Older adults (65+) represent >60% of all cancer survivors. Despite a rapidly aging US population, increasing life expectancy, and rising cancer rates with advancing age, older survivors are under-represented in cancer research, further exacerbated by shortage of investigators trained to address the needs of this heterogeneous group. This career development award is designed to provide integrated training and research experience to support Dr. Faul's goal of becoming an independent investigator in cancer survivorship and aging, specifically to design and evaluate behavioral and psychosocial interventions to improve outcomes of older patients and survivors. Proposed training plans include mentorship and coursework in gerontology, gero-oncology, and research methodology, filling gaps in training regarding the clinical care of elderly patients/survivors and research considerations in behavioral intervention for older adults. BACKGROUND: Older women face synergistic forces of aging and breast cancer treatment where diminished physiologic reserve and increased comorbidities, both hallmarks of advancing age, may confer added risk of functional impairment from treatment. Follow-up care is vital to ongoing health of survivors, particularly important among older women where functional declines may exacerbate frailty and loss of the ability to live independently. Implementation of survivorship care plans is recommended by the IOM, ACoS and ASCO to improve quality of care and outcomes;however scant evidence exists as to their efficacy, nor have care plans tailored to address specific unique needs of older women with cancer. The proposed research in this application addresses recent NCI priority area of examination of survivorship care planning and 2 other public health priority areas of NCI, enhancing the long-term functioning of survivors and improving quality of cancer care.
AIMS : Guided by Andersen's behavioral model informed by Bandura's self-efficacy, the proposed research will (1)examine the relationships between survivorship care planning and functional status of older breast cancer survivors and explore pathways (posited mediators) of the association between care planning and functioning, and (2 based on the results of the previous aim, develop and evaluate the efficacy of a targeted intervention, i.e., survivorship care plan addressing the specific needs of older survivors and skills coaching, among older women completing breast cancer treatment. The results of Phase 1 analyses will be used to finalize materials for a Phase 2 RCT intervention trial to improve functional status of older women completing breast cancer treatment. SUMMARY: The proposed research complements the training and mentorship plans in gero- oncology, aging, behavioral interventions and biostatistics. Through this award Dr. Leigh Anne Faul will meld her previous training in behavioral oncology with gerontology and geriatric oncology to establish an independent research career focusing in cancer survivorship and aging.
The proposed research addresses a new priority area of the National Cancer Institute, survivorship care planning as well as 2 of 4 of NCI's public health priority areas in cancer control, specifically improving outcomes of cancer survivors and enhancing quality of care. This study focuses testing associations and pathways between survivorship care planning and functioning in elderly survivors and includes the development and evaluation of a targeted care planning intervention among older breast cancer survivors, where unaddressed health concerns may exacerbate frailty and dependence, all significant public health concerns.
|Mandelblatt, Jeanne S; Stern, Robert A; Luta, Gheorghe et al. (2014) Cognitive impairment in older patients with breast cancer before systemic therapy: is there an interaction between cancer and comorbidity? J Clin Oncol 32:1909-18|
|Faul, Leigh Anne; Luta, Gheorghe; Sheppard, Vanessa et al. (2014) Associations among survivorship care plans, experiences of survivorship care, and functioning in older breast cancer survivors: CALGB/Alliance 369901. J Cancer Surviv 8:627-37|
|Faul, Leigh Anne; Rivers, Brian; Shibata, David et al. (2012) Survivorship care planning in colorectal cancer: feedback from survivors & providers. J Psychosoc Oncol 30:198-216|
|Mandelblatt, Jeanne S; Faul, Leigh Anne; Luta, George et al. (2012) Patient and physician decision styles and breast cancer chemotherapy use in older women: Cancer and Leukemia Group B protocol 369901. J Clin Oncol 30:2609-14|