The proposed study addresses the long-standing and widespread undertreatment of elderly cancer patients as recognized by the National Cancer Institute and the National Institute on Aging. We will develop and pilot test a behavioral intervention to enhance skills for coping with chemotherapy challenges among elderly colon cancer patients who are being treated with curative intent. Findings will be used to inform a larger-scale trial of this intervention, to increase quality cancer care and optimal chemotherapy completion. Background: In stages II/III colon cancer, elderly patients are more likely to receive chemotherapy regimens that are less intensive than evidence-based recommendations, reducing survival benefit. Problems with symptom management and insufficient patient support have been suggested as key factors underlying this disparity. The proposed study will extend our prior work in medical adherence interventions to elderly adults on intensive chemotherapy regimens. We will explore multi-level challenges to managing chemotherapy as perceived by elderly patients, and use these findings to inform intervention development. The Self-Regulatory Model (SRM) will guide our work to affirm coping strengths while enhancing skills for managing treatment. Research Plan: We will conduct qualitative interviews with stage II/III elderly colon cancer patients receiving chemotherapy (n=20), and review findings with MGH medical oncology staff for additional feedback. Findings will be used to develop a brief behavioral intervention to enhance patient skills for managing chemotherapy challenges. The intervention will be tested in an open trial with elderly colon cancer patients scheduled to initiate chemotherapy (n=12). Intervention process data and pre-/post-intervention psychosocial and medical data will be collected to assess feasibility and acceptability. In an iterative process, ongoing data from exit interviews and therapist experience will be used to modify the intervention protocol. Environment: Study visits will be conducted at the Massachusetts General Hospital Cancer Center (MGHCC) and MGH North Shore Cancer Center (MGHNCC), two major centers with large chemotherapy bays and ample clinical resources. The PI, a new investigator, will receive input from a team of experts in behavioral interventions for medical adherence, psychosocial care in advanced cancer, qualitative research in oncology settings, clinical applications of empirically supported talk therapies, and clinical trials in gastrointestinal cancers, respectively. The investigators will access resources at several MGH institutions, including the Center for Gastrointestinal Cancers, the Center for Psychiatric Oncology and Behavioral Science, and the Behavioral Medicine Service. Relevance of Research: This study will inform and develop a behavioral intervention with the potential to increase rates of optimal chemotherapy completion and disease-free survival benefits of treatment.

Public Health Relevance

In locally advanced (Stages II and III) colon cancer, elderly patients commonly receive chemotherapy regimens that are less intensive than evidence-based recommendations, which reduce the survival benefit of this treatment. We aim to explore the multi-level challenges that elderly patients face in completing optimal regimens, and to develop and pilot test a behavioral intervention to enhance patients'skills for managing these challenges. Establishing strategies to enhance symptom management and increase rates of optimal chemotherapy completion is an important step in improving oncology practice and promoting cancer control and survival.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Small Research Grants (R03)
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Special Emphasis Panel (ZCA1-SRLB-B (M2))
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O'Mara, Ann M
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Massachusetts General Hospital
United States
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