Anxiety With Cancer in the Elderly (ACE): A Cognitive-Behavioral Interv

描述(申请人提供)：这项申请建议开发和评估老年癌症焦虑(≥)，这是一种基于认知行为疗法的焦虑干预措施，旨在满足患有晚期癌症的老年人(OAS；65岁)及其非正式照顾者(配偶/伴侣、成年子女)的独特需求。这项研究将开发ACE(第一阶段)；从癌症患者、他们的护理人员和医疗保健提供者那里获得关于ACE的反馈(第二阶段)；并检查ACE的可接受性、可行性和有效性(第三阶段)。意义重大。焦虑症在骨性关节炎癌症患者及其非正式照顾者中普遍存在 并与更严重的身体副作用、较低的生活质量和治疗依从性、与医疗团队的沟通不畅以及较弱的患者-肿瘤学家联盟有关。此外，超过一半符合精神疾病诊断标准的晚期癌症患者没有接受治疗。CBT是一种经过验证的治疗焦虑的方法。然而，传统的CBT并没有被量身定做，以满足患有晚期癌症的OAS及其照顾者的独特需求。明确的目标。这项研究将开发和评估基于CBT的对晚期癌症患者及其非正式照顾者焦虑的干预的可行性和可接受性。这项研究还将检查干预对焦虑、抑郁、生活质量、应对以及患者与肿瘤医生的沟通和联盟的影响。长期目标。这项研究将支持用更大、更多样化的样本对这种干预进行更广泛的检查，导致针对患有晚期癌症的OAS及其照顾者量身定做的广泛验证和可传播的干预措施。研究计划。对于第一阶段，ACE，将开发一种针对患有晚期癌症的OAS的CBT干预。在第二阶段，10名65岁或以上的患者及其主要照顾者和10名具有老年护理经验的医疗保健提供者将被要求审查ACE并提供反馈。在第三阶段，40名患有晚期癌症和临床显著焦虑的OA癌症患者及其照顾者将被随机分配到ACE或常规护理控制条件下。患者将在基线、干预期间和干预后完成评估。环境参与者将从纽约长老会癌症中心招募，该中心是纽约市最大的癌症护理中心之一，有充足的患者可用。PI将接受国际公认的临床研究人员和老龄化、心理肿瘤学和姑息治疗领域的领导者的指导，并将利用威尔康奈尔医学院(WCMC)临终研究中心和老年医学和姑息治疗部门丰富而多样的资源。与老龄化的相关性。这项研究将提供一种非药物治疗方法，降低晚期癌症患者及其照顾者的焦虑，提高他们的生活质量，并将支持未来对少数群体和其他限制生命的疾病进行干预的研究。

DESCRIPTION (provided by applicant): This application proposes to develop and evaluate Anxiety with Cancer in the Elderly (ACE), a cognitive-behavioral therapy-based (CBT) intervention for anxiety designed to meet the unique needs of older adults (OAs; ≥65 years) with advanced cancer and their informal caregivers (spouse/partner, adult children). This study will develop ACE (Phase I); obtain feedback on ACE from cancer patients, their caregivers, and healthcare providers (Phase II); and examine the acceptability, feasibility, and efficacy of ACE (Phase III). Significance. Anxiety is prevalent in OA cancer patients and their informal caregivers and is associated with more severe physical side-effects, poor quality of life and treatment adherence, poor communication with the healthcare team, and a weaker patient-oncologist alliance. In addition, over half of advanced cancer patients who meet diagnostic criteria for a psychiatric disorder do not receive treatment. CBT is a well-validated treatment for anxiety. However, traditional CBT has not been tailored to meet the unique needs of OAs with advanced cancer and their caregivers. Specific Aims. This study will develop and evaluate the feasibility and acceptability of a CBT-based intervention for anxiety in OAs with advanced cancer and their informal caregivers. This study will also examine the impact of the intervention on anxiety, depression, quality of life, coping, and patient-oncologist communication and alliance. Long-Term Objectives. This study will support a more extensive examination of this intervention with larger more diverse samples, leading to a widely validated and disseminable intervention tailored to OAs with advanced cancer and their caregivers. Research Plan. For Phase I, ACE, a CBT intervention for OAs with advanced cancer will be developed. In Phase II, ten patients, age 65 years or older and their primary caregiver and ten healthcare providers with experience in geriatric care will be asked to review ACE and provide feedback. In Phase III, forty OA cancer patients with advanced cancer and clinically significant anxiety and their caregivers will be randomly assigned to ACE or usual care control condition. Patients will complete assessments at baseline, during the intervention, and post intervention. Environment. Participants will be recruited from the New York Presbyterian Cancer Center, one of the largest cancer care centers in NYC with ample patient availability. The PI will receive mentorship from internationally recognized clinical researchers and leaders in aging, psychooncology, and palliative care and will leverage the rich and diverse resources from the Weill Cornell Medical College (WCMC) Center for End-of- Life Research and the Division of Geriatrics and Palliative Care. Relevance to Aging. This study will provide a non-pharmacologic treatment that will reduce anxiety and improve quality of life in OAs with advanced cancer and their caregivers and will support future research on interventions for OAs of minority groups and with other life-limiting illnesses.