There is a significant need to improve the evidence base for treating older adults with cancer particularly in indolent tumor types such as neuroendocrine tumors. While clinical trials have established new treatment options for patients with advanced (metastatic or surgically unresectable) neuroendocrine tumors, most have focused upon survival as the primary endpoint of success, and patient-centered outcomes are often not included. This is particularly concerning for older adults with an indolent malignancy as potential improvements in survival must be balanced with potential toxicities of therapy in a patient population often impacted by complex co-morbid medical conditions. Therefore, information regarding older adult neuroendocrine tumor patient preferences towards the risks and benefits of treatment and the relative value placed on survival versus the impact on function, cognition, and the ability to live independently is urgently needed. The objective of this study is to fill the knowledge gap relating to patient defined goals and preferences among older adults with advanced neuroendocrine tumors. Through the use of a novel application of the Health Outcomes Tool, Now vs. Later Tool, and Attitude Scale, patient preferences for competing health outcomes will be described. In addition, the association between health status as described by geriatric assessment variables, participant quality of life, and patient perceptions of prognosis and treatment in relation to patient values toward treatment goals and health outcomes will be explored. We hypothesize that older adults with advanced neuroendocrine tumors will favor maintaining quality of life, independence, and/or cognition over prolonging survival. Furthermore, we hypothesize that health status as described by geriatric assessment variables along with patient?s quality of life and patient?s perceptions of prognosis and treatment could be associated with individual treatment goals and preferences. This study will be the first study to provide insight into the desires of older adults with advanced neuroendocrine tumors regarding the importance of quality vs. quantity of life and present vs. future health when beginning a new therapy. A better understanding of how older adult neuroendocrine tumor patients define their goals and priorities may lead to improvements in clinical care and future clinical trial design for older adults with neuroendocrine tumors. By using neuroendocrine tumors as a model, this study could serve as the foundation for future research and incorporation of patient preference tools into daily clinical practice to better guide shared decision making in the treatment of older adults with indolent tumor types. This unique research opportunity will provide the PI with a foundation for uniting aging and oncology research and will provide critical support for the PI?s career development in geriatric oncology.
Patient values toward treatment goals and health outcomes among older adults with advanced neuroendocrine tumors are not well understood. This study will be the first study to provide insight into the desires of older adults aged ?65 years with advanced neuroendocrine tumors regarding the importance of quality vs. quantity of life and present vs. future health when beginning a new therapy. A better understanding of how older adult neuroendocrine tumor patients define their goals and priorities can provide a basis for future research and the incorporation of patient preferences tools into daily clinical practice to enhance shared decision making in the treatment of older adults with indolent tumor types.
