Advancing Capacity to Integrate Exercise into the Care of Older Cancer Survivors: The ACES initiative to establish guidelines, feasibility and best practices for research in cancer and aging

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The growing number of aging cancer survivors will pose a significant challenge for the healthcare system because of the combined effects of cancer treatment and aging on the development of comorbid disease, disability, and accidental death from injuries such as falls. Withinjust 5 years the number of older survivors in theUnited States alone is projected to reach 14 million.Exercise has the potential to improve functioning and QoL in older adults with cancer, however, and despite recent American to survivors. Research because exercise guidelines for cancer survivors from an College of Sports Medicine (ACSM) and the American Society of Clinical Oncology (ASCO) but, due the lack of clinical trials in older cancer survivors, neither position issued age-specific guidelines for older Thus, clinical practice remains bereft of guidance to include exercise in care plans for older patients. in older adults with complex health needs is challenging and they are often excluded from clinical trials teams lack the expertise, experience and resources.An NIH funded cancer, exercise and aging expert group they noted an absence of rigorously planned phase I-II feasibility trials for different exercise modalities that would subsequently inform the a priori design of phase III efficacy trials. Despite this urgent call, there have been no rigorously designed phase I studies in older cancer survivors, including those with functional limitations, to establish the feasibility and safety of any exercise modality and particularly, resistance training. The exercise research improve lack of guidelines and the paucity of clinical t rials specific t o older cancer survivors creates a significant gap that i s impeding the implementation of exercise as a low-cost, accessible, and scalable strategy to outcomes for older survivors.We are directly responding to NOT-CA-22-030 stating NCI's participation in PA-20-070 Research Infrastructure Development for Interdisciplinary Aging Studies that calls for phased R21/R33 applications for “studies that propose advance developing or scaling up a novel research infrastructure that will the science of cancer and aging requiring interdisciplinary collaborations”. Per the PA-20-070 guidelines requiring milestone-driven projects, we propose the following phased R21 to R33 projects: R21 project: Develop consensus-based guidelines for exercise in older (65+) cancer survivors by: 1) assembling a community advisory board for stakeholder input (Y1); 2) conducting a review of published trials and trials in progress (Y1), 3) conducting a Delphi study to outline an initial set of exercise recommendations (Y1); 4) convening an interdisciplinary working group of experts to develop consensus-based exercise guidelines for older cancer survivors (Y2); and, 5) finalizing a guideline-concordant R33 project protocol (Y2). R33 project: Establish the feasibility and safety of resistance training in older functionally limited cancer survivors by: 1) conducting a phase I trial that is concordant with guidelines from the R21 (Y3-5), 2) establishing appropriate comparison groups for futures studies of functional outcomes in older cancer survivors (Y5) and 3) producing a set of best practice guidelines for the conduct of clinical exercise trials in older adults (Y5).