PILOT STUDY OF GERIATRIC ASSESSMENTS IN SENIOR ADULTS WITH MULTIPLE MYELOMA

患有多发性骨髓瘤的老年人老年评估的试点研究

基本信息

批准号：
8342080
负责人：
Tanya M Wildes
金额：
$ 7.6万
依托单位：
WASHINGTON UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-08-01 至 2014-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8342080
关键词：
Adult Affect Age Aging Attention Autologous Benefits and Risks Blinded Cancer Center Caring Chronic Disease Clinical Trials Cohort Studies Comorbidity Data Decision Making Dependence Diagnosis Disease Disease Outcome Dose Effectiveness Elderly Enrollment Epidemiologist Future Geriatric Assessment Geriatrics Goals Hematology Institutes Intervention Knowledge Life Malignant Neoplasms Mission Modeling Multiple Myeloma Newly Diagnosed Oncologist Outcome Patients Physicians Pilot Projects Positioning Attribute Prevalence Public Health Quality of life Reporting Research Research Project Grants Risk Risk Factors Selection for Treatments Site Solid Neoplasm Stem cell transplant Syndrome Therapeutic Agents Time Toxic effect Toxicity due to chemotherapy Training Transplant Recipients Universities Walking Washington Work cancer therapy chemotherapy cohort comparative effectiveness compare effectiveness disability disorder control experience falls follow-up functional decline functional outcomes functional status hearing impairment improved innovation instrumental activity of daily living novel therapeutics older patient oncology prospective response tool treatment strategy

项目摘要

DESCRIPTION (provided by applicant): The number of older adults with multiple myeloma (MM) will double in the next two decades, yet there is a fundamental gap in knowledge of the impact of baseline geriatric syndromes on treatment selection, toxicity and outcomes in older adults with MM. No MM study to date has included comprehensive geriatric assessments or assessed the impact of therapy on geriatric domains over time. The long-term goals of this project are 1) to integrate geriatric assessments into the care of senior adults with MM so that clinicians may predict toxicity and functional decline due to MM therapy and 2) to facilitate decision-making for clinicians and patients by examining the real-world effectiveness of MM therapy in older adults. The objectives of this project are to compare the prevalence of geriatric syndromes in MM patients who receive high dose therapy/autologous stem cell transplant (HDT/ASCT) versus those who do not, and to identify which patients are vulnerable to decline in functional status. The central hypotheses are that patients with comorbidities or dependence in at least one IADL at baseline will be less likely to undergo intense therapy with HDT/ASCT and that patients with comorbidities will be more likely to develop disability in their IADLs after 6 months of followup. The rationale for the proposed research is that understanding the impact of baseline geriatric factors on treatment decisions and identifying which patients are at risk for functional decline will allow more personalized decision-making and targeted interventions for older MM patients at risk for decline. The objectives will be accomplished through two specific aims: 1) To explore the relationship between baseline geriatric assessments and initial treatment selection in older adults with newly diagnosed multiple myeloma; and 2) To determine whether baseline geriatric syndromes predict decline in functional status at 6 months of follow-up in older adults with newly diagnosed multiple myeloma. Aim 1 will be accomplished in an prospective pilot cohort study of 30 patients over the age of 65 with recently diagnosed MM seen at Siteman Cancer Center/ Washington University. Patients will complete the Cancer and Aging Research Group geriatric assessment tool; associations between baseline geriatric assessments and initial treatment strategy (HDT/ASCT vs nontransplant) will be evaluated. For Aim 2, the cohort enrolled in Aim 1 will undergo repeat geriatric assessments at 3 and 6-months of follow-up; risk factors for functional decline will be identified. The contribution of this propsed research is significant because it is the first step in a continuum of research expected to compare the effectiveness of HDT/ASCT to non-transplant treatment strategies both in terms of disease-control and the impact of therapy on quality of survival. The proposed research is innovative because it anticipates an impending paradigm shift wherein cancer is becoming a chronic illness, using MM as a model malignancy to study the interrelationships among geriatric syndromes, treatment selection, long-term toxicities of cancer treatment and survival. PUBLIC HEALTH RELEVANCE: The proposed research is relevant to public health because 10,000 people die of multiple myeloma each year, most of them older adults. While treatment for multiple myeloma can prolong life, the impact of these treatments on functional status and quality of survival is unknown. Thus, the proposed research is relevant to the National Institute of Aging's mission to extend the healthy, active years of life.

描述（由申请人提供）：多发性骨髓瘤（MM）的老年人人数将在未来二十年内翻一番，但了解基线老年综合症对治疗选择，毒性和较旧的结果的影响存在根本的差距成人毫米。迄今为止，尚无MM研究包括全面的老年评估或评估治疗对老年域的影响。该项目的长期目标是1）将老年评估整合到具有MM的老年人的护理中，以便临床医生可以通过检查临床医生预测毒性和功能下降，2）通过检查临床医生和患者的决策MM治疗在老年人中的现实有效性。该项目的目的是比较接受高剂量治疗/自体干细胞移植（HDT/ASCT）与没有的患者的MM老年综合征的患病率，并确定哪些患者容易下降功能状况。中心假设是，在基线时至少有一个IADL的合并症或依赖性的患者不太可能接受HDT/ASCT进行严格的治疗，并且在6个月后，合并症患者更有可能在其IADLS中发展残疾。拟议的研究的理由是，了解基线老年因素对治疗决策的影响，并确定哪些患者有功能下降的风险将允许对面临下降风险的老年MM患者进行更多个性化的决策和有针对性的干预措施。目标将通过两个具体的目的来实现：1）探讨新诊断为多发性骨髓瘤的老年人基线老年评估与初始治疗选择之间的关系； 2）确定基线老年综合症是否可以预测新诊断为多发性骨髓瘤的老年人的6个月随访时功能状况下降。 AIM 1将在一项预期的试点队列研究中完成，对30名65岁以上的患者进行，最近在现场癌症中心/华盛顿大学看到的MM。患者将完成癌症和衰老研究小组老年评估工具；将评估基线老年评估与初始治疗策略（HDT/ASCT与非移植）之间的关联。对于AIM 2，参加AIM 1的队列将在3个月和6个月的随访中重复进行老年评估；将确定功能下降的风险因素。这项支撑研究的贡献非常重要，因为它是一项连续研究的第一步，预计将HDT/ASCT与疾病控制和治疗对生存质量的影响有关的HDT/ASCT与非移植治疗策略进行比较。。拟议的研究具有创新性，因为它预计即将发生的范式转变，其中癌症正成为一种慢性疾病，使用MM作为模型恶性肿瘤来研究老年综合症之间的相互关系，治疗选择，癌症治疗的长期毒性和生存。公共卫生相关性：拟议的研究与公共卫生有关，因为每年有10,000人死于多发性骨髓瘤，其中大多数是老年人。虽然多发性骨髓瘤的治疗可以延长寿命，但这些治疗对功能状态和生存质量的影响尚不清楚。因此，拟议的研究与国家老化研究所的使命延长健康活跃的生活。