Optimizing Functional Outcomes of Older Survivors After Chemotherapy

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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.