Preserving Physical Function in Older Adults with Cancer: Impact of an Optimizing Nutrition Intervention Applied Before and After Surgery
保留患有癌症的老年人的身体功能:手术前后应用优化营养干预的影响
基本信息
- 批准号:10643468
- 负责人:
- 金额:--
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2023
- 资助国家:美国
- 起止时间:2023-07-01 至 2027-06-30
- 项目状态:未结题
- 来源:
- 关键词:Activities of Daily LivingAddressAdultAdvanced Malignant NeoplasmAmino AcidsAnabolismAnorexiaBiphasic PatternCachexiaCancer EtiologyCancer SurvivorClinicalCompensationDataDeteriorationDietary InterventionDimensionsDiseaseElderlyEligibility DeterminationEnrollmentFaceFrail ElderlyGastrointestinal Surgical ProceduresGenitourinary systemGoalsHealthHealthcare SystemsImpaired wound healingInflammationInterventionKnowledgeLeucineLinkMalignant NeoplasmsMalignant neoplasm of gastrointestinal tractMalnutritionMetabolicMissionMorbidity - disease rateMultivitaminMuscleMuscle functionMuscular AtrophyMusculoskeletalNutrientNutritionalNutritional SupportOperative Surgical ProceduresOstomyOutcomeOutcome MeasurePatient-Focused OutcomesPatientsPerioperativePersonal SatisfactionPhasePhysical FunctionPhysiologicalPopulationPostoperative ComplicationsPostoperative PeriodPragmatic clinical trialProtein-Energy MalnutritionProteinsQuality of lifeRandomizedRandomized, Controlled TrialsRecommendationRecoveryRegimenResearchRiskRisk FactorsSurgical complicationSymptomsTestingUrogenital CancerVeteransVitamin AVitamin DVomitingWalkingage-related muscle lossagedappetite lossbeta-hydroxyisovaleric acidcancer cachexiacancer surgerycancer therapychemotherapycombatcopingeffective interventionefficacy evaluationexercise intensityexercise interventionexperiencefrailtyfunctional declinefunctional improvementfunctional restorationgastrointestinalhigh riskhigh risk populationimprovedlipid metabolismmortalityneglectnovelnutritionnutrition related cancerolder patientpreservationpreventprotein metabolismreduce symptomsresearch and developmentresistance exerciserestorationsecondary outcomeside effectsystemic inflammatory responsetargeted treatmenttreatment armtreatment optimizationtumor progression
项目摘要
Cancer is a common cause of [functional decline and morbidity] in older adults, with more than two-thirds of
new cases occurring in adults aged 60 years or more. Surgery is the most effective cancer treatment, but it
brings many risks that threaten recovery of physical function in older patients. Older adults needing surgical
treatment face the threats of age-related loss of muscle [quality, strength and endurance, malnutrition
(including cancer-related nutrition impact)], inflammation, and cachexia [caused by cancer and its
treatments]. Further, older adults often experience marked deterioration of functional abilities and reduced
physical reserve and may never regain their baseline level of physical function. This proposal addresses a gap in
knowledge on perioperative interventions to maximize restoration of functional capacity, minimize muscle loss
due to catabolic circumstances, and prevent malnutrition for these patients. Because a treatment using several
nutrients aimed at multiple mechanisms (targets) is expected to be strongly superior to single nutrient
treatment, we will use this approach to target a number of factors involved in cancer cachexia, including
anorexia, alterations in fat and protein metabolism, and systemic inflammation, as well as to prevent or correct
nutritional deficiencies. We expect this intervention to provide superior recovery of physical function and to
improve [physiologic, metabolic] and Veteran-centered outcomes versus a [typical] treatment. Thus, in a
pragmatic clinical trial, we will test a multi-targeted nutrition intervention, applied in a biphasic pattern (pre-
and post-operatively) in older Veterans newly referred for surgical cancer treatment.
In a two-armed 1:1 randomized controlled trial, we will test this nutrition-optimized treatment for senior health
(NOSH), a multi-targeted treatment provided in biphasic intervals (8 weeks before and 24 weeks after
discharge from surgery), and compare it to a [typical nutrition regimen (Typical )] with regards to (Primary
Aim 1) physical function, [(Secondary Aim 2) physiologic and metabolic outcomes], and (Exploratory Aim 3)
Veteran-centered outcomes, including quality of life (QoL), cancer-related nutrition impact symptoms, and
postoperative outcome measures. Older Veterans approaching surgery for [Stage II-III] gastrointestinal or
genitourinary cancer who are at high risk for having their physical abilities markedly decline during treatment
will be enrolled and randomized to NOSH or the [Typical regimen], with both groups prescribed low-intensity
resistance exercise thrice weekly. The NOSH intervention will include generous high-quality protein (30
g/meal; 1.5 g/kg/d) and other key nutrients linked with muscle preservation, namely b-hydroxy-b-
methylbutyrate, a metabolite of the amino acid leucine (HMB; 3 g/d), and vitamin D and a daily multivitamin
supplemented to a vitamin D level of 800 IU/d). Aim 1 will evaluate changes in physical function in the NOSH
intervention arm relative to the [Typical regimen]. Our working hypothesis is that the NOSH intervention will
result in improved physical function (Aim 1) and [physiologic and metabolic outcomes (Aim 2) relative to the
Typical regimen.] We also predict improvements in Veteran-centered outcomes (Aim 3).
This research addresses an important gap in the evidence for best practice of nutritional care for frail older
adults approaching surgical cancer treatment. If the hypotheses of this study are correct, there will be strong
evidence for a major change in treatment approaches for a heretofore mostly neglected population of high-risk
older adults with cancer. More importantly, this improvement in cancer treatment will lead to stronger, more
rapid physical recoveries and better quality of life for this population. The findings will also benefit the VA by
decreasing demands on the health care system via reductions in postoperative complications and the hastening
of recovery of physical function.
癌症是老年人[功能衰退和发病]的常见原因,超过三分之二的老年人
项目成果
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Kathryn N Starr其他文献
Kathryn N Starr的其他文献
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{{ truncateString('Kathryn N Starr', 18)}}的其他基金
Exploring the Effects of Exercise Training on PTSD Symptoms and Physical Health in Older Veterans with PTSD
探索运动训练对患有 PTSD 的老年退伍军人的 PTSD 症状和身体健康的影响
- 批准号:
10543092 - 财政年份:2020
- 资助金额:
-- - 项目类别:
Nutritional (High Protein) Perihabilitation in Older Veterans Undergoing Surgery
接受手术的老年退伍军人的营养(高蛋白)康复训练
- 批准号:
9292730 - 财政年份:2017
- 资助金额:
-- - 项目类别:
Nutritional (High Protein) Perihabilitation in Older Veterans Undergoing Surgery
接受手术的老年退伍军人的营养(高蛋白)康复训练
- 批准号:
9923463 - 财政年份:2017
- 资助金额:
-- - 项目类别:
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