Improving Outcomes for Older Adults Undergoing Palliative Radiation Treatment

项目总结 我是西奈山伊坎医学院的放射肿瘤学家和早期研究员。我的 工作的重点是提高接受姑息放射治疗(RT)的老年人的护理质量。 每年约有500,000名老年癌症患者接受治疗，以提高生活质量。姑息疗法 RT(PRT)-旨在减轻症状而不是治愈的RT-既有好处也有坏处， 尤其对于老年人，他们的癌症发生在多发病和老年病的复杂环境中 包括功能或认知障碍在内的情况。PRT可以显著改善疼痛等症状 和神经功能。然而，它也可能导致疲劳、灼伤和其他可持续数年的不良影响 月份。其他负担包括每天出差数周参加PRT会议；由于 关节活动受限；以及紧身口罩，这可能会让认知受损的人感到恐惧。如果 PRT负担过重，经常被中断或过早停止，限制了其疗效。年龄较大的患者可能 由于复杂和相互关联的癌症特异性和老年性疾病，特别容易受到PRT的影响 条件。然而，人们对这些老年疾病对PRT相关结果的贡献知之甚少。 包括它们与(1)完成RT的困难；(2)功能、住院和死亡率的变化的关系 放疗后；(3)自我报告的毒性反应和生活质量。为了解决这些知识差距，我建议2 相互关联和互补的研究：(1)对一项具有全国代表性的大型研究进行的回溯性队列研究 2000年至2018年医疗保险现行受益人调查中65岁≥转移性癌症成人样本 (MCBS)，将老年评估数据与行政索赔联系起来，以(A)确定相关因素 与PRT相关的结果(例如，放疗完成、放疗后功能、住院和死亡率)和(B) 表征患者复杂性的不同表型特征，然后检查它们与相同的 结果；和(2)一项前瞻性队列研究，采用了比MCBS更详细的评估，以(A) 进一步细化PRT与功能和生活质量的关联，并(B)探索与自我报告的RT- 相关毒物。这些研究的结果将有助于提高对贫困高危人群的认识。 PRT结果，并将支持未来的R01应用程序，测试有针对性的老年医学驱动的干预 这改善了PRT的结果，对老年人来说很重要。我的长期目标是成为一名独立的调查员 他是老年病学、姑息治疗和放射肿瘤学交叉学科的领导者，他改进了治疗 为接受PRT的老年人做出决定和设计干预措施。比森奖将支持我的 (1)老年病学和老年肿瘤学的发展；(2)以人口为基础的观测数据及其分析； (3)在老年人中的前瞻性研究设计和实施；以及(4)在老年病学方面的领导地位，以促进 研究成果的传播和实施。这些研究和培训活动最终将使我做好准备 成为老龄化领域的领导者，将RT交付与晚期癌症老年人的独特需求保持一致。

PROJECT SUMMARY I am a radiation oncologist and early-stage investigator at the Icahn School of Medicine at Mount Sinai. My work has focused on improving the quality of care of older adults undergoing palliative radiation therapy (RT), a treatment used in approximately 500,000 older cancer patients each year to improve quality of life. Palliative RT (PRT) – RT intended to reduce symptoms rather than achieve cure – creates both benefits and harms, particularly for older adults in whom cancer occurs in complex settings of multimorbidity and geriatric conditions including functional or cognitive impairments. PRT can dramatically improve symptoms such as pain and neurologic function. Yet it may also cause fatigue, burns, and other adverse effects that can persist for months. Other burdens include weeks of daily travel to attend PRT sessions; painful body positioning due to restricted joint mobility; and tight-fitting face masks which can be terrifying to cognitively impaired persons. If PRT is too burdensome, it is often interrupted or prematurely stopped, limiting its efficacy. Older patients may be particularly vulnerable to PRT as a result of complex and interrelated cancer-specific and geriatric conditions. Yet, little is known about the contribution of these geriatric conditions to PRT-related outcomes, including how they relate to (1) difficulties completing RT; (2) changes in function, hospitalization, and mortality after RT; and (3) self-reported toxicities and quality of life. To address these knowledge gaps, I propose 2 interrelated and complementary studies: (1) a retrospective cohort study of a large, nationally representative sample of adults ≥65 years with metastatic cancer from the 2000-2018 Medicare Current Beneficiary Survey (MCBS), which links geriatric assessment data with administrative claims, to (a) determine factors associated with PRT-related outcomes (e.g. completion of RT, function after RT, hospital admission, and mortality) and (b) characterize distinct phenotypic profiles of patient complexity, then examine their associations with the same outcomes; and (2) a prospective cohort study employing more detailed assessments than are in MCBS to (a) further refine associations of PRT with function and QOL and (b) explore associations with self-reported RT- related toxicities. Results from these studies will lead to improved recognition of individuals at high risk of poor PRT outcomes and will support a future R01 application testing a targeted and geriatrics-driven intervention that improves PRT outcomes important to older adults. My long-term goal is to be an independent investigator and leader at the intersection of geriatrics, palliative care, and radiation oncology who improves treatment decisions and designs interventions for older adults receiving PRT. The Beeson Award will support my development in (1) geriatrics and geriatric oncology; (2) population-based observational data and its analyses; (3) prospective study design and implementation in older adults; and (4) leadership in geriatrics to facilitate research dissemination and implementation. These research and training activities will ultimately prepare me to become a leader in aging who aligns RT delivery with the unique needs of older adults with advanced cancer.