Mitigating Cancer-Related Cognitive Dysfunction in Older Adults with Breast Cancer

缓解老年乳腺癌患者与癌症相关的认知功能障碍

• 批准号: 10356909
• 负责人: Allison Marian Magnuson
• 金额: $ 23.84万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-15 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10356909
• 关键词: Address; Adjuvant Chemotherapy; Affect; Age; Area; Attention; Award; Behavior Therapy; Behavioral; Biological; Biological Factors; Biometry; California; Cancer Etiology; Caregivers; Clinical; Clinical Trials; Cognition; Cognitive; Cognitive Therapy; Cognitive aging; Cohort Studies; Community Clinical Oncology Program; Coping Skills; Data; Development; Digit structure; Educational Intervention; Educational workshop; Elderly; Enrollment; Ensure; Evaluation; Failure; Feedback; Financial compensation; Geriatric Assessment; Geriatrics; Goals; Hydrocortisone; Impaired cognition; Integration Host Factors; Intervention; Intervention Studies; Interview; Leadership; Malignant Neoplasms; Measurable; Measurement; Measures; Mediating; Memory; Mentors; Methods; Neuropsychological Tests; Neuropsychology; Oncologist; Oncology; Participant; Patient Self-Report; Patients; Perception; Persons; Population; Positioning Attribute; Psychological Factors; Psychologist; Quality of life; Randomized; Randomized Controlled Trials; Reporting; Research; Research Personnel; Risk; Salivary; Series; Site; Standardization; Structure; Survivors; Teaching Method; Techniques; Testing; Time; Training; Treatment-Related Cancer; Universities; Verbal Learning; Videoconferencing; Woman; Work; active control; aged; arm; behavioral study; biological adaptation to stress; cancer risk; cancer therapy; cancer-related cognitive impairment; caregiver interventions; chemotherapy; clinically significant; cognitive function; cognitive rehabilitation; cognitive reserve; comorbidity; coping mechanism; design; executive function; experience; follow-up; functional independence; health information technology; improved; improved outcome; innovation; instrumental activity of daily living; interest; malignant breast neoplasm; memory process; multidisciplinary; negative affect; older patient; prevent; primary outcome; processing speed; programs; side effect; skills; stress management; telephone-based; tool; usability; young cancer survivor

PROJECT SUMMARY Cancer-related cognitive dysfunction (CRCD) is a significant problem, affecting up to 75% of patients receiving chemotherapy. Older adults are at greater risk of developing CRCD which can negatively affect their functional independence and quality of life. Memory and Attention Adaptation Training (MAAT) is a promising tool that improves perceived cognition in younger cancer survivors with CRCD. For older adults with cancer, MAAT could be delivered alongside chemotherapy to mitigate the development of CRCD (when risk is highest) and CRCD-related effects on functional independence for older adults. However, MAAT will require adaptation to meet the unique needs of older adults to optimize usability and efficacy for this population. I have worked with my mentors to develop preliminary data for this proposal, demonstrating: 1) older patients and caregivers are concerned about the cognitive effects of chemotherapy; 2) nearly half of patients with breast cancer receiving adjuvant chemotherapy report a clinically significant decline in self-reported cognition; 3) it is feasible to study behavioral interventions in clinical trials for older adults with cancer receiving chemotherapy; and 4) older adults receiving chemotherapy are interested in participating in a clinical trial evaluating a cognitive intervention. The overarching goal of this proposal is to adapt MAAT for older adults using input from patient and caregiver stakeholders, and subsequently gather data on the preliminary effects of the adapted MAAT (MAAT-Geriatrics [G]) on perceived cognition, objective cognitive measures and functional independence in 85 older adults with breast cancer receiving adjuvant chemotherapy compared to active control condition in a 2- arm pilot randomized controlled trial (RCT). The research plan combines the use of standardized quantitative measures of cognition and functional independence with semi-structured interviews (mixed methods), so that data from both can be integrated to gain a better understanding of MAAT-G's effects that are not fully captured by traditional quantitative measures alone. Dr. Magnuson is an emerging leader in the field of geriatric oncology with a focus on cognition. However, in order to become an independent researcher who designs and implements behavioral interventions to prevent cognitive decline and improve outcomes for older adults with cancer, she requires additional training and experience in: 1) CRCD measurement and assessment of biologic mechanisms of CRCD; 2) the design, execution and analysis of RCTs involving cognitive interventions; 3) the design and analysis of mixed methods trials; and 4) development and refinement of her leadership skills. An outstanding mentor team supports this proposal (Mohile/Hurria–geriatric oncology/leadership, Janelsins/Ferguson–CRCD/cognitive interventions, Lin–cognitive aging, Morrow–behavioral interventions, Wittink–mixed methods, Culakova-biostatistics). The training and research plan will position Dr. Magnuson to become one of the few geriatric oncologists studying cognition and cognitive interventions, and develop a much-needed cognitive intervention for older adults at risk for developing CRCD.

项目摘要 与癌症相关的认知功能障碍（CRCD）是一个重大问题，影响多达75％的患者接受 化学疗法。老年人有更大的风险患CRCD，这可能会对其功能产生负面影响 独立性和生活质量。记忆和注意力适应训练（MAAT）是一个有前途的工具 通过CRCD改善了年轻癌症存活的认知。对于癌症的老年人，MAAT 可以与化学疗法一起进行以减轻CRCD的发展（风险最高）和 CRCD相关的对老年人功能独立性的影响。但是，MAAT需要适应 满足老年人的独特需求，以优化该人群的可用性和效率。我曾与 我的导师要为此提案制定初步数据，证明：1）老年患者和看护者是 关注化学疗法的认知作用； 2）几乎一半的乳腺癌患者接受 辅助化疗报告自我报告认知的临床显着下降； 3）研究是可行的 接受化疗的癌症老年人的临床试验中的行为干预； 4）年龄较大 接受化疗的成年人有兴趣参加评估认知的临床试验 干涉。该提案的总体目标是使用患者的意见适应老年人的MAAT 和照料者利益相关者，随后收集有关改编的MAAT初步影响的数据 （Maat-Geriatrics [g]）关于感知认知，客观认知措施和功能独立性85 与2-的主动对照条件相比，患有乳腺癌的老年人接受了调整化疗 手臂飞行员随机对照试验（RCT）。研究计划结合了标准化定量的使用 通过半结构化访谈（混合方法）的认知和功能独立性的度量，以便 可以整合来自两者的数据，以更好地了解MAAT-G的效果，但未完全捕获 仅通过传统的定量措施。 Magnuson博士是老年人领域的新兴领导者 肿瘤学的重点是认知。但是，为了成为设计和设计的独立研究人员 实施行为干预措施，以防止认知能力下降并改善老年人 癌症，她需要额外的培训和经验：1）CRCD测量和评估生物学 CRCD的机制； 2）RCT的设计，执行和分析涉及认知干预； 3） 混合方法试验的设计和分析； 4）发展和完善她的领导能力。一个 杰出的心理团队支持这一建议（Mohile/Hurria-敏锐肿瘤学/领导力， Janelsins/Ferguson – CRCD/认知干预措施，LIN认知衰老，明天 - 行为干预措施， wittink - 混合方法，culakova-biostatistics）。培训和研究计划将把马格努森博士定位为 成为研究认知和认知干预措施的少数老年肿瘤学家之一，并发展 急需患有CRCD风险的老年人的认知干预。