Over 60% of cancers occur in older persons, and the number of older cancer patients is expected to grow as the population ages. Older cancer patients are at increased risk of treatment complications, and there is no standard approach for reducing chemotherapy toxicity. Several studies, including a Cancer and Aging Research Group (CARG) study in 500 patients, have demonstrated that 50% of older patients have severe toxicity from chemotherapy within 3 months of treatment initiation and that measures within a geriatric assessment (GA), a validated approach to assessing health status in older persons, can predict severe chemotherapy toxicities. Although geriatric assessment has great potential to improve adverse outcomes of older adults with cancer, the majority of oncologists have not adopted GA, largely because of lack of knowledge on how to best incorporate GA into clinical care. The overall hypothesis of this proposed research is that providing oncologists with information from geriatric assessment with and targeted interventions guided by GA for older patients can reduce the risk of chemotherapy toxicity. The principal investigator, a geriatric oncologist, and the research team assembled through CARG are well positioned to successfully complete this high-impact research. The study will be conducted in 2 phases. In Phase 1, patients aged 70 and over (n=240) with metastatic solid tumor malignancies who are planning to receive first-line chemotherapy at University of Rochester Community Clinical Oncology Program (CCOP) sites will be recruited over the course of 1 year. Usual-care practices including physician characteristics, prescribing patterns, patient and physician decision-making for chemotherapy initiation, and chemotherapy toxicity will be captured. In Phase 2, we will conduct a 2-armed cluster randomized study utilizing CCOP sites. Prior to chemotherapy initiation, patients aged 70 and over (n=688) with metastatic solid tumor malignancies will complete a GA. The oncologists at sites randomized to Arm 1 will receive a summary of GA results plus targeted interventions to consider for implementation. In Arm 2, oncologists will only receive information from GA regarding severe depression or cognitive impairment. The primary outcome will be a comparison of the proportion of patients who have severe chemotherapy toxicity at 3 months after chemotherapy initiation. Secondary outcomes will include comparisons of survival, the number of interventions implemented in both groups, and decision-making for chemotherapy. An exploratory aim will evaluate whether or not GA plus targeted interventions can slow functional and physical decline in older patients with advanced cancer. With regard to expected outcomes, this proposal will fill vital gaps in knowledge regarding whether GA can improve outcomes of older cancer patients and the mechanisms of how GA can improve quality of life (decisions, GA-driven interventions). These data will have a positive impact by providing a pragmatic mechanism for incorporating GA into routine clinical oncology care to improve outcomes of older adults with metastatic cancer.

Public Health Relevance

Over 60% of cancers occur in older persons, and the number of older cancer patients is expected to grow with the aging of the population. Older cancer patients are at increased risk of chemotherapy toxicity, and no standard approach exists to identifying risk and implementing interventions to prevent adverse outcomes. The overarching goal of this proposal is to evaluate whether providing oncologists with geriatric assessment (GA) information with targeted interventions can decrease chemotherapy toxicity in older adults. With regard to expected outcomes, this proposal will fill vital gaps in knowledge regarding whether GA can improve outcomes of older cancer patients and the mechanisms of how GA can improve decision-making and quality of life.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
4R01CA177592-04
Application #
9097609
Study Section
Special Emphasis Panel (ZCA1)
Program Officer
O'Mara, Ann M
Project Start
2013-09-09
Project End
2019-06-30
Budget Start
2016-07-01
Budget End
2017-06-30
Support Year
4
Fiscal Year
2016
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
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
Magnuson, Allison; Lemelman, Tatyana; Pandya, Chintan et al. (2018) Geriatric assessment with management intervention in older adults with cancer: a randomized pilot study. Support Care Cancer 26:605-613
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 :
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; Pandya, Chintan; Zittel, Jason et al. (2017) Associations of sleep disturbance with physical function and cognition in older adults with cancer. Support Care Cancer 25:3161-3169
Magnuson, Allison; Wallace, James; Canin, Beverly et al. (2016) Shared Goal Setting in Team-Based Geriatric Oncology. J Oncol Pract 12:1115-1122
Gramling, Robert; Fiscella, Kevin; Xing, Guibo et al. (2016) Determinants of Patient-Oncologist Prognostic Discordance in Advanced Cancer. JAMA Oncol 2:1421-1426

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