Intervention to Increase Chemotherapy Tolerance in Elderly Cancer Patients

提高老年癌症患者化疗耐受性的干预措施

• 批准号: 8296499
• 负责人: Lara Traeger
• 金额: $ 8.85万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-05 至 2013-12-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8296499
• 关键词: Address; Adherence; Adjuvant Chemotherapy; Adult; Advanced Malignant Neoplasm; Adverse effects; Age; Aging; Behavior Therapy; Behavioral Medicine; Behavioral Sciences; Biological Aging; Cancer Center; Cancer Control; Cancer Patient; Chemotherapy-Oncologic Procedure; Chronic Disease; Clinical; Colon Carcinoma; Communication; Community Health Systems; Coping Skills; Data; Development; Disease; Disease Outcome; Disease-Free Survival; Distress; Elderly; Environment; Excision; Face; Family; Feedback; Fluorouracil; Future; General Hospitals; Health Status; Health system; Home environment; Individual; Institution; Intervention; Intervention Trial; Interview; Intravenous; Life; Literature; Longevity; Malignant Neoplasms; Malignant neoplasm of gastrointestinal tract; Massachusetts; Medical; Medical Oncology; Medicare; Modeling; Morbidity - disease rate; National Cancer Institute; National Institute on Aging; Operative Surgical Procedures; Outcome; Patient Schedules; Patients; Peer Group; Perception; Phase; Populations at Risk; Process; Protocols documentation; Provider; Psychosocial Assessment and Care; Qualitative Research; Records; Regimen; Research; Research Personnel; Resources; Risk; Risk Factors; Role; Services; Shapes; Staging; Survival Rate; Symptoms; Testing; Therapy Clinical Trials; Treatment Protocols; Visit; Vulnerable Populations; Work; base; brief intervention; cancer care; chemotherapy; clinical application; cognitive change; computerized data processing; coping; evidence based guidelines; experience; gastrointestinal; improved; mortality; older patient; oncology; post intervention; preference; programs; psychosocial; skills; social; symptom management; therapy development; treatment adherence

DESCRIPTION (provided by applicant): The proposed study addresses the long-standing and widespread undertreatment of elderly cancer patients as recognized by the National Cancer Institute and the National Institute on Aging. We will develop and pilot test a behavioral intervention to enhance skills for coping with chemotherapy challenges among elderly colon cancer patients who are being treated with curative intent. Findings will be used to inform a larger-scale trial of this intervention, to increase quality cancer care and optimal chemotherapy completion. Background: In stages II/III colon cancer, elderly patients are more likely to receive chemotherapy regimens that are less intensive than evidence-based recommendations, reducing survival benefit. Problems with symptom management and insufficient patient support have been suggested as key factors underlying this disparity. The proposed study will extend our prior work in medical adherence interventions to elderly adults on intensive chemotherapy regimens. We will explore multi-level challenges to managing chemotherapy as perceived by elderly patients, and use these findings to inform intervention development. The Self-Regulatory Model (SRM) will guide our work to affirm coping strengths while enhancing skills for managing treatment. Research Plan: We will conduct qualitative interviews with stage II/III elderly colon cancer patients receiving chemotherapy (n=20), and review findings with MGH medical oncology staff for additional feedback. Findings will be used to develop a brief behavioral intervention to enhance patient skills for managing chemotherapy challenges. The intervention will be tested in an open trial with elderly colon cancer patients scheduled to initiate chemotherapy (n=12). Intervention process data and pre-/post-intervention psychosocial and medical data will be collected to assess feasibility and acceptability. In an iterative process, ongoing data from exit interviews and therapist experience will be used to modify the intervention protocol. Environment: Study visits will be conducted at the Massachusetts General Hospital Cancer Center (MGHCC) and MGH North Shore Cancer Center (MGHNCC), two major centers with large chemotherapy bays and ample clinical resources. The PI, a new investigator, will receive input from a team of experts in behavioral interventions for medical adherence, psychosocial care in advanced cancer, qualitative research in oncology settings, clinical applications of empirically supported talk therapies, and clinical trials in gastrointestinal cancers, respectively. The investigators will access resources at several MGH institutions, including the Center for Gastrointestinal Cancers, the Center for Psychiatric Oncology and Behavioral Science, and the Behavioral Medicine Service. Relevance of Research: This study will inform and develop a behavioral intervention with the potential to increase rates of optimal chemotherapy completion and disease-free survival benefits of treatment.

描述（由申请人提供）：拟议的研究解决了国家癌症研究所和国家老龄化研究所承认的老年癌症患者长期和广泛的治疗不足问题。我们将开发并试点测试一种行为干预，以提高正在接受治疗的老年结肠癌患者应对化疗挑战的技能。研究结果将用于为这种干预措施的更大规模试验提供信息，以提高癌症护理质量和最佳化疗完成率。背景资料：在II/III期结肠癌中，老年患者更有可能接受强度低于循证建议的化疗方案，从而降低生存获益。症状管理和患者支持不足的问题已被认为是造成这种差异的关键因素。这项拟议的研究将把我们先前在医疗依从性干预方面的工作扩展到接受强化化疗方案的老年人。我们将探讨老年患者对化疗管理的多层次挑战，并利用这些发现为干预措施的制定提供信息。自我调节模型（SRM）将指导我们的工作，以确认应对优势，同时提高管理治疗的技能。研究计划：我们将对接受化疗的II/III期老年结肠癌患者（n=20）进行定性访谈，并与MGH肿瘤内科工作人员一起审查结果，以获得额外的反馈。研究结果将用于开发一种简短的行为干预，以提高患者管理化疗挑战的技能。干预措施将在一项开放试验中进行测试，老年结肠癌患者计划开始化疗（n=12）。将收集干预过程数据和干预前/后的心理社会和医学数据，以评估可行性和可接受性。在一个迭代过程中，来自离职面谈和治疗师经验的持续数据将用于修改干预方案。工作环境：研究访视将在马萨诸塞州综合医院癌症中心（MGHCC）和MGH北岸癌症中心（MGHNCC）进行，这两个主要中心拥有大型化疗室和充足的临床资源。PI是一名新的研究者，将分别从一个专家团队那里获得关于医疗依从性的行为干预、晚期癌症的心理社会护理、肿瘤学环境中的定性研究、经验支持的谈话疗法的临床应用以及胃肠道癌症的临床试验的信息。研究人员将访问几个MGH机构的资源，包括胃肠道癌症中心，精神肿瘤学和行为科学中心以及行为医学服务。研究的相关性：这项研究将提供信息并开发一种行为干预措施，有可能提高最佳化疗完成率和治疗的无病生存率。