C. SPECIFIC THEMATIC AREA- PATTERNS OF CARE 1. Rationale Based on Relevant Scientific Expertise at the University of Wisconsin. The overarching goal of this thematic area is to build infrastructure for conducting population-based patterns of care studies in cancer treatment for older patients. The UW possesses a real opportunity to build in this area. We have tremendous resources and skills in cancer, aging, and the population-based sciences. Our significant strengths relevant to this thematic area include: ? Aging - Aging researchers who conduct large population-based studies of aging and the life course (including WLS and MIDUS) through IOA and CDHA. ? Geriatrics - Geriatrics researchers who conduct studies in health care delivery, falls and mobility disorders, dementia, sarcopenia, and swallowing disorders through the GRECC and WAI. ? Cancer control research - Cancer epidemiologists who conduct large, population-based studies of cancer etiology, prevention, treatment, and outcomes through the UWCCC program in Cancer Control and Population Sciences. ? Clinical cancer research - Clinical cancer researchers who conduct clinical trials for adults and children in all types of cancer through the UWCCC program in clinical research. ? Health services research - Health services researchers who conduct studies on the quality of health care, treatment decision-making, cost-effectiveness, and health disparities through the Department of Population Health Sciences and the Center for Urban Population Health (CUPH). ? Health systems engineering - Health systems engineers who conduct research on approaches to improve treatment decision-making and the quality of health care through the Center for Quality and Productivity Improvement (CQPI) and the Systems Engineering Initiative for Patient Safety (SEIPS). ? Sociodemographic disparities in health - Social scientists who conduct research on socioeconomic inequalities and health disparities in aging populations through CDHA and IOA. ? Community cancer care - Multidisciplinary geriatric oncology teams who provide care to a medically underserved population in a community setting through the Center for Cancer and Aging. Substantial collaborations and overlap exist among these researchers at UW-Madison, but no integrated infrastructure that brings these researchers together around this common theme. Most of these researchers conduct studies in either cancer or aging research, but very few of these collaborations have focused on the interface between cancer and aging research, and almost none of these activities have examined patterns of care. The contribution of this planning and development activity will be to address this important omission in three ways: 1) building an integrated infrastructure through a UWCCC Aging Program, 2) catalyzing new projects, and 3) building new linkages between existing projects (Table 1). 2. Research Priorities. We will address each of the three research priorities within this thematic area. a. Develop a data matrix of items from relevant databases. Our short-term goal is to develop a set of key content areas and items to measure comorbidities and age-related frailties, treatment decisions, and the quality of cancer care for older patients in four existing databases that include Wisconsin populations: two population-based longitudinal studies of aging (the WLS and MIDUS) and two population-based electronic medical record systems (the Wm. S. Middleton Veterans Memorial Hospital and the Aurora Health System). Although only four databases are chosen as examples for this collaboration, we expect that many more opportunities will arise over time. Our long-term research goal is to conduct studies to evaluate the appropriate role of age-related frailties and comorbidites in determining treatment decisions and outcomes for older cancer patients from disparate sociodemographic backgrounds. b. Develop a dictionary of data elements as a resource for investigators. Our short-term goal is to develop documentation and protocols for our databases that allow potential investigators to easily access these data and evaluate research opportunities. Instead of limiting our documentation to what exists in the data, we will also document gaps in data content and quality and will identify possible secondary data linkages or primary data collection methods to address these gaps. Our long-term goal is to facilitate studies on treatment decisions and outcomes for older cancer patients, utilizing and optimizing all the available resources, data linkages, and primary data collection facilities at the UW and its affiliates. c. Incorporate clinical expertise that is available in the cancer centers to improve the quality of care of the medically underserved, aging population. Our short-term goal is to work with the Center for Cancer and Aging as well as the Center for Urban Population Health to develop a protocol for accessing data on the medically underserved population treated by the Aurora Sinai Medical Center in Milwaukee, Wisconsin. Our long-term research goal is to examine treatment decisions and outcomes for older cancer patients in this medically underserved area, and to compare these patterns of care to similar cancer patients who are treated at the UWCCC. We will extend our efforts to the medically underserved population in the downtown Milwaukee community care setting via the Center for Cancer and Aging and the Center for Urban Population Health. 3. Mechanisms of Addressing Research Priorities. We will address these three research priorities by conducting a series of internal meetings, workshops, and retreats, and by supporting pilot studies on these databases. Our goal is to produce at least two funded R01 proposals over the five years and to develop the infrastructure to continue and expand on this initial research agenda over time. Given the broad array of expertise currently available on this campus, we have no current plans to recruit additional faculty for this thematic area. We will encourage incoming faculty and postdoctoral trainees to participate in our workshops, retreats, and pilot projects to expand the pool of active researchers in this area. SPECIFIC THEMATIC AREA- EFFECTS OF COMORBIDITY ON CANCER 1. Rationale Based on Relevant Scientific Expertise at the University of Wisconsin. More than 60% of newly diagnosed cancers reportedly occur in patients over the age of 65 years. (Yancik, Havlik et al. 1996) This age group accounts for more than 50% of cancer-related deaths and projected to expand to almost 20% of the United States population by the year 2030. (Yancik, Havlik et al. 1996; Yancik 1997) However, despite the high incidence and mortality of cancers in the elderly, the potential impact of ageassociated comorbidities on the diagnosis and treatment of cancers has not been adequately addressed. The rationale for advancing the thematic area of """"""""Effects of Comorbidity on Cancer"""""""" in this proposed Aging and Cancer Program is based on the solid foundation of several UW investigators, who are acknowledged leaders in comorbidity research and, as a group, represent the strengths of UW in the following fields relevant to this thematic area: ? Nationally recognized expertise in characterizing the potential impact of comorbid conditions on the life course and psychosocial well-being of older adults ? Demonstrated ability to evaluate the effects of cancer and related therapies on the development and consequences of multiple geriatric syndromes commonly seen in elderly cancer patients, and not examined in any current comorbidity assessment instrument ? Expertise to develop and validate a reliable comorbidity assessment scale which is efficient, user friendly, easy to administer, clinically feasible, culturally sensitive, and cost effective ? Demonstrated skills in planning and conducting multisite longitudinal studies in aging, skills that will be essential in executing the final validation studies for the proposed """"""""Wisconsin Comorbidity Assessment Scale (W CAS)"""""""" Our proposal to establish an Aging and Cancer Program provides a unique opportunity to bring together investigators from across the UW to develop an interdisciplinary team with expertise in the following five domains targeted by WCAS"""""""" comorbid conditions; cognition and mood; physical function skills; falls and mobility; and rnedicationslpolypharmacy. 2. Research Priorities? Based on the research priorities identified for the thematic area of """"""""comorbidity"""""""" in the NCVN[A Workshop Repor_ and the ava[Qab[l[ty of reDevant expertise at UW, the following three ma]or priorities wi[B be addressed: ? To devebp a comprehensive, vaDidated, comorb[dity assessment scale that targets comorbid conditions commonBy obseHed in older cancer patients ? To estabnish if the proposed assessment scale would be sensitive to evaluate the potentiaB impact of comorbidities on patient care and outcomes ? To develop predictive models which permit individual treatment decision making concerning ad]uvant therapy and prevention We plan to accomp0ish these priorities by establishing a """"""""working group"""""""" combining the disciplina_ expertise of geriatrics, medical oncobgy, neuropsychoiogy, physical therapy, kinesiobgy, nursing, and pharmacy, and researchers experienced in developing and vaiidating assessment instruments. C. SPECIFIC THEMATIC AREA: PSYCHOSOClAL ISSUES AND LATE MEDICAL EFFECTS 1. Rationale Based on Relevant Scientific Expertise at the University of Wisconsin. We have an extremely strong rationale for advancing """"""""Psychosocial Issues and Late Medical Effects"""""""" within the Aging and Cancer Program at UW-Madison. Our unique strengths are highlighted below: ? We have a history at UW-Madison of groundbreaking research in psychosocial factors associated with quality of life (QOL) across the life course, and specifically in understanding the course of successful aging. ? We have exemplary models of multidisciplinary collaboration across this campus and of multi-site collaboration. ? We have established programs of research in psychosocial issues and late medical effects within the WCCC Cancer Control Program. ? Although not extensive, we have emergent collaborations between aging and cancer researchers in the psychosocial area that will readily facilitate growth and success in 2. Research Priorities: Quality of Life, Cancer Caregiving, Reducing Late Medical and Psychosocial Effects of Treatment. Our priority research areas are based on the research priorities identified in the Workshop Report and the potential at UW-Madison and the WCCC to launch major research efforts in these areas. For each, we provide information on extant campus expertise and summarize plans for meetings and workshops. Early in Year 1, a thematic meeting will be held to bring together researchers across all three areas to share ideas and develop collaborations within and across each of the priorities below. In years 2 - 5, thematic meetings will reconvene these investigators to review progress, set future directions, and develop plans for pilot projects in the three priority areas. The goal is to fund two pilot projects each in years 2, 3, and 4. 1. Rationale Based on Relevant Scientific Expertise at the UWCCCC. The report of the Institute of Medicine and National Cancer Policy Board of 2001, Improving Palliative Care in Cancer (/OM, 2001), defines 6 skill sets required for the practice of palliative care. This report expands palliative care beyond the skill of caring for the dying to include communication, advanced care planning, treatment of symptoms related to disease, treatment of symptoms related to therapy, and psychosocial care including bereavement support. The importance of palliative care across the spectrum of cancer has been documented by UW investigators (Cleary and Carbone, 1997), stressing that palliative care is not just for the dying. Despite the advances in the treatment of cancer, issues such as breaking bad news and advanced care planning have been neglected. Some 50% of patients diagnosed with cancer die of their disease, and in the case of frail older patients, suffer from comorbid conditions which also require significant palliative care. UWCCC is well situated to develop the Palliative Care thematic area within the Aging and Cancer Program as it has: ? A nationally recognized palliative care program and leadership that focuses on integration. ? A strong affiliation with a community hospice program (daily census in home, 140; inpatient, 20). ? A strong Cancer Communication program that incorporates palliative care. ? A Population Health program with expertise to assess variability in the provision of palliative care. ? Faculty with the ability to assess symptom management and totest appropriate interventions. ? Nationally recognized leadership in the area of cancer pain management. 2. Research Priorities. We have identified 3 research areas to pursue within the Palliative Care thematic area. An overview of these areas and how they address research priorities that were identified in the Workshop Report are provided in Table 2. These areas were selected based on both their importance to the aging/cancer interface and the conclusion that these have high potential for developing an established Aging and Cancer Program within the 5-year project period. C. SPECIFIC THEMATIC AREA-THE BIOLOGY OF AGING AND CANCER 1. Rationale Based on Relevant Scientific Expertise at the University of Wisconsin. There exists a strong rationale for developing a thematic area in """"""""The Biology of Aging and Cancer"""""""" within the new Aging and Cancer Program at the UWCCC. This statement is based on: a) the clear need to address critical questions which are at the interface of age-associated cancers and the biology of the aging process. b) an extensive history of groundbreaking basic cancer research at the UW-Madison's Cancer Centers which continues today in the UWCCC. c) a strengthening program in basic biological gerontology. d) past and ongoing collaborations between gerontologists and oncologists/cancer biologists which are important to expand. 2. Research Priorities. We have identified four linked research areas to pursue within this thematic area. These areas and how they address Workshop Report research priorities are shown in Table 3. These areas were selected based on their importance to the aging/cancer interface and their high potential for developing an established Program on Aging and Cancer within the 5-year project period. Further, these areas are ripe for translational research.
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