Mitigating Cancer-Related Cognitive Dysfunction in Older Adults with Breast Cancer

项目总结 癌症相关认知功能障碍(CRCD)是一个严重的问题，高达75%的患者接受 化疗。老年人患慢性阻塞性肺疾病的风险更大，这可能会对他们的功能产生负面影响 独立性和生活质量。记忆和注意力适应训练(MAAT)是一种很有前途的工具 改善患有CRCD的年轻癌症幸存者的认知能力。对于患有癌症的老年人，MAAT 可以在化疗的同时使用，以缓解CRCD的发展(当风险最高时)和 慢性阻塞性肺疾病对老年人功能独立性的影响。然而，MAAT将需要适应 满足老年人的独特需求，以优化这一群体的可用性和有效性。我曾与 我的导师为这项提议开发了初步数据，证明：1)年长的患者和照顾者 关注化疗的认知影响；2)近一半的乳腺癌患者接受了 辅助化疗报告临床上自我报告的认知能力显著下降；3)研究是可行的 接受化疗的老年癌症患者临床试验中的行为干预；4)老年人 接受化疗的成年人有兴趣参加一项评估认知能力的临床试验 干预。这项提案的首要目标是利用患者的意见使MAAT适应老年人 和照顾者利益相关者，并随后收集关于调整后的MAAT的初步效果的数据 知觉认知、客观认知测量与功能独立性的研究 接受辅助化疗的老年乳腺癌患者与主动控制条件下的2- ARM飞行员随机对照试验(RCT)。该研究计划结合了标准化量化方法的使用 使用半结构化访谈(混合方法)测量认知和功能独立性，以便 来自两者的数据可以集成在一起，以更好地了解未完全捕获的MAAT-G的影响 仅通过传统的数量指标。马格努森博士是老年医学领域的一位新兴领导者 关注认知的肿瘤学。然而，为了成为一名独立的研究人员，设计和 实施行为干预以防止认知能力下降并改善老年人的预后 对于癌症，她需要在以下方面进行额外的培训和经验：1)CRCD测量和生物评估 CRCD的机制；2)涉及认知干预的随机对照试验的设计、执行和分析；3)认知干预 混合方法试验的设计和分析；以及4)发展和完善她的领导技能。一个 杰出的导师团队支持这一建议(莫希勒/赫里亚-老年肿瘤学/领导力， Janelsins/Ferguson-CRCD/认知干预，LIN-认知老化，次日行为干预， Wittink-混合方法，卡拉科娃-生物统计学)。培训和研究计划将使马格努森博士 成为研究认知和认知干预的为数不多的老年肿瘤学家之一，并开发出 对有CRCD风险的老年人进行亟需的认知干预。

PROJECT SUMMARY Cancer-related cognitive dysfunction (CRCD) is a significant problem, affecting up to 75% of patients receiving chemotherapy. Older adults are at greater risk of developing CRCD which can negatively affect their functional independence and quality of life. Memory and Attention Adaptation Training (MAAT) is a promising tool that improves perceived cognition in younger cancer survivors with CRCD. For older adults with cancer, MAAT could be delivered alongside chemotherapy to mitigate the development of CRCD (when risk is highest) and CRCD-related effects on functional independence for older adults. However, MAAT will require adaptation to meet the unique needs of older adults to optimize usability and efficacy for this population. I have worked with my mentors to develop preliminary data for this proposal, demonstrating: 1) older patients and caregivers are concerned about the cognitive effects of chemotherapy; 2) nearly half of patients with breast cancer receiving adjuvant chemotherapy report a clinically significant decline in self-reported cognition; 3) it is feasible to study behavioral interventions in clinical trials for older adults with cancer receiving chemotherapy; and 4) older adults receiving chemotherapy are interested in participating in a clinical trial evaluating a cognitive intervention. The overarching goal of this proposal is to adapt MAAT for older adults using input from patient and caregiver stakeholders, and subsequently gather data on the preliminary effects of the adapted MAAT (MAAT-Geriatrics [G]) on perceived cognition, objective cognitive measures and functional independence in 85 older adults with breast cancer receiving adjuvant chemotherapy compared to active control condition in a 2- arm pilot randomized controlled trial (RCT). The research plan combines the use of standardized quantitative measures of cognition and functional independence with semi-structured interviews (mixed methods), so that data from both can be integrated to gain a better understanding of MAAT-G's effects that are not fully captured by traditional quantitative measures alone. Dr. Magnuson is an emerging leader in the field of geriatric oncology with a focus on cognition. However, in order to become an independent researcher who designs and implements behavioral interventions to prevent cognitive decline and improve outcomes for older adults with cancer, she requires additional training and experience in: 1) CRCD measurement and assessment of biologic mechanisms of CRCD; 2) the design, execution and analysis of RCTs involving cognitive interventions; 3) the design and analysis of mixed methods trials; and 4) development and refinement of her leadership skills. An outstanding mentor team supports this proposal (Mohile/Hurria–geriatric oncology/leadership, Janelsins/Ferguson–CRCD/cognitive interventions, Lin–cognitive aging, Morrow–behavioral interventions, Wittink–mixed methods, Culakova-biostatistics). The training and research plan will position Dr. Magnuson to become one of the few geriatric oncologists studying cognition and cognitive interventions, and develop a much-needed cognitive intervention for older adults at risk for developing CRCD.