The Impact of Comorbidity on Older Cancer Patients

描述(申请人提供)：背景：癌症通常是老年人的疾病，老年癌症患者往往比年轻的癌症患者预后更差。这可能至少部分归因于随着年龄增长而出现的无数非癌症问题。 具体目标：在老年结直肠癌患者中，我们将确定并存疾病(心脏病、慢性阻塞性肺疾病(COPD)和糖尿病)与以下疾病的关系： 初诊时的癌症分期； 1.手术切除、辅助治疗和监视结肠镜检查； 2.手术切除和辅助治疗的效果； 3.死亡、住院或生活质量下降的概率；以及 4.患者和医生的治疗偏好和治疗目标。 研究计划：最初，我们将使用基于人口的SEER-Medicare链接数据库，该数据库将肿瘤登记信息与Medicare管理数据相结合。我们将探讨心脏病、慢性阻塞性肺病和糖尿病如何影响老年结直肠癌患者的护理模式、治疗效果和结果。然后，我们将对患有结直肠癌以及三种感兴趣的共同疾病之一的患者进行定性研究。我们将确定医生和患者如何将共病情况纳入他们的治疗偏好和目标。随后将进行额外的探索性分析和赠款编写。 职业发展规划：我的职业目标是成为一名独立的研究员，应用严格的临床研究方法，将老年病学的原理纳入老年癌症患者的研究--特别是关于非癌症疾病如何影响老年患者的研究。我将与我的导师和一个熟练的多学科团队密切合作，完成一项严格的研究、课程和独立学习计划。 意义：这项工作将产生有关合并疾病对老年结直肠癌患者影响的临床相关新见解，并指导未来在这一脆弱人群中加强治疗偏好和目标沟通的努力。

DESCRIPTION (provided by applicant): BACKGROUND: Cancer is commonly a disease of the elderly, and elderly cancer patients tend to have worse outcomes than their younger counterparts. This is likely due, at least in part, to the myriad of noncancer problems that tend to accrue with age. SPECIFIC AIMS: Among elderly patients with colorectal cancer, we will identify the relation between comorbid conditions (heart disease, chronic obstructive pulmonary disease (COPD), and diabetes) and: Cancer stage at the time of initial diagnosis; 1. Use of surgical resection, adjuvant therapy, and surveillance colonoscopy; 2. Effectiveness of surgical resection and adjuvant therapy; 3. Probability of death, hospitalization, or diminished quality of life; and, 4. Patient and physician treatment preferences and goals of therapy. RESEARCH PLAN: Initially, we will use the population-based SEER-Medicare linked database, which combines tumor registry information with Medicare administrative data. We will explore how heart disease, COPD, and diabetes impact patterns of care, treatment effectiveness and outcomes of elderly colorectal cancer patients. We will then conduct a qualitative study of patients who have colorectal cancer as well as one of the three comorbid conditions of interest. We will identify how physicians and patients incorporate comorbid conditions into their treatment preferences and goals. This will be followed by additional exploratory analyses and grant-writing . CAREER DEVELOPMENT PLAN: My career goal is to become an independent investigator, applying rigorous clinical research methods that incorporate the principles of geriatrics into the study of elderly patients with cancer - specifically on how non-cancer conditions affect elderly patients. I will work closely with my mentors and a skilled multi-disciplinary team, completing a rigorous program of research, coursework, and independent study. SIGNIFICANCE: This work will generate clinically relevant new insights about the impact of comorbid illness on elderly patients with colorectal cancer, and guide future efforts to enhance communication of treatment preferences and goals in this vulnerable population .