||1R01CA249467-01 Interpret this number
||University Of Rochester
||Optimizing Functional Outcomes of Older Survivors After Chemotherapy
The overarching goal of this proposal, submitted in response to RFA-CA-19-035, is to evaluate if an aging-
sensitive survivorship intervention improves outcomes valued by older adults and their caregivers
during the transition into survivorship from curative-intent chemotherapy. This proposal is important
because by 2040, 73% of survivors will be aged 65+ and almost 50% will be aged 75+. Unfortunately, aging-
related conditions (e.g., physical and cognitive function impairments) are not addressed routinely in survivorship
care. Preliminary research by all multiple principal investigators (MPIs: Mohile, Janelsins, Mustian) suggests that
a Geriatric Evaluation and Management (GEM) intervention is effective for surveilling, triaging and managing
physical and cognitive impairments, improving patient and caregiver satisfaction, and fostering communication
about aging-related conditions during chemotherapy in older cancer patients and their caregivers. Preliminary
research by MPIs also suggests that a Survivorship Health Promotion program is effective for improving physical
function among older survivors after chemotherapy. Our MPI team has shown that GEM and Survivorship Health
Promotion are feasible to implement in older patients, survivors and caregivers in nationwide samples recruited
via the University of Rochester Cancer Center (URCC) NCI Community Oncology Research Program (NCORP)
Research Base network. To fill existing empirical gaps in survivorship care for older survivors and caregivers,
we created a novel intervention called Survivorship-GEM by combining these two very promising and synergistic
programs. Survivorship-GEM is directed by oncology advanced practice providers (APPs), because they
routinely direct care for survivors in the community. We propose to conduct a two-arm cluster randomized trial
comparing the efficacy of our novel Survivorship-GEM intervention to usual care for improving physical and
cognitive function, satisfaction with care, completion of referral appointments, and hospitalizations among older
survivors. We will also examine the effect of Survivorship-GEM on oncology APP communication with primary
care providers and on caregiver distress and satisfaction with care. We will randomize 30 NCORP community
oncology practices to two arms: 1) Survivorship-GEM or 2) usual care. Survivors aged 65+ (n=720) and
caregivers (if available, estimated n=500) will complete baseline assessments at the end of curative-intent
chemotherapy for a solid tumor malignancy with follow-ups at 6 and 12 months. Our uniquely qualified,
multidisciplinary team includes expertise in geriatrics, clinical trials, nursing, primary care, behavioral oncology,
rehabilitation, health disparities, biostatistics, and implementation science. The team also benefits from
collaborations with the Cancer and Aging Research Group Advisory Board and the SCOREboard patient
advocate group. The APP-directed Survivorship-GEM intervention is highly innovative and has tremendous
potential to improve outcomes in older survivors and caregivers by surveilling, triaging and managing the effects
of chemotherapy and by fostering health promotion.
Cognitive Function in Older Adults With Cancer: Assessment, Management, and Research Opportunities.
, Ahles T.
, Chen B.T.
, Mandelblatt J.
, Janelsins M.C.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2021-07-01; 39(19), p. 2138-2149.