Treatment burden, defined as ?the work of being a patient and how it impacts patients' functioning and well-being,? is emerging as an important concept that affects quality of life and caregiver well-being in other chronic conditions. Despite the fact that cancer is a burdensome chronic disease, few studies have specifically evaluated treatment burden in cancer. Importantly, cancer is more prevalent in older adults who may already experience high treatment burden from existing geriatric conditions. Compared to younger counterparts, older cancer patients tend to value non-traditional outcomes (e.g. quality of life) and rely on caregivers to coordinate transportation for clinic visits, manage medications, and assist in decision-making. A lack of understanding of the relationships between cancer, aging, treatment burden, and caregiver roles may result in care delivery that is misaligned with the goals of older adults. Non-muscle invasive bladder cancer (NMIBC) is an ideal cancer for studying treatment burden for three reasons: highest median age at diagnosis of all cancer sites; a high recurrence rate necessitating frequent visits for surveillance, bladder instillations, and ambulatory surgery; and a high prevalence of baseline multimorbidity. The objective of this application is to elucidate the relationship between geriatric conditions and treatment burden in older NMIBC patients and their caregivers.
The Specific Aims are: 1) Assess the relative contribution of individual geriatric conditions to overall healthcare utilization in the year following NMIBC diagnosis in SEER- Medicare, a nationally representative dataset, 2). Evaluate the associations of specific geriatric conditions and cumulative frailty with patient-reported treatment burden after NMIBC diagnosis in 100 older adults, and 3) Evaluate the associations of patient-reported treatment burden, specific geriatric conditions, and cumulative frailty with caregiver-reported strain in 100 caregivers. This study is innovative because it engages patient and caregiver perspectives to define the new concept of treatment burden within aging and cancer. This study is significant because understanding the relationship between cancer, geriatric conditions, and treatment burden is the critical next step towards redesigning care to reduce the footprint of healthcare work for older cancer patients and caregivers. This GEMSSTAR research project, mentoring committee, and professional development plan will help the PI to become one of the few independent investigators with expertise at the intersection of aging, urologic oncology, and patient-centered outcomes research.

Public Health Relevance

The proposed research is relevant to public health because understanding the relationship between geriatric conditions and treatment burden in the context of cancer is critical to designing care that maintains or improves quality of life in older cancer patients and caregivers and reduces the growing footprint of healthcare work. This research is relevant to the 70 million older adults who will be diagnosed with cancer in the coming years, and aligns with the NIA's goal to design interventions to maintain well-being and reduce the burden of age-related diseases.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Small Research Grants (R03)
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Special Emphasis Panel (ZAG1)
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Salive, Marcel
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Geisinger Clinic
United States
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