Grants for Early Medical/Surgical Specialists' Transition to Aging Research (GEMSSTAR)

项目摘要：超过一半的新诊断癌症患者年龄在65岁以上，而老年患者的数量 随着人口老龄化，患有癌症的成年人预计会增加。患有癌症的老年人更有可能是 治疗不足和过早中断治疗的患者比年轻患者更多，通常导致 更糟糕的结果。研究表明，糟糕的症状管理和社会支持不足可能解释了 这是对老年癌症患者的次优治疗。因此，努力更好地理解和解决姑息性 老年癌症患者的护理需求至关重要。我们建议开发一个老年门诊 护理干预侧重于患有不可治愈的胃肠道(GI)的老年人独特的姑息护理需求 和肺癌。在老年癌症中，胃肠道癌和肺癌是癌症死亡的主要原因。 人群中，以及患有不可治愈的胃肠道疾病和肺癌的患者经历了高发病率的身体和 心理症状。我们将首先对肿瘤学、老年病和姑息治疗进行定性访谈。 临床医生，随后是患者，探索他们对干预的必要组成部分的看法。 通过探索这些关键利益相关者的观点，我们寻求开发一种跨学科的干预措施，以 老年不治之癌患者的需求。值得注意的是，干预将全面解决 这些患者独特的老年和姑息治疗需求。然后我们将进行随机试验(n=50) 老年护理干预与常规护理的可行性对照试验(RCT) ≥70岁的患者患有新诊断的不可治愈的癌症。我们将估计干预措施的影响规模 生活质量、身体功能、身体和心理症状、认知和老年障碍。这个 研究将在马萨诸塞州综合医院进行，利用该公司的临床和研究专业知识 癌症中心、老年医学部、姑息保健科和精神病科 行为医学服务部。主要导师将由詹妮弗·特梅尔医学博士提供，她是一位全国性的- 在为不治之症患者开发和测试支持性护理干预措施方面的公认专家 癌症。其他导师包括Lara Traeger博士、Ardeshir Hashmi医学博士、Vicki Jackson医学博士、公共卫生硕士、Supriya Mohile，医学博士和William Dale，医学博士。这个由老年肿瘤学专家组成的良师益友团队 护理、定性研究方法和干预发展致力于确保 拟开展的研究。拟议的研究不仅将加深我们对老年人支持性护理需求的了解 老年癌症患者，但也开发了一种新的干预措施来解决这些担忧并改善 这些患者群体的生活质量。值得注意的是，GEMSSTAR将提供至关重要的支持，因为我寻求成为 老年肿瘤学研究的领先者。我的首要目标是成为一名独立调查员，研究 改善为癌症老年患者提供的支持性护理的干预措施。这笔赠款将提供 支持我在老龄化研究方面建立跟踪记录所需的指导、培训和经验。

Project Summary: Over half of newly diagnosed cancer patients are over age 65, and the number of older adults with cancer is expected to grow as the population ages. Older adults with cancer are more likely to be undertreated and experience premature discontinuation of treatment than younger patients, often resulting in worse outcomes. Studies suggest that poor symptom management and inadequate social support may explain this suboptimal treatment of older cancer patients. Thus, efforts to better understand and address the palliative care needs of older adults with cancer are critically important. We propose to develop an outpatient geriatric care intervention focused on the unique palliative care needs of older adults with incurable gastrointestinal (GI) and lung cancers. GI and lung cancers are among the leading causes of cancer death in the geriatric cancer population, and patients with incurable GI and lung cancers experience high rates of both physical and psychological symptoms. We will first conduct qualitative interviews with oncology, geriatric and palliative care clinicians, followed by patients, to explore their perceptions of the necessary components of the intervention. By exploring the views of these key stakeholders, we seek to develop a transdisciplinary intervention tailored to the needs of older patients with incurable cancer. Notably, the intervention will comprehensively address the unique geriatric and palliative care needs of these patients. We will then conduct a pilot (n=50), randomized controlled trial (RCT) to demonstrate the feasibility of the geriatric care intervention versus usual care in patients age ≥70 with newly diagnosed, incurable cancer. We will estimate the effect size of the intervention for quality of life, physical function, physical and psychological symptoms, cognition and geriatric impairments. The study will take place at Massachusetts General Hospital, drawing on the clinical and research expertise of the Cancer Center, Geriatric Medicine Unit, Palliative Care Department and the Department of Psychiatry's Behavioral Medicine Service. Primary mentorship will be provided by Jennifer Temel, MD, a nationally- recognized expert in the development and testing of supportive care interventions for patients with incurable cancers. Additional mentors include Lara Traeger PhD, Ardeshir Hashmi MD, Vicki Jackson MD, MPH, Supriya Mohile, MD, MS and William Dale, MD, PhD. This mentorship team of experts in geriatric oncology, palliative care, qualitative research methods and intervention development are committed to ensuring the success of the proposed research. The proposed study will not only further our understanding of the supportive care needs of older adults with cancer, but also develop a novel intervention to address these concerns and improve the quality of life of this patient population. Notably, the GEMSSTAR will provide vital support as I seek to become a leader in geriatric oncology research. My overarching goal is to become an independent investigator studying interventions to improve the supportive care provided to older adults with cancer. This grant will provide support for the mentorship, training and experience I need to establish a track record in aging research.