A Patient-Oriented Research Program in Geriatric Oncology

项目概要： 超过60%的癌症发生在老年人中，预计癌症患者的数量将增加。 老年评估（GA）是一种有效的以患者为中心的评估健康状况的方法，可以识别 有不良后果风险的老年癌症患者。大多数肿瘤学家没有采用 遗传算法，很大程度上是因为缺乏知识，如何利用遗传算法来指导沟通和决策。 罗切斯特大学（UR）NCI社区肿瘤学的两项多中心随机分组研究 由主要研究者（PI）领导的研究项目（NCORP）正在评估GA干预是否可以 改善有关年龄相关问题的沟通（由以患者为中心的结果研究资助 研究所合同）和减少癌症治疗的毒性（由NCI R 01资助），通过改善决策- 制作。我们的初步数据表明：1）年龄相关的问题和症状负担不是 在肿瘤学临床遇到有效解决; 2）社区肿瘤学家经常提供化疗， 虚弱的老年人有严重的后果; 3）相当比例的老年患者患有晚期癌症 正在接受治疗的患者和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， 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 以病人为导向的研究，并为这一代表性不足的领域的学员提供机会。的 PI，一位老年肿瘤学家，和研究团队，包括沟通，姑息治疗，护理专家， 和老年肿瘤学研究都处于有利地位，以完成这一建议的目标。总体 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年龄相关的问题和症状，风险和利益， 通过对PI的多中心研究数据的二次分析， 并实施干预措施，将GA整合到肿瘤护理中，以改善风险沟通 和化疗对老年患者的益处。在K24的支持下，PI将完成特定的职业生涯 发展活动，这将提高她在传播研究和指导的技能， 领导关于预期成果，本提案将填补在以下方面的重大知识空白： GA如何改善沟通和成果的机制。这项研究将产生积极的影响 通过提供一个务实的机制，将GA纳入社区肿瘤诊所， 通过更有效的沟通，改善老年癌症患者的预后。此K24将允许PI 桥梁老年肿瘤学和通信研究领域，汇集了一个 专家和老年肿瘤学学员的跨学科团队，通过对现有 来自资助的临床试验和新项目实施的数据。

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.