Improving Outcomes for Older Adults Undergoing Palliative Radiation Treatment

改善接受姑息放射治疗的老年人的结果

• 批准号: 10680470
• 负责人: Kavita Vyas Dharmarajan
• 金额: $ 24.26万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10680470
• 关键词: Address; Adult; Advanced Malignant Neoplasm; Adverse effects; Aging; Award; Burn injury; Cancer Patient; Categories; Characteristics; Cognitive; Complex; Data; Data Analyses; Data Set; Decision Making; Development; Disseminated Malignant Neoplasm; Dissemination and Implementation; Dose; Elderly; Fatigue; Future; Geriatric Assessment; Geriatrics; Goals; Guidelines; Hospital Mortality; Hospitalization; Impaired cognition; Impairment; Individual; Interruption; Intervention; Knowledge; Leadership; Length; Link; Maintenance; Malignant Neoplasms; Measures; Medical Oncologist; Medicare; Nervous System Physiology; Oncology; Outcome; Pain; Palliative Care; Patient Self-Report; Patient-Focused Outcomes; Patients; Performance; Persons; Pharmaceutical Preparations; Phenotype; Prospective Studies; Prospective, cohort study; Quality of Care; Quality of life; Radiation Oncologist; Radiation Oncology; Radiation therapy; Recovery; Research Activity; Research Design; Research Personnel; Retrospective cohort study; Risk; Risk Factors; Sampling; Social support; Surveys; Testing; Toxic effect; Toxicity due to chemotherapy; Training; Training Activity; Travel; Treatment-related toxicity; Work; adverse outcome; beneficiary; body position; chemotherapy; clinical practice; experience; face mask; functional decline; functional disability; high risk; improved; improved outcome; instrument; joint mobilization; medical schools; mortality; multiple chronic conditions; older patient; opioid use; palliative; population based; premature; profiles in patients; reduce symptoms; research data dissemination; sociodemographic factors; symptomatic improvement; therapy design; therapy outcome

PROJECT SUMMARY I am a radiation oncologist and early-stage investigator at the Icahn School of Medicine at Mount Sinai. My work has focused on improving the quality of care of older adults undergoing palliative radiation therapy (RT), a treatment used in approximately 500,000 older cancer patients each year to improve quality of life. Palliative RT (PRT) – RT intended to reduce symptoms rather than achieve cure – creates both benefits and harms, particularly for older adults in whom cancer occurs in complex settings of multimorbidity and geriatric conditions including functional or cognitive impairments. PRT can dramatically improve symptoms such as pain and neurologic function. Yet it may also cause fatigue, burns, and other adverse effects that can persist for months. Other burdens include weeks of daily travel to attend PRT sessions; painful body positioning due to restricted joint mobility; and tight-fitting face masks which can be terrifying to cognitively impaired persons. If PRT is too burdensome, it is often interrupted or prematurely stopped, limiting its efficacy. Older patients may be particularly vulnerable to PRT as a result of complex and interrelated cancer-specific and geriatric conditions. Yet, little is known about the contribution of these geriatric conditions to PRT-related outcomes, including how they relate to (1) difficulties completing RT; (2) changes in function, hospitalization, and mortality after RT; and (3) self-reported toxicities and quality of life. To address these knowledge gaps, I propose 2 interrelated and complementary studies: (1) a retrospective cohort study of a large, nationally representative sample of adults ≥65 years with metastatic cancer from the 2000-2018 Medicare Current Beneficiary Survey (MCBS), which links geriatric assessment data with administrative claims, to (a) determine factors associated with PRT-related outcomes (e.g. completion of RT, function after RT, hospital admission, and mortality) and (b) characterize distinct phenotypic profiles of patient complexity, then examine their associations with the same outcomes; and (2) a prospective cohort study employing more detailed assessments than are in MCBS to (a) further refine associations of PRT with function and QOL and (b) explore associations with self-reported RT- related toxicities. Results from these studies will lead to improved recognition of individuals at high risk of poor PRT outcomes and will support a future R01 application testing a targeted and geriatrics-driven intervention that improves PRT outcomes important to older adults. My long-term goal is to be an independent investigator and leader at the intersection of geriatrics, palliative care, and radiation oncology who improves treatment decisions and designs interventions for older adults receiving PRT. The Beeson Award will support my development in (1) geriatrics and geriatric oncology; (2) population-based observational data and its analyses; (3) prospective study design and implementation in older adults; and (4) leadership in geriatrics to facilitate research dissemination and implementation. These research and training activities will ultimately prepare me to become a leader in aging who aligns RT delivery with the unique needs of older adults with advanced cancer.

项目总结

项目成果

Retrospective analysis of characteristics associated with higher-value radiotherapy episodes of care for bone metastases in Medicare fee-for-service beneficiaries.

• DOI: 10.1136/bmjopen-2021-049009
• 发表时间: 2021-10-19
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Marshall D;Aldridge MD;Dharmarajan K
• 通讯作者: Dharmarajan K

Polypharmacy in older adults with cancer undergoing radiotherapy: A review.

• DOI: 10.1016/j.jgo.2022.02.007
• 发表时间: 2022-07
• 期刊: JOURNAL OF GERIATRIC ONCOLOGY
• 影响因子: 3
• 作者: Novak, Jennifer;Goldberg, Annette;Dharmarajan, Kavita;Amini, Arya;Maggiore, Ronald J.;Presley, Carolyn J.;Nightingale, Ginah
• 通讯作者: Nightingale, Ginah

Serious Illness Communication Training Among Radiation Oncology Residents.

• DOI: 10.1016/j.prro.2022.11.008
• 发表时间: 2023-05
• 期刊: PRACTICAL RADIATION ONCOLOGY
• 影响因子: 3.3
• 作者: Christensen, Michael;Kumar, Kiran A.;Wang, Winnie S.;Dharmarajan, Kavita V.;Chang, Zieanna;McStay, Carla Khalaf;Barina, Alexis;Siropaides, Caitlin
• 通讯作者: Siropaides, Caitlin

Palliative Care as a Component of High-Value and Cost-Saving Care During Hospitalization for Metastatic Cancer.

姑息治疗是转移性癌症住院期间高价值且节省成本的护理的一部分。

• DOI: 10.1200/op.23.00576
• 发表时间: 2024
• 期刊: JCO oncology practice
• 影响因子: 4
• 作者: Lu,Sifan;Rakovitch,Eileen;Hannon,Breffni;Zimmermann,Camilla;Dharmarajan,KavitaV;Yan,Michael;DeAlmeida,JohnR;Yao,ChristopherMKL;Gillespie,ErinF;Chino,Fumiko;Yerramilli,Divya;Goonaratne,Ethan;Abdel-Rahman,Fadwa;Othman,Hiba

Association between adjuvant radiation treatment and breast cancer-specific mortality among older women with comorbidity burden: A comparative effectiveness analysis of SEER-MHOS.

有合并症负担的老年女性辅助放射治疗与乳腺癌特异性死亡率之间的关联：SEER-MHOS 的比较有效性分析。

• DOI: 10.1002/cam4.6493
• 发表时间: 2023-09
• 期刊: Cancer medicine
• 影响因子: 4