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

项目摘要 癌症相关的认知功能障碍（CRCD）是一个重要的问题，影响高达75%的接受化疗的患者。 化疗老年人患CRCD的风险更大，这可能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感知认知。对于患有癌症的老年人，MAAT 可以与化疗一起提供，以减轻CRCD的发展（当风险最高时）， CRCD对老年人功能独立性的相关影响然而，MAAT将需要进行调整， 满足老年人的独特需求，以优化该人群的可用性和功效。I have worked with 我的导师为这项提议开发了初步数据，证明：1）老年患者和护理人员 关注化疗的认知影响; 2）近一半的乳腺癌患者接受 辅助化疗报告自我报告的认知有临床意义的下降; 3）研究 接受化疗的老年癌症患者临床试验中的行为干预;以及4）老年人 接受化疗的成年人有兴趣参加一项临床试验， 干预该提案的总体目标是利用患者的输入，为老年人调整MAAT 和照顾者利益相关者，并随后收集关于经调整的MAAT的初步影响的数据 （MAAT-Geriatrics [G]）对85名老年人的感知认知、客观认知测量和功能独立性的研究 接受辅助化疗的老年乳腺癌患者与积极对照组相比， 随机对照试验（RCT）。该研究计划结合使用标准化的定量 采用半结构化访谈（混合方法）测量认知和功能独立性，以便 从这两个方面获得的数据可以综合起来，以便更好地了解MAAT-G的影响，而这些影响还没有被完全捕捉到 传统的量化方法。Magnuson博士是老年医学领域的新兴领导者 关注认知的肿瘤学然而，为了成为一名独立的研究人员， 实施行为干预，以预防认知能力下降，并改善老年人的结果， 她需要额外的培训和经验：1）CRCD测量和生物学评估 CRCD的机制; 2）涉及认知干预的RCT的设计，执行和分析; 3） 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提议（Mohile/Hurria-老年肿瘤学/领导， Janelsins/Ferguson-CRCD/认知干预，Lin-认知老化，Morrow-行为干预， Wittink-混合方法，Culakova-生物统计学）。培训和研究计划将使马格努森博士 成为为数不多的研究认知和认知干预的老年肿瘤学家之一，并开发出一种 对有患CRCD风险的老年人进行急需的认知干预。

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.