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

项目摘要/摘要。肺癌是老年人的一种疾病，他们是研究最少的人群。 癌症研究中的患者群体。在理解新疗法的影响方面，证据差距依然存在 如免疫治疗对功能状态、残疾恢复能力(恢复力)和临床的影响 老年人的结果(例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将保持功能独立(即无残疾)置于生存之上。 尽管老年人有这种共同的愿望，但在日常生活的基本活动(ADL)方面的残疾， 日常生活活动(IADL)和活动能力是癌症治疗的常见后果。功能状态 就ADLS、IADLS和移动性而言，在整个治疗过程中往往没有监测。在老年人中 患肺癌的人，身体机能差和焦虑、抑郁等心理症状 它们是共同的，是潜在的可修改的风险因素，以实现复原力而不是残疾。干预措施 将重点放在帮助老年人增强复原力和防止治疗期间的功能衰退上是当务之急 需要的。因此，本应用程序的目标是测试一种新的支持性护理干预措施 旨在提高患有晚期肺癌的老年人的复原力。这种支持性护理干预， 被称为接受肺癌治疗的老年人的恢复能力(ROAR-LCT)旨在帮助 患者通过优化对癌症的弹性反应来改变行为以保持功能状态 治疗，实际上是为了减轻老年人的治疗负担。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与 护理标准，以评估a)可行性和b)对功能状态的初步影响(主要结果)。 第二和第三个目标是比较次要结果的差异(身体能力和心理 症状)和探查结果(症状负担和治疗毒性)两项研究之间的差异 组。作为一名老年胸部肿瘤学家，我的总体职业目标是成为一名独立的内科医生-科学家 进行研究以了解肺癌诊断和发展后的残疾问题 经验性地支持了改善老年人的复原力反应和预防残疾的战略。这 奖励和培训计划将提供支持，以提高我对患者报告的功能的了解 老年人的结果，将这一知识应用到行为临床试验的设计中，并分享 在新的领导角色中的知识。为了帮助确保这一应用程序的成功，我建立了 有一个杰出的导师团队，在行为干预、癌症控制、肺癌、 还有老年病。这一奖项将为我提供我所需要的额外培训和职业发展 一位独立的内科科学家，专注于癌症和衰老，并实现我成为 她是老年肿瘤学领域的国际领导者，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.