Optimizing Functional Outcomes of Older Survivors After Chemotherapy

优化老年幸存者化疗后的功能结果

• 批准号: 10434652
• 负责人: Michelle C Janelsins
• 金额: $ 70.34万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10434652
• 关键词: Acceleration; Adult; Advocate; Aftercare; Age; Aging; Appointment; Behavioral; Biometry; Cancer Center; Cancer Patient; Cancer Survivor; Caregivers; Caring; Climate; Clinical Services; Clinical Trials; Cluster randomized trial; Cognition; Collaborations; Communication; Communities; Community Clinical Oncology Program; Discipline; Discipline of Nursing; Distress; Elderly; Emergency department visit; Ensure; Evaluation; Fostering; Geriatric Assessment; Geriatrics; Goals; Health Promotion; Healthcare; Hospitalization; Impaired cognition; Impairment; Intervention; Malignant Neoplasms; Medical; Modeling; National Cancer Institute; Oncology; Outcome; Patients; Personal Satisfaction; Physical Function; Population; Primary Care; Principal Investigator; Provider; Qualifying; Questionnaires; Randomized; Recommendation; Rehabilitation therapy; Reporting; Research; Sampling; Schedule; Solid Neoplasm; Standardization; Survivors; Testing; Thermometers; Training; Treatment/Psychosocial Effects; Triage; Universities; Walking; aged; arm; base; cancer therapy; chemotherapy; clinical trial enrollment; clinically relevant; clinically significant; cognitive function; comparative efficacy; efficacious intervention; efficacy testing; experience; functional outcomes; health disparity; implementation science; improved; improved outcome; innovation; multidisciplinary; novel; older patient; primary care provider; programs; provider communication; psychologic; psychosocial; recruit; response; satisfaction; survivorship; treatment as usual

Project Summary: The overarching goal of this proposal, submitted in response to RFA-CA-19-035, is to evaluate if an aging- sensitive survivorship intervention improves outcomes valued by older adults and their caregivers during the transition into survivorship from curative-intent chemotherapy. This proposal is important because by 2040, 73% of survivors will be aged 65+ and almost 50% will be aged 75+. Unfortunately, aging- related conditions (e.g., physical and cognitive function impairments) are not addressed routinely in survivorship care. Preliminary research by all multiple principal investigators (MPIs: Mohile, Janelsins, Mustian) suggests that a Geriatric Evaluation and Management (GEM) intervention is effective for surveilling, triaging and managing physical and cognitive impairments, improving patient and caregiver satisfaction, and fostering communication about aging-related conditions during chemotherapy in older cancer patients and their caregivers. Preliminary research by MPIs also suggests that a Survivorship Health Promotion program is effective for improving physical function among older survivors after chemotherapy. Our MPI team has shown that GEM and Survivorship Health Promotion are feasible to implement in older patients, survivors and caregivers in nationwide samples recruited via the University of Rochester Cancer Center (URCC) NCI Community Oncology Research Program (NCORP) Research Base network. To fill existing empirical gaps in survivorship care for older survivors and caregivers, we created a novel intervention called Survivorship-GEM by combining these two very promising and synergistic programs. Survivorship-GEM is directed by oncology advanced practice providers (APPs), because they routinely direct care for survivors in the community. We propose to conduct a two-arm cluster randomized trial comparing the efficacy of our novel Survivorship-GEM intervention to usual care for improving physical and cognitive function, satisfaction with care, completion of referral appointments, and hospitalizations among older survivors. We will also examine the effect of Survivorship-GEM on oncology APP communication with primary care providers and on caregiver distress and satisfaction with care. We will randomize 30 NCORP community oncology practices to two arms: 1) Survivorship-GEM or 2) usual care. Survivors aged 65+ (n=720) and caregivers (if available, estimated n=500) will complete baseline assessments at the end of curative-intent chemotherapy for a solid tumor malignancy with follow-ups at 6 and 12 months. Our uniquely qualified, multidisciplinary team includes expertise in geriatrics, clinical trials, nursing, primary care, behavioral oncology, rehabilitation, health disparities, biostatistics, and implementation science. The team also benefits from collaborations with the Cancer and Aging Research Group Advisory Board and the SCOREboard patient advocate group. The APP-directed Survivorship-GEM intervention is highly innovative and has tremendous potential to improve outcomes in older survivors and caregivers by surveilling, triaging and managing the effects of chemotherapy and by fostering health promotion.

项目摘要： 为响应RFA-CA-19-035而提交的本提案的总体目标是评估老化- 敏感的生存干预改善了老年人及其照顾者所重视的结果 从治愈性化疗过渡到生存期。这个提议很重要 因为到2040年，73%的幸存者年龄将在65岁以上，近50%的幸存者年龄将在75岁以上。不幸的是，衰老- 相关条件（例如，身体和认知功能障碍）在生存率中没有得到常规处理 在乎所有多个主要研究者（MPI：Mohile，Janelsins，Mustian）的初步研究表明， 老年评估和管理（GEM）干预对于监测、分类和管理 身体和认知障碍，提高患者和护理人员的满意度，并促进沟通 关于老年癌症患者及其照顾者在化疗期间与衰老相关的状况。初步 MPIs的研究还表明，生存健康促进计划对改善身体健康是有效的。 化疗后老年幸存者的功能。我们的MPI团队已经表明，GEM和生存健康 在全国范围内招募的样本中，在老年患者、幸存者和照顾者中实施推广是可行的 通过罗切斯特大学癌症中心（URCC）NCI社区肿瘤学研究计划（NCORP） 研究基地网。为了填补老年幸存者和照顾者生存护理方面现有的经验空白， 我们创造了一种新的干预称为生存GEM结合这两个非常有前途和协同作用 程序.生存-GEM由肿瘤学高级实践提供者（APP）指导，因为他们 对社区中的幸存者进行常规的直接护理。我们建议进行一项两组随机分组试验 将我们的新型生存-GEM干预与常规护理的疗效进行比较， 认知功能，对护理的满意度，完成转诊预约，以及老年人的住院情况 幸存者我们还将检查Survivorship-GEM对肿瘤学APP与主要 护理提供者和照顾者的痛苦和对护理的满意度。我们将随机抽取30个NCORP社区 肿瘤学实践分为两组：1）生存-GEM或2）常规护理。65岁以上的幸存者（n=720）和 护理人员（如果可用，估计n=500）将在治疗意图结束时完成基线评估 恶性实体瘤化疗，随访6个月和12个月。我们独一无二的， 多学科团队包括老年医学，临床试验，护理，初级保健，行为肿瘤学， 康复、健康差距、生物统计和实施科学。该团队还受益于 与癌症和衰老研究小组顾问委员会和SCOREboard患者合作 倡导团体。APP指导的生存-GEM干预具有高度创新性， 通过监测、分类和管理影响，有可能改善老年幸存者和照顾者的结局 化疗和促进健康。