Patterns and predictors of symptoms, falls, and functioning across treatment and recovery in patients treated with neurotoxic chemotherapy for cancer

接受神经毒性癌症化疗的患者在整个治疗和康复过程中的症状、跌倒和功能的模式和预测因素

• 批准号: 10260394
• 负责人: KERRI M WINTERS-STONE
• 金额: $ 63.2万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-10 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10260394
• 关键词: Address; Adverse effects; Aftercare; Age; Attention; Behavioral; Body mass index; Cancer Patient; Cancer Survivor; Caring; Characteristics; Chemotherapy-Oncologic Procedure; Chemotherapy-induced peripheral neuropathy; Clinical; Clinical Pathways; Clinical Practice Guideline; Clinical assessments; Data; Development; Dose; Early Diagnosis; Early Intervention; Equilibrium; Etiology; Fall prevention; Gait; Gait abnormality; Goals; Growth; Guidelines; Health Care Costs; Impairment; Intervention; Knowledge; Lead; Life; Link; Long-Term Survivors; Longitudinal Studies; Malignant Neoplasms; Measures; Medication Management; Modeling; Monitor; Neuropathy; Obesity; Oncology; Pain management; Patient Self-Report; Patients; Pattern; Peripheral Nervous System Diseases; Persons; Phase; Physical Function; Physical activity; Prevention strategy; Provider; Quality of life; Recording of previous events; Recovery; Rehabilitation therapy; Reporting; Resources; Risk; Risk Factors; Survivors; Symptoms; Technology; Testing; Treatment Side Effects; Treatment-Related Cancer; Woman; aggressive therapy; cancer care; cancer therapy; chemotherapy; clinical practice; comorbidity; disability; disability risk; fall risk; falls; follow-up; functional decline; functional disability; high risk; improved; innovation; men; neurotoxic; novel; patient safety; productivity loss; rehabilitation strategy; sex; shared decision making; sociodemographics; survivorship; treatment planning

Recent reports suggest that falls increase by 25%-50% in cancer patients and are linked to treatment-related side effects, such as chemotherapy-induced peripheral neuropathy (CIPN), that alter mobility (gait and balance). Falls and functional impairments in cancer patients remain largely unrecognized and under-treated, in part because it is not yet known what level of symptoms impact mobility, the specific mobility deficits that increase fall and disability risk, or which patients are most at risk. Our long-term objective is to prevent falls and disability associated with cancer treatment by informing clinicians about which and when patients show increased risk for falls and functional decline and informing rehabilitation providers about which mobility deficits to target. A critical first step toward this objective is to characterize the natural trajectories of symptoms, functioning, and falls across the in-treatment and recovery phases of cancer care. To achieve this goal, we will use detailed symptom tracking, simple clinical tests, passive continuous monitoring of daily mobility and physical activity, and self-report falls and disability collected before, during, and one year after treatment in 200 patients prescribed neurotoxic chemotherapy for cancer. The Specific Aims of this study are: 1) to characterize trajectories of neuropathy symptoms and functioning (objective mobility, physical activity, self-report functioning and disability) across treatment and one year of recovery among persons receiving neurotoxic chemotherapy for cancer and 2) Determine the simplest predictors of symptom and functioning trajectories to identify patients in whom different treatment options should be considered and/or who would benefit from early and targeted rehabilitation interventions. This study is innovative because it will be the first study to 1) reveal how cancer treatment could lead to increased risk of falls and disability in survivorship, 2) measure changes in symptoms, mobility and falls across a course of chemotherapy and into recovery, 3) employ continuous passive monitoring technologies as sensitive and specific measures of mobility and activity changes during daily life; and, 4) apply a novel analytic approach - growth mixture modeling (GMM) - to identify the distinct trajectories of changes in symptoms, functioning and falls associated with neurotoxic chemotherapy. Collectively the knowledge gained from this study can be used to identify which patients might benefit from early intervention via alterations in treatment plans and/or referral to rehabilitation. Findings from this study could provide new information for oncology teams to improve patient safety and enhance survivorship care plans for those receiving neurotoxic chemotherapies. Currently, clinical practice guidelines focus on pharmacologic management of pain associated with CIPN, which remains suboptimal, with little attention to prevention of falls and functional decline. This study could have a significant impact by defining the natural trajectories of functional declines related to CIPN so that early detection efforts can be integrated into the clinical pathway of patients receiving neurotoxic treatment and targeted care provided for at-risk patients.

最近的报告表明，癌症患者的福尔斯增加了25%-50%，并与治疗相关 副作用，如化疗引起的周围神经病变（CIPN），改变活动性（步态和平衡）。 癌症患者的福尔斯和功能障碍在很大程度上仍未得到认识和治疗，部分原因是 由于尚不清楚症状影响移动性的程度， 跌倒和残疾风险，或者哪些患者风险最大。我们的长期目标是预防福尔斯和残疾 与癌症治疗相关，告知临床医生哪些患者和何时显示出增加的风险， 福尔斯和功能下降，并告知康复提供者哪些行动能力不足的目标。一个关键 实现这一目标的第一步是描述症状、功能和福尔斯跌倒的自然轨迹 癌症护理的治疗和恢复阶段。为了实现这一目标，我们将使用详细的症状跟踪， 简单的临床测试，被动持续监测日常活动和身体活动，以及自我报告的福尔斯 在200例神经毒性药物治疗前、治疗中和治疗后一年收集残疾和残疾数据 癌症的化疗本研究的具体目的是：1）描述神经病变的轨迹 症状和功能（客观活动，身体活动，自我报告功能和残疾） 接受神经毒性化疗的癌症患者的治疗和一年的康复，以及2） 确定症状和功能轨迹的最简单预测因素，以识别不同 应考虑治疗方案和/或谁将受益于早期和有针对性的康复 干预措施。这项研究具有创新性，因为它将是第一项揭示癌症治疗如何 导致福尔斯和残疾生存风险增加，2）测量症状、活动性和福尔斯的变化 在整个化疗过程和恢复中，3）采用连续被动监测技术， 敏感和具体的措施的流动性和活动的变化在日常生活中;和，4）应用一种新的分析 方法-增长混合模型（GMM）-以确定症状变化的不同轨迹， 与神经毒性化疗相关的功能和福尔斯。从本研究中获得的知识 可用于确定哪些患者可能通过改变治疗计划从早期干预中获益 和/或转介康复。这项研究的发现可以为肿瘤学团队提供新的信息， 改善患者安全，并加强接受神经毒性化疗患者的生存护理计划。 目前，临床实践指南集中在与CIPN相关的疼痛的药理学管理上， 仍然是次优的，很少注意预防福尔斯和功能下降。这项研究可能有一个 通过定义与CIPN相关的功能下降的自然轨迹， 努力可以整合到接受神经毒性治疗和靶向护理的患者的临床路径中 为高危患者提供。