗法的影响方面存在证据差距 例如对功能状态的免疫治疗，从残疾中恢复的能力（弹性），以及临床 结果（如症状负担和治疗毒性）。目前的证据表明， 大多数患有癌症的老年人优先考虑保持功能独立性（即没有残疾）而不是生存。 尽管老年人有这种共同的愿望，但日常生活基本活动（ADL）的残疾， 日常生活活动（IADL）和移动性是癌症治疗的常见结果。功能状态 在ADL、IADL和活动性方面，在整个治疗过程中通常不进行监测。在老年人中 肺癌患者的体能差和焦虑、抑郁等心理症状， 常见的，代表潜在的可修改的风险因素，以实现弹性，而不是残疾。干预措施 重点是帮助老年人在治疗期间增强弹性和预防功能衰退， needed.因此，本申请的目的是专门测试一种新的支持性护理干预 旨在增强老年晚期肺癌患者的恢复力。这种支持性护理干预， 名为接受肺癌治疗的老年人的弹性（ROAR-LCT），旨在帮助 患者通过优化对癌症的弹性反应，参与行为改变以保持功能状态 治疗，并提供虚拟，以减少老年人的治疗负担。这项建议的第一个目的是 是进行ROAR-LCT试点随机临床试验，包括物理治疗加放松， 标准治疗，以评价a）可行性和B）对功能状态的初步影响（主要结局）。 第二和第三个目标是比较次要结果差异（身体能力和心理能力）。 症状）和探索性结局差异（症状负担和治疗毒性） 组作为一名老年胸肿瘤学家，我的总体职业目标是成为一名独立的医生-科学家 开展研究，了解肺癌诊断后的残疾问题， 经验支持的战略，以提高老年人的复原力和预防残疾。这 奖励和培训计划将提供支持，以提高我对患者报告功能的了解 老年人的结果，在行为临床试验的设计中实施这些知识，并分享这些知识。 在新的领导角色中的知识。为了帮助确保这个应用程序的成功，我已经建立了关系 拥有一支杰出的导师团队，他们在行为干预，癌症控制，肺癌， 和老年医学这个奖项将为我提供额外的培训和职业发展，我需要成为 一个独立的医生，科学家专注于癌症和衰老，并实现我的长期目标，成为 她是老年肿瘤学的国际领导者，也是学术医学领域女性的榜样和导师。

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.