Over 60% of cancers occur in older persons, and the number of patients with cancer is expected to grow. Geriatric assessment (GA), a validated patient-centered approach for assessing health status, can identify older patients with cancer who are at risk of adverse outcomes. The majority of oncologists have not adopted GA, largely because of lack of knowledge on how to utilize GA to guide communication and decision-making. Two multicenter cluster randomized studies in the University of Rochester (UR) NCI Community Oncology Research Program (NCORP) led by the Principal Investigator (PI) are evaluating if a GA intervention can improve communication about age-related issues (funded by a Patient Centered Outcomes Research Institute contract) and reduce toxicity from cancer treatment (funded by a NCI R01) through improved decision- making. Our preliminary data illustrates that: 1) age-related concerns and symptom burden are not addressed effectively in oncology clinical encounters; 2) community oncologists often provide chemotherapy to frail older adults with serious consequences; 3) a significant proportion of older patients with advanced cancer undergoing treatment and their caregivers believe the cancer will be cured; and 4) the majority of older patients would choose to forgo cancer treatment if they knew there would be serious functional and/or cognitive consequences. The current proposal builds on the PI's geriatric oncology program by developing new patient-oriented research and providing opportunities for mentees in this underrepresented area. The PI, a geriatric oncologist, and the research team including experts in communication, palliative care, caregiver and geriatric oncology research are well positioned to complete the aims of this proposal. The overarching aims are to: 1) develop insight into how to improve communication between older patients with cancer, their oncologists, and their caregivers about age-related concerns and symptoms, the risks and benefits of treatment, and prognosis through secondary analyses of data from the PI's multi-site studies and 2) develop and implement an intervention to integrate GA into oncology care to improve communication about the risks and benefits of chemotherapy for older patients. With support of this K24, the PI will complete specific career development activities that will enhance her skills in communication research and for mentoring and leadership. With regard to expected outcomes, this proposal will fill vital gaps in knowledge regarding the mechanisms of how GA can improve communication and outcomes. This research will have a positive impact by providing a pragmatic mechanism for incorporating GA into community oncology clinics to improve outcomes of older adults with cancer through more effective communication. This K24 will allow the PI to bridge the fields of geriatric oncology and communication research by bringing together an interdisciplinary team of experts and geriatric oncology mentees through novel analyses of existing data from funded clinical trials and the implementation of a new project.

Public Health Relevance

The K24 Mid-Career Award in Patient-Oriented Research would enable the Principal Investigator, Dr. Mohile, to expand her research skills and mentoring activities to further the growth of a patient-oriented research program in geriatric oncology. Preliminary data from her multi-site cluster randomized studies evaluating whether a geriatric assessment intervention improves outcomes of older patients with cancer have highlighted significant gaps in communication about symptom burden, the risks and benefits of treatment, and prognosis between older patients with advanced cancer, their community oncologists, and their caregivers. The overarching research goals of this proposal are to: 1) develop insight into how to improve communication between oncologists, older patients, and caregivers and 2) design and implement an innovative technology- mediated tool to improve communication about the risks and benefits of chemotherapy for older patients with cancer.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Midcareer Investigator Award in Patient-Oriented Research (K24)
Project #
1K24AG056589-01A1
Application #
9533783
Study Section
Neuroscience of Aging Review Committee (NIA)
Program Officer
Salive, Marcel
Project Start
2018-04-01
Project End
2023-03-31
Budget Start
2018-04-01
Budget End
2019-03-31
Support Year
1
Fiscal Year
2018
Total Cost
Indirect Cost
Name
University of Rochester
Department
Internal Medicine/Medicine
Type
School of Medicine & Dentistry
DUNS #
041294109
City
Rochester
State
NY
Country
United States
Zip Code
14627
Mohile, Supriya G; Dale, William; Somerfield, Mark R et al. (2018) Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology. J Clin Oncol 36:2326-2347
Mohile, Supriya G; Magnuson, Allison; Pandya, Chintan et al. (2018) Community Oncologists' Decision-Making for Treatment of Older Patients With Cancer. J Natl Compr Canc Netw 16:301-309
Loh, Kah Poh; McHugh, Colin; Mohile, Supriya G et al. (2018) Using Information Technology in the Assessment and Monitoring of Geriatric Oncology Patients. Curr Oncol Rep 20:25
Mohile, Supriya G; Dale, William; Somerfield, Mark R et al. (2018) Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology Summary. J Oncol Pract 14:442-446
Ramsdale, Erika; Lemelman, Tatyana; Loh, Kah Poh et al. (2018) Geriatric assessment-driven polypharmacy discussions between oncologists, older patients, and their caregivers. J Geriatr Oncol 9:534-539
Dunne, Richard F; Roussel, Breton; Culakova, Eva et al. (2018) Characterizing cancer cachexia in the geriatric oncology population. J Geriatr Oncol :
Hurria, Arti; Levit, Laura A; Dale, William et al. (2015) Improving the Evidence Base for Treating Older Adults With Cancer: American Society of Clinical Oncology Statement. J Clin Oncol 33:3826-33