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Decreasing Polypharmacy in Older Adults with Curable Cancers

减少患有可治愈癌症的老年人的多重用药

基本信息

批准号：
10594983
负责人：
ERIKA E RAMSDALE
金额：
$ 24.88万
依托单位：
UNIVERSITY OF ROCHESTER
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-04-01 至 2025-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10594983
关键词：
Address Adherence Adopted Advocate Affect Aging Area Benefits and Risks Board Certification Caring Client satisfaction Clinic Clinic Visits Clinical Clinical Data Clinical Pharmacists Clinical Trials Design Cluster randomized trial Collaborations Community Clinical Oncology Program Dangerousness Data Data Science Development Plans Dose Educational Intervention Elderly Enrollment Focus Groups Geriatrics Goals Holly Hospitalization Informatics Intervention Interview Knowledge Malignant Neoplasms Measures Medicare Medicine Mentors Mentorship Methodology Methods National Cancer Institute Nurses Oncologist Oncology Outcome Patient Education Patients Pharmaceutical Preparations Pharmacists Phase Physical Function Polypharmacy Population Prevalence Process Protocols documentation Qualitative Methods Reporting Research Research Personnel Resources Series Structure Symptoms Technology Testing Time Toxicity due to chemotherapy Training Universities Withdrawal Work adverse outcome age related arm beneficiary cancer care cancer therapy care delivery career development chemotherapy cohort efficacy outcomes end of life falls functional status implementation barriers implementation facilitators implementation outcomes implementation science implementation strategy improved improved outcome innovation multidisciplinary older patient outcome prediction post intervention pragmatic trial primary care provider professor programs randomized, clinical trials research and development secondary analysis skills statistics survival prediction survivorship symposium trial design

项目摘要

PROJECT SUMMARY/ABSTRACT Polypharmacy (PP), or the concurrent use of multiple medications, affects up to 92% of older adults with cancer. It has been associated with adverse outcomes in these patients including poor adherence to and tolerance of cancer therapy, decrease in physical functioning, unplanned hospitalizations, falls, increased symptoms, and lower survival. “Deprescribing,” or the planned discontinuation of medications which may be potentially unsafe or inappropriate, is an intervention strategy which has the potential to decrease PP and improve outcomes. Deprescribing has not been studied in older adults with cancer receiving chemotherapy. Given the association of PP with reduced relative dose intensity (RDI) of chemotherapy, a ratio of dosing received to standard dosing, a deprescribing intervention could improve RDI in older adults with cancer receiving curative-intent chemotherapy; RDI of chemotherapy is a predictor of survival in these patients. This proposal presents a five-year research and career development plan focused on investigating both the preliminary efficacy and the optimal implementation of deprescribing interventions in older adults with PP and curable cancers. The candidate, Dr. Erika Ramsdale, is an Assistant Professor of Medicine at the University of Rochester and is board-certified in both Oncology and Geriatric Medicine. This proposal builds upon her prior work demonstrating that PP is prevalent in older adults receiving chemotherapy and that a pharmacist-led deprescribing intervention is feasible to implement in an oncology clinic with high patient satisfaction. The aims of the proposed study are: 1/adapt and refine potentially scalable deprescribing interventions; 2/investigate the effects of deprescribing interventions on RDI and other adverse outcomes in older adults undergoing curative- intent chemotherapy, and 3/identify barriers and facilitators of deprescribing interventions for patients, oncologists, and pharmacists. Focus groups and interviews with pharmacists, oncologists, nurses, primary care providers, and patient advocates will allow initial adaptation of the proposed interventions. A “pre-pilot” cohort of 8 patients with PP and cancer planned to receive curative-intent chemotherapy will undergo a pharmacist-led deprescribing intervention with additional iterative adaptations. Then, 72 patients will be allocated to a pharmacist-led deprescribing intervention versus patient education intervention in a cluster- randomized trial of 12 oncologist clusters. The proposal describes a comprehensive mentorship and training plan to develop complementary skills in clinical trial design, implementation science, and data science (encompassing informatics and statistics). Under the guidance of her primary mentor Dr. Supriya Mohile, co- mentors Dr. Gary Morrow, Dr. Lisa Zubkoff, and Dr. Holly Holmes, and advisors Dr. Sally Norton and Dr. Martin Zand, she will advance her skills in these areas with the long-term goal of becoming an independent cancer care delivery researcher implementing and testing multi-level interventions, including technology interventions, to address polypharmacy in older adults with cancer.

项目概要/摘要多药治疗 (PP)，即同时使用多种药物，影响高达 92% 的老年人癌症。它与这些患者的不良后果相关，包括依从性差和癌症治疗的耐受性、身体机能下降、计划外住院、跌倒、增加症状，并降低生存率。 “取消处方”，或计划停止用药，这可能是潜在不安全或不适当的干预策略，有可能降低 PP 和改善结果。尚未对接受化疗的患有癌症的老年人进行取消处方的研究。鉴于 PP 与化疗相对剂量强度 (RDI) 降低的相关性，剂量比接受标准剂量后，取消处方干预可以改善患有癌症的老年人的 RDI 接受治愈性化疗；化疗的 RDI 是这些患者生存的预测因子。这提案提出了一个五年研究和职业发展计划，重点调查老年 PP 和 PP 患者减药干预的初步疗效和最佳实施可治愈的癌症。候选人埃里卡·拉姆斯代尔 (Erika Ramsdale) 博士是纽约大学医学助理教授罗彻斯特，并获得肿瘤学和老年医学委员会认证。这个提议建立在她之前的基础上研究表明 PP 在接受化疗的老年人中普遍存在，并且药剂师主导的在肿瘤诊所实施取消处方干预是可行的，患者满意度很高。目标拟议研究的内容包括： 1/调整和完善潜在可扩展的处方干预措施； 2/调查取消干预措施对接受治疗的老年人的 RDI 和其他不良后果的影响意向化疗，以及 3/确定对患者取消干预措施的障碍和促进因素，肿瘤学家和药剂师。焦点小组和对药剂师、肿瘤学家、护士、初级医师的访谈护理提供者和患者倡导者将允许对拟议的干预措施进行初步调整。 “预试点” 由 8 名计划接受治疗性化疗的 PP 和癌症患者组成的队列将接受药剂师主导的取消处方干预，并进行额外的迭代调整。届时，72名患者将被分配给药剂师主导的处方干预与集群中的患者教育干预 12 个肿瘤学家集群的随机试验。该提案描述了全面的指导和培训计划发展临床试验设计、实施科学和数据科学方面的互补技能（包括信息学和统计学）。在她的主要导师 Supriya Mohile 博士的指导下，共同导师 Gary Morrow 博士、Lisa Zubkoff 博士和 Holly Holmes 博士，顾问 Sally Norton 博士和 Martin 博士 Zand，她将提高这些领域的技能，长期目标是成为一名独立的癌症患者护理服务研究人员实施和测试多层次干预措施，包括技术干预措施，解决老年癌症患者的多重用药问题。