Advancing Capacity to Integrate Exercise into the Care of Older Cancer Survivors: The ACES initiative to establish guidelines, feasibility and best practices for research in cancer and aging

越来越多的老年癌症幸存者将对医疗体系构成重大挑战 由于癌症治疗和衰老对并存疾病的发展的综合影响， 残疾，以及因跌倒等伤害而意外死亡。在短短5年内，中国老年幸存者的数量 仅美国一国就预计将达到1400万人。锻炼具有改善功能和 然而，患有癌症的老年人的生活质量，尽管最近 美国人 至 幸存者。 研究 因为 癌症幸存者的锻炼指南 运动医学院(ACSM)和美国临床肿瘤学会(ASCO)，但 由于缺乏对老年癌症幸存者的临床试验，这两个职位都没有发布针对老年人的特定年龄指南 因此，临床实践仍然缺乏将运动纳入老年患者护理计划的指导。 对于有复杂健康需求的老年人来说是具有挑战性的，他们经常被排除在临床试验之外 团队缺乏专业知识、经验和资源。一位由NIH资助的癌症、运动和衰老专家 他们注意到，没有针对不同运动方式的严格计划的I-II阶段可行性试验 这将随后为第三阶段疗效试验的先验设计提供信息。尽管有这一紧急呼吁，但仍有 没有在老年癌症幸存者中进行严格设计的I期研究，包括那些有功能限制的人， 确定任何锻炼方式的可行性和安全性，特别是抵抗力训练。这个 锻炼身体 研究 改进 缺少 指南和缺乏针对老年癌症幸存者的临床试验产生了显著的 我认为S阻碍了锻炼作为一种低成本、可获得和可扩展的战略的实施 老年幸存者的结果。我们直接回应了NOT-CA-22-030说明NCI的参与 在PA-20-070中，跨学科老龄化研究的研究基础设施开发需要分阶段进行 R21/R33申请“研究建议 预付款 开发或扩展新的研究基础设施， 癌症和老龄化科学需要跨学科合作“。根据PA-20-070指南 由于需要里程碑驱动的项目，我们提出了以下分阶段的R21至R33项目：R21项目： 为老年(65岁以上)癌症幸存者制定基于共识的锻炼指南，方法是：1)组建一个社区 利益攸关方意见咨询委员会(Y1)；2)对已公布的试验和进行中的试验进行审查(Y1)； 3)进行德尔福研究，概述一套初步的锻炼建议(Y1)；4)召集 跨学科专家工作组为老年癌症制定基于共识的练习指南 幸存者(Y2)；以及5)最终确定符合指南的R33项目协议(Y2)。R33项目：建立 对功能受限的老年癌症幸存者进行抵抗力训练的可行性和安全性：1)进行一个阶段 I符合R21(Y3-5)指南的试验，2)建立适当的对照小组 对老年癌症幸存者的功能结果的未来研究(Y5)和3)产生一套最佳实践 老年人进行临床运动试验的指南(Y5)。

The growing number of aging cancer survivors will pose a significant challenge for the healthcare system because of the combined effects of cancer treatment and aging on the development of comorbid disease, disability, and accidental death from injuries such as falls. Withinjust 5 years the number of older survivors in theUnited States alone is projected to reach 14 million.Exercise has the potential to improve functioning and QoL in older adults with cancer, however, and despite recent American to survivors. Research because exercise guidelines for cancer survivors from an College of Sports Medicine (ACSM) and the American Society of Clinical Oncology (ASCO) but, due the lack of clinical trials in older cancer survivors, neither position issued age-specific guidelines for older Thus, clinical practice remains bereft of guidance to include exercise in care plans for older patients. in older adults with complex health needs is challenging and they are often excluded from clinical trials teams lack the expertise, experience and resources.An NIH funded cancer, exercise and aging expert group they noted an absence of rigorously planned phase I-II feasibility trials for different exercise modalities that would subsequently inform the a priori design of phase III efficacy trials. Despite this urgent call, there have been no rigorously designed phase I studies in older cancer survivors, including those with functional limitations, to establish the feasibility and safety of any exercise modality and particularly, resistance training. The exercise research improve lack of guidelines and the paucity of clinical t rials specific t o older cancer survivors creates a significant gap that i s impeding the implementation of exercise as a low-cost, accessible, and scalable strategy to outcomes for older survivors.We are directly responding to NOT-CA-22-030 stating NCI's participation in PA-20-070 Research Infrastructure Development for Interdisciplinary Aging Studies that calls for phased R21/R33 applications for “studies that propose advance developing or scaling up a novel research infrastructure that will the science of cancer and aging requiring interdisciplinary collaborations”. Per the PA-20-070 guidelines requiring milestone-driven projects, we propose the following phased R21 to R33 projects: R21 project: Develop consensus-based guidelines for exercise in older (65+) cancer survivors by: 1) assembling a community advisory board for stakeholder input (Y1); 2) conducting a review of published trials and trials in progress (Y1), 3) conducting a Delphi study to outline an initial set of exercise recommendations (Y1); 4) convening an interdisciplinary working group of experts to develop consensus-based exercise guidelines for older cancer survivors (Y2); and, 5) finalizing a guideline-concordant R33 project protocol (Y2). R33 project: Establish the feasibility and safety of resistance training in older functionally limited cancer survivors by: 1) conducting a phase I trial that is concordant with guidelines from the R21 (Y3-5), 2) establishing appropriate comparison groups for futures studies of functional outcomes in older cancer survivors (Y5) and 3) producing a set of best practice guidelines for the conduct of clinical exercise trials in older adults (Y5).