PSYCHOSOCIAL SUPPORT & INTENSIVE CANCER TREATMENT

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Cancer is a major health problem among the elderly. Despite advances in cancer treatment and options, some elderly may not have the opportunity to participate in cancer treatment because of social factors. Advances in the treatment of acute leukemia and small cell lung cancer have clearly shown improvement in duration and quality of survival with occasional long-term survivors. Patients who achieve complete response have significantly improved survival regardless of age; however, early deaths related to: toxicities, comorbid conditions, or other factors, may be important in limiting the number of elderly patients who can achieve complete response. Since the social environment is closely tied to physical and mental health, the current study is designed to characterize social supports at the time of initial treatment and, subsequently, to determine if such supports are related to treatment, toxicity, or treatment outcome. The identification of such social support variables may, in future studies, be used to predict treatment outcomes, to develop treatment stratification, or design, interventions (e.g., adding missing supports) to improve treatment options. Patients with small cell lung cancer or acute leukemia represent the two largest patient groups at UMCC and have treatment outcomes which can be observed within the proposed project period. The intensity of treatment for both diseases is such that the patients make regular visits facilitating data collection. Thus, all patients with these two diseases will be enrolled in the current evaluation of the impact of social support on disease treatment and outcome. These patients will be treated on current standard UMCC treatment protocols allowing for the standardization of treatment and supportive care. These factors are of extreme importance to the current proposals since they minimize variables which can contribute to patient mortality. The investigators and support personnel have expertise in the treatment of these diseases as well as the design implementation analysis of the social support instruments which will be used in this grant. These instruments include the case mix and severity assessment method of Horn, the Dimensions of Social Support Scale by Cohen and the Older Americans Resources questionnaire. These instruments will be complemented by the collection of demographic and clinical data as well as an assessment of pretreatment prognostic factors. All statistical projections suggest that case accrual will be sufficient to analyze the variables collected so that successful completion of the project is anticipated within the funding time frame.