Optimizing Functional Outcomes of Older Survivors After Chemotherapy

项目总结： 针对RFA-CA-19-035提交的这项提案的首要目标是评估是否存在老化- 敏感的生存干预改善老年人及其照顾者重视的结果 在从治疗意向化疗过渡到存活的过程中。这项建议很重要 因为到2040年，73%的幸存者将超过65岁，近50%的人将超过75岁。不幸的是，衰老- 相关的疾病(例如，身体和认知功能障碍)在生存中通常不会被提及。 关心。所有多名首席调查人员(MPI：Mohile，Janelsins，Mustian)的初步研究表明 老年评估和管理(GEM)干预对监测、分类和管理是有效的 身体和认知障碍，提高患者和照顾者的满意度，并促进沟通 关于老年癌症患者及其照顾者在化疗期间的衰老相关情况。初步 MPIS的研究还表明，生存健康促进计划对改善身体状况有效 化疗后老年幸存者的功能。我们的MPI团队已经证明了GEM和Survivship Health 在全国范围内招募的老年患者、幸存者和照顾者中进行推广是可行的 通过罗切斯特大学癌症中心(URCC)NCI社区肿瘤学研究计划(NCORP) 研究基地网络。为了填补老年幸存者和照顾者生存护理方面的现有经验空白， 我们创造了一种新的干预措施，名为Survivorship-GEM，将这两种非常有前途的协同作用结合在一起 程序。Survivship-GEM由肿瘤学高级实践提供商(APP)指导，因为他们 对社区中的幸存者进行例行的直接护理。我们建议进行一项双臂整群随机试验 我们的新型生存-宝石干预与常规护理在改善体力和健康方面的疗效比较 老年人的认知功能、护理满意度、转诊预约完成率和住院情况 幸存者。我们还将研究Survivorship-GEM对肿瘤学应用程序与初级医生交流的影响 护理提供者和照顾者对护理的苦恼和满意。我们将随机选择30个NCORP社区 肿瘤学实践有两个方面：1)生存-宝石或2)常规护理。65岁以上的幸存者(n=720)和 照顾者(如果有的话，估计n=500)将在治疗意向结束时完成基线评估 1例实体瘤恶性肿瘤化疗，术后6个月和12个月随访。我们唯一合格的， 多学科团队包括老年病学、临床试验、护理、初级保健、行为肿瘤学、 康复、健康差距、生物统计学和实施科学。该团队还受益于 与癌症和老龄化研究小组顾问委员会和记分板患者的合作 倡导者团体。APP导向的幸存者-宝石干预是高度创新的，并具有巨大的 通过监测、分类和管理影响改善老年幸存者和照顾者结局的潜力 通过加强化疗和促进健康促进来实现这一目标。

Project Summary: The overarching goal of this proposal, submitted in response to RFA-CA-19-035, is to evaluate if an aging- sensitive survivorship intervention improves outcomes valued by older adults and their caregivers during the transition into survivorship from curative-intent chemotherapy. This proposal is important because by 2040, 73% of survivors will be aged 65+ and almost 50% will be aged 75+. Unfortunately, aging- related conditions (e.g., physical and cognitive function impairments) are not addressed routinely in survivorship care. Preliminary research by all multiple principal investigators (MPIs: Mohile, Janelsins, Mustian) suggests that a Geriatric Evaluation and Management (GEM) intervention is effective for surveilling, triaging and managing physical and cognitive impairments, improving patient and caregiver satisfaction, and fostering communication about aging-related conditions during chemotherapy in older cancer patients and their caregivers. Preliminary research by MPIs also suggests that a Survivorship Health Promotion program is effective for improving physical function among older survivors after chemotherapy. Our MPI team has shown that GEM and Survivorship Health Promotion are feasible to implement in older patients, survivors and caregivers in nationwide samples recruited via the University of Rochester Cancer Center (URCC) NCI Community Oncology Research Program (NCORP) Research Base network. To fill existing empirical gaps in survivorship care for older survivors and caregivers, we created a novel intervention called Survivorship-GEM by combining these two very promising and synergistic programs. Survivorship-GEM is directed by oncology advanced practice providers (APPs), because they routinely direct care for survivors in the community. We propose to conduct a two-arm cluster randomized trial comparing the efficacy of our novel Survivorship-GEM intervention to usual care for improving physical and cognitive function, satisfaction with care, completion of referral appointments, and hospitalizations among older survivors. We will also examine the effect of Survivorship-GEM on oncology APP communication with primary care providers and on caregiver distress and satisfaction with care. We will randomize 30 NCORP community oncology practices to two arms: 1) Survivorship-GEM or 2) usual care. Survivors aged 65+ (n=720) and caregivers (if available, estimated n=500) will complete baseline assessments at the end of curative-intent chemotherapy for a solid tumor malignancy with follow-ups at 6 and 12 months. Our uniquely qualified, multidisciplinary team includes expertise in geriatrics, clinical trials, nursing, primary care, behavioral oncology, rehabilitation, health disparities, biostatistics, and implementation science. The team also benefits from collaborations with the Cancer and Aging Research Group Advisory Board and the SCOREboard patient advocate group. The APP-directed Survivorship-GEM intervention is highly innovative and has tremendous potential to improve outcomes in older survivors and caregivers by surveilling, triaging and managing the effects of chemotherapy and by fostering health promotion.