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.

项目摘要 我是西奈山伊坎医学院的放射肿瘤学家和早期研究员。我 工作的重点是提高接受姑息性放射治疗（RT）的老年人的护理质量， 每年约有50万老年癌症患者接受治疗，以改善生活质量。姑息 RT（PRT）-旨在减轻症状而不是实现治愈的RT-既有好处也有坏处， 特别是对于老年人，他们的癌症发生在复杂的环境中， 包括功能或认知障碍的病症。PRT可以显著改善疼痛等症状 和神经功能。然而，它也可能导致疲劳，烧伤和其他不良影响，可以持续 个月其他负担包括数周的日常旅行参加PRT会议;由于疼痛的身体定位， 关节活动受限;以及对认知障碍者来说可能是可怕的紧身面罩。如果 PRT负担太重，经常被中断或过早停止，限制了其功效。老年患者可能 由于复杂和相互关联的癌症特异性和老年性， 条件然而，人们对这些老年疾病对PRT相关结果的影响知之甚少， 包括它们与（1）完成RT的困难;（2）功能变化、住院和死亡率的关系 RT后;（3）自我报告的毒性和生活质量。为了解决这些知识差距，我建议2 相互关联和互补的研究：（1）一项大型的、具有全国代表性的回顾性队列研究 来自2000-2018年Medicare当前受益人调查的≥65岁转移性癌症成人样本 （MCBS），将老年评估数据与行政索赔联系起来，以（a）确定相关因素 PRT相关结局（例如，RT完成、RT后功能、住院和死亡率）和（B） 描述患者复杂性的不同表型特征，然后检查它们与相同的 结果;和（2）采用比MCBS更详细的评估的前瞻性队列研究，以（a） 进一步细化PRT与功能和QOL的关联，以及（B）探索与自我报告的RT的关联。 相关毒性。这些研究的结果将有助于提高对贫困高风险个体的认识。 PRT结果，并将支持未来的R 01应用程序测试有针对性的老年人驱动干预 改善对老年人重要的PRT结果。我的长期目标是成为一名独立调查员 他是老年病学、姑息治疗和放射肿瘤学交叉领域的领导者， 为接受PRT的老年人制定决策和设计干预措施。比森奖将支持我的 （1）老年医学和老年肿瘤学的发展;（2）基于人群的观察数据及其分析; (3)前瞻性研究设计和实施的老年人;和（4）领导在老年医学，以促进 研究的传播和实施。这些研究和培训活动最终将使我做好准备， 成为老龄化领域的领导者，将RT交付与晚期癌症老年人的独特需求相结合。

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

The Safety and Efficacy of Radiation Therapy with Concurrent Dexamethasone, Cyclophosphamide, Etoposide, and Cisplatin-Based Systemic Therapy for Multiple Myeloma.

• DOI: 10.1016/j.clml.2021.09.015
• 发表时间: 2022-03
• 期刊: CLINICAL LYMPHOMA MYELOMA & LEUKEMIA
• 影响因子: 2.7
• 作者: Nehlsen, Anthony D.;Sindhu, Kunal K.;Moshier, Erin;Richter, Joshua;Richard, Shambavi;Chari, Ajai;Sanchez, Larysa;Parekh, Samir;Cho, Hearn Jay;Jagannath, Sundar;Dharmarajan, Kavita
• 通讯作者: Dharmarajan, Kavita