Cancer Control in Older Adults

描述(申请人提供)：Silliman博士是一名老年病学家和临床流行病学家，他在过去20年的研究中强调了癌症治疗中与年龄相关的差异，这在很大程度上与患者与医生沟通的质量有关。由于共病在老年癌症患者护理中的关键作用，她的研究工作也探索了其测量的替代方法。最后，她的工作考虑了治疗差异对一系列健康结果的影响：(1)一般和乳腺癌特有的情绪健康；(2)上半身功能；(3)乳腺癌复发和死亡率。她目前资助的R01旨在：(1)描述治疗、肿瘤和患者特征对HMO环境下乳腺癌特定结果的单独和联合影响；(2)在付费服务环境下，研究乳腺癌及其治疗、与年龄相关的并发症和功能障碍以及长期老年乳腺癌幸存者的健康结果之间的关系。在K05更新期间，西里曼博士建议研究多种疾病对癌症治疗和结果的影响。具体地说，她将(1)扩大定义患有多种疾病的老年妇女最佳乳腺癌护理的科学证据；(2)开发新的测量策略和应用程序，以提高我们对乳腺癌作为乳腺癌治疗和预后的独立变量、混淆因素和效果修饰物的理解；(3)建立研究数据库基础设施，以支持对患有多种疾病的老年癌症患者进行癌症护理质量和有效性的研究；(4)发展以老年人癌症预防和控制为研究重点的年轻研究人员。在资助期内的新研究将比较事件护理和普遍的非乳腺癌共病情况，特别是护理质量和卫生保健利用；坚持预防性卫生保健战略；以及老年乳腺癌幸存者和年龄和共病匹配的对照组接受的临终护理。相关性：西里曼博士已经成功地将流行病学的基础科学应用于老年人的癌症流行。她的定位是丰富我们在老年人癌症预防和控制方面的知识，并培养下一代癌症控制科学家。

DESCRIPTION (provided by applicant): Dr. Silliman is a geriatrician and clinical epidemiologist whose research over the past 20 years has highlighted age-associated disparities in cancer treatment, related in large part to the quality of patient- physician communication. Because of the critical role of comorbidity in the care of older cancer patients, her investigative work has also explored alternative methods of its measurement. Finally, her work has considered the implications of treatment variations on a range of health outcomes: (1) general and breast cancer-specific emotional health; (2) upper body function; and (3) breast cancer recurrence and mortality. Her currently funded R01s are designed to: (1) characterize the separate and joint effects of treatment, tumor, and patient characteristics on breast cancer-specific outcomes in the HMO setting; and (2) examine the relationships among breast cancer and its treatment, age-related comorbidities and functional impairments, and health outcomes in long-term older breast cancer survivors in the fee-for-service setting. During the K05 renewal period, Dr. Silliman proposes to study the impact of multiple morbidities on cancer care and outcomes. Specifically, she will (1) expand the scientific evidence that defines optimal breast cancer care for older women with multiple morbidities; (2) develop new measurement strategies and applications to improve our understanding of multiple morbidity as an independent variable, confounder, and effect modifier of breast cancer treatment and outcomes; (3) develop a research database infrastructure to support studies of cancer care quality and effectiveness among older cancer patients with multiple morbidities; and (4) develop young investigators whose research focuses on cancer prevention and control in older adults. New research during the funding period will compare the care for incident and prevalent non- breast cancer comorbid conditions, specifically quality of care and health care utilization; adherence to preventive health care strategies; and end of life care received by older breast cancer survivors and an age and comorbidity-matched comparison group. Relevance: Dr. Silliman has successfully applied the basic science of epidemiology to the cancer epidemic in older adults. She is positioned to enrich our knowledge of cancer prevention and control in older adults and to develop the next generation of cancer control scientists.