OLDER BREAST CANCER PATIENTS: RISK FOR COGNITIVE DECLINE

老年乳腺癌患者：认知能力下降的风险

基本信息

批准号：
8067884
负责人：
Tim Alan Ahles
金额：
$ 80.94万
依托单位：
GEORGETOWN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-06-01 至 2014-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8067884
关键词：
Accounting Activities of Daily Living Address Adverse effects Affect Aftercare Age Aged, 80 and over Aging Alleles Alzheimer&apos s Disease Alzheimer&apos s disease risk Americas Animals Area Attention Behavioral Blood Body mass index Boston Brain Breast Breast Cancer Treatment Cancer Patient Cancer Survivorship Categories Cause of Death Chemotherapy-Oncologic Procedure Clinical Clinical Data Cognition Cognitive Cognitive Therapy Cognitive deficits Communities Comprehensive Cancer Center Consumer Advocacy Country Data Decision Making Diagnosis Diffuse Disease Dose Education Elderly Enrollment Exposure to Fatigue Female Foundations Frequencies Friends Fright Future General Population Generations Genes Genetic Polymorphism Gray unit of radiation dose Growth Guidelines Health High Prevalence Hormonal Image Impaired cognition In Situ Incidence Institute of Medicine (U.S.)Intervention Intervention Studies Interview Investigation Knowledge Language Lead Learning Life Expectancy Link Literature Magnetic Resonance Imaging Malignant Neoplasms Measures Medical Records Medicine Memorial Sloan-Kettering Cancer Center Memory Modality Modeling Moods Neurologist Neuropsychological Tests Newly Diagnosed Older Population Oncologist Outcome Participant Patients Pharmaceutical Preparations Pharmacogenetics Population Population Study President&apos s Cancer Panel Preventive Intervention Protocols documentation Psychologist Psychosocial Factor Public Health Quality of Care Quality of life Race Recommendation Records Recruitment Activity Regimen Reporting Research Research Priority Risk Risk Factors Scientist Short-Term Memory Source Speed Structure Surveys Survival Rate Symptoms System Systemic Therapy Telephone Interviews Testing Time Translating Universities Vascular Diseases Visuospatial Woman Work abstracting advocacy organizations age group base cancer therapy chemotherapy clinical decision-making cognitive change cognitive function cohort design executive function experience follow-up genetic profiling genetic risk factor gray matter hormone therapy human old age (65+)improved interest malignant breast neoplasm next generation normal aging older patient older women prevent primary outcome prospective secondary outcome trend white matter

项目摘要

DESCRIPTION (provided by applicant): Women 65 and older ("older women") account for nearly half of all new cases of breast cancer. With the "graying of America" the absolute number of older women diagnosed and undergoing breast cancer treatment will almost double by the year 2030. Treatment guidelines for these older patients include systemic therapy and older women are interested in chemotherapy for even small returns in survival extension. But systemic therapy is not without side effects, and numerous studies have documented cognitive decline after receipt of these agents. Imaging and animal studies confirm that cancer chemotherapy affects brain structure and function. However, very little is actually known about cognitive decline in older patients, because virtually all of the existing research has been conducted in younger patients. Since aging itself is associated with cognitive decline, older patients are likely to be particularly vulnerable to the adverse cognitive effects of systemic therapy. Our preliminary work suggests that this is the case, but this has never been empirically tested. This study will be the first large scale, prospective, controlled investigation to evaluate cognitive changes in older cancer patients. We use the vulnerability model of cancer survivorship to describe systemic therapy effects on cognition over a 12 month period, test associations between cognition and quality of life and to evaluate whether APOE polymorphisms moderate cognitive outcomes. We have assembled a team of oncologists, geriatricians, neurologists, neuro-, cognitive and behavioral psychologists and consumers from Lombardi Comprehensive Cancer Center, Memorial Sloan-Kettering Cancer Center, Boston University and Y- Me (a national consumer advocacy organization). We will enroll 325 newly diagnosed older breast cancer patients and an equal number of non-cancer friend controls. Participants will undergo baseline (pre-systemic therapy) neuropsychological testing and telephone interviews; clinical data will be abstracted from records. Participants will repeat cognitive testing and QOL measures 12 months after baseline. The primary outcome is change in the summary score on tests in the Attention, Working Memory, and Psychomotor Speed Domain. Four additional domains are included as secondary outcomes to assess broader cognitive function and examine differential impact: Language; Executive Functioning; Learning and Memory; Visuospatial. The results of this study will contribute to designing appropriate regimens for older women, developing preventive interventions, informing clinical decision-making about treatment, and guiding second generation studies. Overall, this topic has high research, clinical and public health importance, given the projected growth in the older population, rising incidence with advancing age, trends towards increasing use of systemic therapy in older patients, use of more aggressive dosing regimens, high survival rates, and increasing life expectancy.

描述（由申请人提供）：65 岁及以上的女性（“老年女性”）占所有新发乳腺癌病例的近一半。随着“美国老龄化”，到 2030 年，被诊断出并接受乳腺癌治疗的老年女性的绝对数量将几乎翻倍。这些老年患者的治疗指南包括全身治疗，老年女性对化疗感兴趣，因为即使是延长生存期的回报很小。但全身治疗并非没有副作用，许多研究都记录了接受这些药物后认知能力下降。影像学和动物研究证实癌症化疗会影响大脑结构和功能。然而，实际上对老年患者认知能力下降的情况知之甚少，因为几乎所有现有研究都是在年轻患者中进行的。由于衰老本身与认知能力下降有关，因此老年患者可能特别容易受到全身治疗的不良认知影响。我们的初步工作表明情况确实如此，但从未经过实证检验。这项研究将是第一个评估老年癌症患者认知变化的大规模、前瞻性、对照研究。我们使用癌症生存的脆弱性模型来描述 12 个月内系统治疗对认知的影响，测试认知与生活质量之间的关联，并评估 APOE 多态性是否会调节认知结果。我们组建了一支由肿瘤学家、老年病学家、神经学家、神经、认知和行为心理学家以及来自隆巴迪综合癌症中心、纪念斯隆-凯特琳癌症中心、波士顿大学和 Y-Me（全国消费者权益组织）的消费者组成的团队。我们将招募 325 名新诊断的老年乳腺癌患者和同等数量的非癌症朋友对照。参与者将接受基线（系统治疗前）神经心理学测试和电话访谈；临床数据将从记录中提取。参与者将在基线后 12 个月重复认知测试和生活质量测量。主要结果是注意力、工作记忆和精神运动速度领域测试总分的变化。另外四个领域被纳入作为次要结果，以评估更广泛的认知功能并检查差异影响：语言；执行职能；学习与记忆；视觉空间。这项研究的结果将有助于为老年女性设计适当的治疗方案、制定预防干预措施、为治疗的临床决策提供信息并指导第二代研究。总体而言，考虑到老年人口的预计增长、发病率随年龄增长而上升、老年患者越来越多地使用全身治疗的趋势、使用更积极的给药方案、高生存率，该主题具有很高的研究、临床和公共卫生重要性，并延长预期寿命。