Over half of newly diagnosed cancer patients are over age 65, and the number of older adults with cancer is expected to grow as the population ages. Older adults with cancer are more likely to be undertreated and experience premature discontinuation of treatment than younger patients, often resulting in worse outcomes. Studies suggest that poor symptom management and inadequate social support may explain this suboptimal treatment of older cancer patients. Thus, efforts to better understand and address the palliative care needs of older adults with cancer are critically important. We propose to develop an outpatient geriatric care intervention focused on the unique palliative care needs of older adults with incurable gastrointestinal (GI) and lung cancers. GI and lung cancers are among the leading causes of cancer death in the geriatric cancer population, and patients with incurable GI and lung cancers experience high rates of both physical and psychological symptoms. We will first conduct qualitative interviews with oncology, geriatric and palliative care clinicians, followed by patients, to explore their perceptions of the necessary components of the intervention. By exploring the views of these key stakeholders, we seek to develop a transdisciplinary intervention tailored to the needs of older patients with incurable cancer. Notably, the intervention will comprehensively address the unique geriatric and palliative care needs of these patients. We will then conduct a pilot (n=50), randomized controlled trial (RCT) to demonstrate the feasibility of the geriatric care intervention versus usual care in patients age ?70 with newly diagnosed, incurable cancer. We will estimate the effect size of the intervention for quality of life, physical function, physical and psychological symptoms, cognition and geriatric impairments. The study will take place at Massachusetts General Hospital, drawing on the clinical and research expertise of the Cancer Center, Geriatric Medicine Unit, Palliative Care Department and the Department of Psychiatry's Behavioral Medicine Service. Primary mentorship will be provided by Jennifer Temel, MD, a nationally- recognized expert in the development and testing of supportive care interventions for patients with incurable cancers. Additional mentors include Lara Traeger PhD, Ardeshir Hashmi MD, Vicki Jackson MD, MPH, Supriya Mohile, MD, MS and William Dale, MD, PhD. This mentorship team of experts in geriatric oncology, palliative care, qualitative research methods and intervention development are committed to ensuring the success of the proposed research. The proposed study will not only further our understanding of the supportive care needs of older adults with cancer, but also develop a novel intervention to address these concerns and improve the quality of life of this patient population. Notably, the GEMSSTAR will provide vital support as I seek to become a leader in geriatric oncology research. My overarching goal is to become an independent investigator studying interventions to improve the supportive care provided to older adults with cancer. This grant will provide support for the mentorship, training and experience I need to establish a track record in aging research.
Over half of newly diagnosed cancers occur in older persons, and this population of aging patients often presents a unique set of challenges for clinicians, including the need for attentive supportive care. The purpose of the present investigation is to develop and pilot test a geriatric care intervention tailored to the specific geriatric and palliative care needs of older adults with incurable cancer. Through this study, we will gain a deeper understanding of the supportive care needs of older adults with incurable cancer as well as create a state-of-the-art geriatric care intervention that addresses these concerns and improves patients' quality of life.
