A Patient-Oriented Research Program in Geriatric Oncology

项目总结： 超过60%的癌症发生在老年人中，癌症患者的数量预计还会增加。 老年评估(GA)是一种以患者为中心的有效评估健康状况的方法，可以确定 有不良后果风险的老年癌症患者。大多数肿瘤学家还没有采用 遗传算法，很大程度上是因为缺乏关于如何利用遗传算法指导沟通和决策的知识。 罗切斯特大学(UR)NCI社区肿瘤学的两项多中心整群随机研究 由首席调查员(PI)领导的研究计划(NCORP)正在评估GA干预是否可以 改善与年龄相关问题的沟通(由以患者为中心的结果研究资助 机构合同)，并通过改进决策减少癌症治疗的毒性(由NCI R01资助)- 制作。我们的初步数据表明：1)与年龄相关的担忧和症状负担不是 在肿瘤学临床中有效解决；2)社区肿瘤学家经常为 身体虚弱的老年人，后果严重；3)相当大比例的老年晚期癌症患者 正在接受治疗并且他们的照顾者相信癌症会被治愈；以及4)大多数老年患者 如果他们知道会有严重的功能和/或认知障碍，就会选择放弃癌症治疗 后果。目前的提案建立在PI的老年肿瘤学计划的基础上，通过开发新的 以患者为导向的研究，并在这一代表性不足的领域为学员提供机会。这个 老年肿瘤学家Pi和包括沟通、姑息治疗、护理专家在内的研究团队 而老年肿瘤学研究处于很好的地位，可以完成这项提案的目标。最重要的是 目的是：1)深入了解如何改善老年癌症患者之间的沟通， 肿瘤学家和他们的照顾者关于与年龄相关的担忧和症状，以及 通过对PI的多点研究数据的二次分析进行治疗和预后，以及2)发展 并实施干预措施，将GA整合到肿瘤护理中，以改善有关风险的沟通 以及化疗对老年患者的好处。在K24的支持下，PI将完成特定的职业生涯 发展活动，将提高她在沟通、研究和指导方面的技能 领导力。关于预期结果，这项提议将填补关于以下方面的重要知识空白 关于遗传算法如何改善沟通和成果的机制。这项研究将产生积极的影响 通过提供实用的机制将GA纳入社区肿瘤学诊所，以改善 通过更有效的沟通，改善老年癌症患者的预后。这款K24将允许PI 通过将一个 跨学科的专家团队和老年肿瘤学学员通过对现有的 来自资助的临床试验和一个新项目实施的数据。

PROJECT SUMMARY: Over 60% of cancers occur in older persons, and the number of patients with cancer is expected to grow. Geriatric assessment (GA), a validated patient-centered approach for assessing health status, can identify older patients with cancer who are at risk of adverse outcomes. The majority of oncologists have not adopted GA, largely because of lack of knowledge on how to utilize GA to guide communication and decision-making. Two multicenter cluster randomized studies in the University of Rochester (UR) NCI Community Oncology Research Program (NCORP) led by the Principal Investigator (PI) are evaluating if a GA intervention can improve communication about age-related issues (funded by a Patient Centered Outcomes Research Institute contract) and reduce toxicity from cancer treatment (funded by a NCI R01) through improved decision- making. Our preliminary data illustrates that: 1) age-related concerns and symptom burden are not addressed effectively in oncology clinical encounters; 2) community oncologists often provide chemotherapy to frail older adults with serious consequences; 3) a significant proportion of older patients with advanced cancer undergoing treatment and their caregivers believe the cancer will be cured; and 4) the majority of older patients would choose to forgo cancer treatment if they knew there would be serious functional and/or cognitive consequences. The current proposal builds on the PI's geriatric oncology program by developing new patient-oriented research and providing opportunities for mentees in this underrepresented area. The PI, a geriatric oncologist, and the research team including experts in communication, palliative care, caregiver and geriatric oncology research are well positioned to complete the aims of this proposal. The overarching aims are to: 1) develop insight into how to improve communication between older patients with cancer, their oncologists, and their caregivers about age-related concerns and symptoms, the risks and benefits of treatment, and prognosis through secondary analyses of data from the PI's multi-site studies and 2) develop and implement an intervention to integrate GA into oncology care to improve communication about the risks and benefits of chemotherapy for older patients. With support of this K24, the PI will complete specific career development activities that will enhance her skills in communication research and for mentoring and leadership. With regard to expected outcomes, this proposal will fill vital gaps in knowledge regarding the mechanisms of how GA can improve communication and outcomes. This research will have a positive impact by providing a pragmatic mechanism for incorporating GA into community oncology clinics to improve outcomes of older adults with cancer through more effective communication. This K24 will allow the PI to bridge the fields of geriatric oncology and communication research by bringing together an interdisciplinary team of experts and geriatric oncology mentees through novel analyses of existing data from funded clinical trials and the implementation of a new project.