Perioperative mental health intervention for older adults undergoing cancer surgery

摘要/项目摘要-项目2 抑郁和焦虑在老年癌症患者中被低估和治疗不足。超过一百万 今年老年人将被诊断出患有癌症。这些人中的每一个都有更大的风险， 抑郁症/焦虑症比一般老年人更严重。围手术期是一个特别脆弱的时期， 因为患者同时面临着改变生活的诊断以及功能和身体的 大手术带来的变化大多数患有癌症和抑郁/焦虑症的老年人不会 接受适当的心理健康治疗，如果他们这样做，它通常是药物治疗，进一步 加剧了本已猖獗的多种药物治疗在本提案中，我们将优化和测试定制的 为接受癌症手术的老年患者提供药物和行为干预包， 临床上显著的抑郁和焦虑症状。我们将建立一个围手术期的心理保健 干预包包括：（1）应用经过验证的行为干预，行为激活（BA）， 基于患者偏好和需求的策略;以及（2）药物优化和取消处方（MOD）， 有针对性地优化抗抑郁药物的剂量，并停止有害或无效的药物。 目标1（适应）：通过协作规划方法，我们将适应、制定和实施 最佳的围手术期心理健康干预捆绑老年人接受计划的癌症手术。 通过利益相关者的投入，我们将开发和迭代适应行为和药物优化， 在这一人群中实施干预措施。在初步方案制定之后，通过 治疗开发试验，我们将通过互动反馈迭代优化干预措施， 接受癌症大手术的65岁以上患者和其他利益相关者指出了障碍， 主持人完成节目。目的2（测试）：使用混合1型随机对照试验设计， 我们将比较干预组合与常规护理在减少以下症状方面的有效性： 接受肿瘤手术的老年癌症患者的抑郁和焦虑。为此，100名患者 有抑郁和焦虑症状的患者将被随机分配到药物和行为治疗组， 干预捆绑或常规护理。术前抑郁和焦虑与许多不良反应有关， 术后结局，包括内科并发症、福尔斯、谵妄和死亡率。因此，药物 优化和取消处方，在干预捆绑与行为激活治疗抑郁症 和焦虑的老年癌症患者，预计不仅改善抑郁和焦虑的症状 还有其他重要的术后结果。

Abstract/Project Summary – PROJECT 2 Depression and anxiety are under-recognized and undertreated in older adults with cancer. More than a million older adults will be diagnosed with cancer this year. Each of these individuals are at greater risk for depression/anxiety than the general older population. The perioperative period is a particularly vulnerable time, as the patient is concurrently confronted with a life-changing diagnosis as well as functional and physical changes that accompany a major surgery. Most older adults with both cancer and depression/anxiety do not receive appropriate mental health treatment, and if they do, it is typically pharmacologic treatment only, further exacerbating already rampant polypharmacy. In this proposal, we will optimize and test a tailored pharmacological and behavioral intervention bundle for older patients undergoing surgery for cancer, with clinically significant depressive and anxiety symptoms. We will institute a perioperative mental healthcare intervention bundle including: (1) applying a proven behavioral intervention, behavioral activation (BA), with strategies based on patient preferences and needs; and (2) medication optimization and deprescribing (MOD), targeting to optimize dosages of anti-depressant medications, and stopping harmful or ineffective medications. Aim 1 (Adaptation): Informed by a collaborative planning approach, we will adapt, develop and implement an optimal perioperative mental health intervention bundle for older adults undergoing planned cancer surgery. Through stakeholder input, we will develop and iteratively adapt a behavioral and medication optimization intervention bundle for implementation in this population. Following initial protocol development, through treatment development trials, we will iteratively optimize the intervention through interactive feedback from patients over the age of 65 undergoing major surgery for cancer, and other stakeholders, noting barriers and facilitators to program completion. Aim 2 (Testing): Using a hybrid Type 1 randomized controlled trial design, we will compare the effectiveness of the intervention bundle with usual care in reducing symptoms of depression and anxiety in older patients with cancer undergoing oncologic surgery. For this aim, 100 patients with symptoms of depression and anxiety will be randomly assigned to the pharmacological and behavioral intervention bundle or usual care. Pre-operative depression and anxiety are associated with a host of adverse outcomes after surgery, including medical complications, falls, delirium, and mortality. Thus, medication optimization and deprescribing, in an intervention bundle with behavioral activation treatment of depression and anxiety in older adults with cancer, is expected to improve not only symptoms of depression and anxiety but also other important post-operative outcomes.