A Patient-Oriented Research Program in Geriatric Oncology

以患者为中心的老年肿瘤学研究项目

• 批准号: 10370333
• 负责人: Supriya G. Mohile
• 金额: $ 17.21万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10370333
• 关键词: Adjuvant Chemotherapy; Advanced Malignant Neoplasm; Affect; Aging; Area; Assessment tool; Audiotape; Award; Benefits and Risks; Cancer Prognosis; Caregivers; Caring; Clinic; Clinical; Clinical Oncology; Cognitive; Communication; Communication Research; Communities; Community Clinical Oncology Program; Complex; Conflict (Psychology); Contracts; Data; Data Analyses; Data Set; Decision Making; Elderly; Enrollment; Frail Elderly; Funding; Geriatric Assessment; Geriatrics; Goals; Growth; Health; Health Status; Impairment; Intervention; Investigation; Knowledge; Leadership; Malignant Neoplasms; Mediating; Mentors; Modeling; Morbidity - disease rate; Oncologist; Oncology; Outcome; Palliative Care; Patient-Focused Outcomes; Patients; Performance Status; Phase; Positioning Attribute; Principal Investigator; Process; Prognosis; Randomized; Randomized Clinical Trials; Regimen; Research; Research Institute; Risk; Site; Symptoms; Toxic effect; Toxicity due to chemotherapy; Training; Uncertainty; Universities; Work; adverse outcome; age related; cancer care; cancer clinical trial; cancer therapy; care delivery; career; career development; chemotherapy; clinical encounter; clinical trial implementation; design; improved; improved outcome; innovation; innovative technologies; insight; intervention effect; mortality; novel; older patient; oncology program; patient oriented; patient oriented research; programs; research and development; research study; routine care; secondary analysis; skills; tool; treatment risk

PROJECT SUMMARY: Over 60% of cancers occur in older persons, and the number of patients with cancer is expected to grow. Geriatric assessment (GA), a validated patient-centered approach for assessing health status, can identify older patients with cancer who are at risk of adverse outcomes. The majority of oncologists have not adopted GA, largely because of lack of knowledge on how to utilize GA to guide communication and decision-making. Two multicenter cluster randomized studies in the University of Rochester (UR) NCI Community Oncology Research Program (NCORP) led by the Principal Investigator (PI) are evaluating if a GA intervention can improve communication about age-related issues (funded by a Patient Centered Outcomes Research Institute contract) and reduce toxicity from cancer treatment (funded by a NCI R01) through improved decision- making. Our preliminary data illustrates that: 1) age-related concerns and symptom burden are not addressed effectively in oncology clinical encounters; 2) community oncologists often provide chemotherapy to frail older adults with serious consequences; 3) a significant proportion of older patients with advanced cancer undergoing treatment and their caregivers believe the cancer will be cured; and 4) the majority of older patients would choose to forgo cancer treatment if they knew there would be serious functional and/or cognitive consequences. The current proposal builds on the PI's geriatric oncology program by developing new patient-oriented research and providing opportunities for mentees in this underrepresented area. The PI, a geriatric oncologist, and the research team including experts in communication, palliative care, caregiver and geriatric oncology research are well positioned to complete the aims of this proposal. The overarching aims are to: 1) develop insight into how to improve communication between older patients with cancer, their oncologists, and their caregivers about age-related concerns and symptoms, the risks and benefits of treatment, and prognosis through secondary analyses of data from the PI's multi-site studies and 2) develop and implement an intervention to integrate GA into oncology care to improve communication about the risks and benefits of chemotherapy for older patients. With support of this K24, the PI will complete specific career development activities that will enhance her skills in communication research and for mentoring and leadership. With regard to expected outcomes, this proposal will fill vital gaps in knowledge regarding the mechanisms of how GA can improve communication and outcomes. This research will have a positive impact by providing a pragmatic mechanism for incorporating GA into community oncology clinics to improve outcomes of older adults with cancer through more effective communication. This K24 will allow the PI to bridge the fields of geriatric oncology and communication research by bringing together an interdisciplinary team of experts and geriatric oncology mentees through novel analyses of existing data from funded clinical trials and the implementation of a new project.

项目概要： 超过 60% 的癌症发生在老年人中，并且癌症患者的数量预计还会增加。 老年评估 (GA) 是一种经过验证的以患者为中心的健康状况评估方法，可以识别 面临不良后果风险的老年癌症患者。大多数肿瘤学家尚未采用 GA，很大程度上是因为缺乏如何利用GA来指导沟通和决策的知识。 罗切斯特大学 (UR) NCI 社区肿瘤​​学的两项多中心整群随机研究 由首席研究员 (PI) 领导的研究计划 (NCORP) 正在评估 GA 干预是否可以 改善有关年龄相关问题的沟通（由以患者为中心的结果研究资助） 研究所合同）并通过改进决策减少癌症治疗的毒性（由 NCI R01 资助） 制作。我们的初步数据表明：1）与年龄相关的担忧和症状负担并不 在肿瘤学临床实践中有效解决； 2) 社区肿瘤​​学家经常提供化疗 体弱的老年人，后果严重； 3）很大一部分老年患者患有晚期癌症 正在接受治疗并且他们的护理人员相信癌症会被治愈； 4) 大多数老年患者 如果他们知道癌症治疗会严重影响功能和/或认知，他们会选择放弃 结果。当前的提案以 PI 的老年肿瘤学计划为基础，开发了新的 以患者为导向的研究，并为这一代表性不足的领域的学员提供机会。这 PI，一位老年肿瘤学家，以及包括沟通、姑息治疗、护理人员专家在内的研究团队 老年肿瘤学研究完全有能力完成该提案的目标。首要的 目标是：1）深入了解如何改善老年癌症患者、他们的癌症患者之间的沟通 肿瘤科医生及其护理人员了解与年龄相关的问题和症状、风险和益处 通过对 PI 多中心研究的数据进行二次分析来确定治疗和预后，2) 制定 并实施干预措施，将 GA 纳入肿瘤护理，以改善风险沟通 以及化疗对老年患者的益处。在这个K24的支持下，PI将完成特定的职业生涯 发展活动将提高她在传播研究和指导方面的技能 领导。就预期成果而言，该提案将填补有关以下方面的重要知识空白： GA 如何改善沟通和结果的机制。这项研究将产生积极影响 通过提供务实的机制将 GA 纳入社区肿瘤诊所，以改善 通过更有效的沟通来改善患有癌症的老年人的结果。该 K24 将允许 PI 通过汇集老年肿瘤学和传播研究领域 由专家和老年肿瘤学学员组成的跨学科团队通过对现有技术的新颖分析 来自资助的临床试验和新项目实施的数据。