An Expanded Framework to Measure Cognitive Function in Older Adults Undergoing Hematopoietic Cell Transplantation

项目总结/摘要 数量空前的患有血液恶性肿瘤的老年人正在接受造血细胞移植。 移植（HCT）。虽然以前只为年轻患者保留，但在过去十年中， 老年人已经接受了这种强化治疗。癌症和治疗相关的认知变化导致 痛苦，阻碍恢复正常的日常生活和角色，并恶化生活质量（QOL）。短和长- HCT对认知功能的长期影响以及这些认知变化影响生活活动的程度 老年患者的社会角色参与情况尚不清楚。认知能力下降的患病率和风险 对于老年人来说，HCT后可能更大，因为更多的现有健康状况（例如， 血管疾病）和HCT前的身体和心理功能受损，可因 治疗和整体HCT经验。为了解决这一差距，我们提出了一种生物心理社会癌症， 老化框架来测量接受HCT的老年人的认知功能。本研究将在A 目前的试点队列研究，目的是：1）检查受影响的认知领域的概况和轨迹， 通过神经心理学测试测量的认知功能; 2）确定老年评估因素 与HCT前认知损害和100天、6个月和12个月时的认知下降相关 探讨HCT后患者回归生活活动、参与社会角色和生活质量的经验 HCT前以及HCT后6个月和12个月。本研究将额外入组48例患者，这些患者为：60 岁及以上，患有血液恶性肿瘤，并在 巴菲特癌症中心患者将完成神经认知测试和老年评估， 以下时间点：HCT前和HCT后100天、6个月和12个月的随访。患者将 参与HCT前的半结构化访谈以及HCT后6个月和12个月的随访。我们有 组建了一支强大的跨学科团队，在老年医学，老年肿瘤学， 神经心理学和定性方法进行拟议的研究。这项研究将奠定基础 用于NIH职业发展奖申请和一项更大的多机构前瞻性队列研究， 确定与认知结果差的风险更大相关的因素，并帮助设计支持性护理 考虑HCT与衰老、现有健康状况和 多因素老年医学关注，以促进和改善老年HCT接受者的功能和QOL。

PROJECT SUMMARY/ABSTRACT An unprecedented number of older adults with hematological malignancies are receiving hematopoietic cell transplantation (HCT). While previously reserved for younger patients, in the past decade a growing number of older adults have undertaken this intense treatment. Cancer and treatment-related cognitive changes cause distress, hinder resumption of normal routine and roles, and worsen quality of life (QOL). The short and long- term effects of HCT on cognitive function and the extent to which these cognitive changes affect life activities and participation in social roles in older patients are not known. The prevalence and risk of cognitive decline post-HCT are likely greater for older adults because of a greater number of existing health conditions (e.g. vascular disease) and impaired physical and psychologic function pre-HCT that can be exacerbated by treatment and the overall HCT experience. To address this gap, we propose a biopsychosocial cancer and aging framework to measure cognitive function in older adults undergoing HCT. This study will expand on a current pilot cohort study and aims to: 1) examine the profile of cognitive domains affected and the trajectory of cognitive function as measured by neuropsychological testing; 2) identify geriatric assessment factors associated with pre-HCT cognitive impairment and cognitive decline at 100 days, 6 months and 12 months post-HCT; and 3) explore patients’ experiences returning to life activities, participation in social roles and QOL pre-HCT and at 6 months and 12 months post-HCT. This study will enroll 48 additional patients who are: 60 years of age and older, have a hematological malignancy and undergoing an autologous or allogeneic HCT at the Buffett Cancer Center. Patients will complete neurocognitive testing and geriatric assessments at the following time points: pre-HCT and follow-up post-HCT at 100 days, and 6 and 12 months. Patients will participate in semi-structured interviews pre-HCT and on follow up post-HCT at 6 and 12 months. We have assembled a strong interdisciplinary team with clinical and research expertise in geriatrics, geriatric oncology, neuropsychology, and qualitative methods to conduct the proposed study. This research will lay the foundation for a NIH career development award application and for a larger, multi-institutional prospective cohort study to identify factors associated with greater risk for poor cognitive outcomes and help design supportive care interventions that consider the interactions between HCT with aging, existing health conditions and multifactorial geriatric concerns to promote and improve function and QOL for older HCT recipients.